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US Endocrinology Highlights The Double Burden of Infectious Diseases and Diabetes— A Bidirectional Relationship Eugene Sobngwi, MD, PhD 1 and Jean Claude Mbanya, MD, PhD, FRCP (UK) 2 1. Associate Professor, National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon; 2. Professor of Medicine and Endocrinology, Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1 and Laboratory of Molecular Medicine and Metabolism, The Biotechnology Centre, University of Yaoundé 1, Cameroon Abstract There is growing evidence for an etiological interaction between infectious diseases and diabetes, as well as for bidirectional influence of clinical presentation, spread, and outcomes. Some HIV treatments increase diabetes risk, and some infectious diseases may determine unique phenotypes of diabetes. Individuals who have type 2 diabetes have increased risk for tuberculosis and viral hepatitis and have poorer treatment outcomes. Joint noncommunicable diseases (NCDs) and infectious diseases clinics are the ideal method of tackling the double burden of these diseases in developing countries. Keywords Diabetes, infectious diseases, non-communicable diseases, developing countries Disclosure: Eugene Sobngwi, MD, PhD, and Jean Claude Mbanya, MD, PhD, FRCP (UK), have no conflicts of interest to declare. No funding was received for the publication of this article. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Received: April 7, 2015 Accepted: April 14, 2015 Citation: US Endocrinology, 2015;11(1):24–5 Correspondence: Jean Claude Mbanya, MD, PhD, FRCP (UK), Professor of Medicine and Endocrinology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, BP 8046, Yaoundé, Cameroon. E: jcmbanya@yahoo.co.uk In 1971, Omran described the concept of epidemiologic transition to improve the understanding of patterns of disease in opposition of single disease epidemiology across the world and to provide better forecast and societal response to disease patterns. 1 Although three main types of transition were described, including the classic transition experienced by most developed countries, the accelerated transition experienced by countries such as Japan and Mauritius, and the delayed transition that accommodates the so-called double burden of disease, it is now widely accepted that many countries face different stages of transition as a result of inequalities. The pattern of disease thus varies across countries, but also across populations or settings within the same country, defining the polarized model of health transition. Emerging and re-emerging pandemics coexist with the burgeoning noncommunicable disease epidemic. The relation between infectious diseases and the most common noncommunicable disease is not yet fully understood. But there is growing evidence for an etiological interaction, as well as for interactions influencing clinical presentation, spread, and outcomes of these diseases. Chronic noncommunicable diseases (NCDs), such as diabetes, cardiovascular diseases (CVD), and cancers, are emerging as leading causes of mortality and morbidity in sub-Saharan Africa (SSA), where an estimated 22 million people lived having diabetes in 2014. 2 In the near future, SSA is expected to undergo the largest proportional increase in the burden of diabetes, with an estimated 41.5 million Africans expected to be living with the disease by 2035. 3 Similarly, it is expected that in 2015, an estimated 1.2 million deaths will be attributable to CVD 112 in this region. 4 Moreover, this figure is expected to double by 2030. 4 Substantial progress has been made in Africa in reducing the burden of many types of infectious diseases, but the big killers—tuberculosis (TB), malaria, HIV, hepatitis B, and hepatitis C—remain endemic across SSA. The relationship between infectious and noninfectious diseases is thought to be bidirectional. For instance, individuals who have type 2 diabetes (T2D) have a threefold-increased risk for TB, as well as poorer treatment outcomes, 5 HIV antiretroviral treatment (ART) has been linked to the development of the metabolic syndrome, 6,7 and T2D affects clinical outcomes in patients who have hepatitis. 8,9 The convergence of these conditions presents new challenges and opportunities to enact responsive changes in research and disease management. 10 The increasing survival among people infected by HIV in developing countries—a result of better access to ART—decreased mortality, and increased life expectancy are paralleled by a growing burden of CVD and diabetes mellitus. 11 There is evidence to suggest that NCDs will grow even more quickly among people who have HIV, whether as the result of the natural history of the infection itself or as a result of related coinfections and treatments. For instance, HIV infection is associated with increased risk for insulin resistance (IR), and some ART treatment regimens have been found to be associated with metabolic derangements, in particular the occurrence of T2D. 12,13 Likewise, TB and viral hepatitis coinfection are highly common in people having HIV infection and are independently associated with increased risk for T2D. 14,15 However, the contribution of HIV infection, ART, and coinfections to the predicted doubling of diabetes Tou c h ME d ica l ME d ia