The Bidirectional Relationship Between Diabetes and Tuberculosis in Nigeria: Epidemiological Insights and Control Strategies
Nigeria faces a double burden of tuberculosis (TB) and diabetes mellitus (DM), creating a syndemic in which DM increases the risk of active TB and worsens TB outcomes, while TB and its treatment can destabilize glycaemic control and unmask previously undiagnosed DM. Nationally, adult diabetes prevalence is substantial with a very high proportion undiagnosed, while TB incidence remains among the highest in Africa. Nigerian facility data show (i) high DM prevalence among TB patients and a large “additional yield” of newly diagnosed DM when systematic screening is implemented, and (ii) frequent dysglycaemia (DM/prediabetes) at TB diagnosis with performance limitations of point-of-care HbA1c in program settings. This review synthesizes Nigeria-relevant epidemiology, mechanisms of bidirectionality, diagnostic challenges, and practical integrated control strategies aligned with WHO guidance and Nigeria’s National Strategic Plan (NSP), emphasizing bidirectional screening, integrated clinical workflows, and health-system strengthening.