New research finds tuberculosis (TB) is more difficult to treat if the patient has type 2 diabetes. The study examined 737 Indonesians with tuberculosis screened for type 2. Nearly 15 percent had type 2, and initially, their TB was as severe as the non-diabetics. After two months of treatment, TB sputum tests were positive 18.1 percent for those with type 2 and only 10 percent in non-diabetics. At the six month mark, 22.2 percent of type 2s had positive sputum results compared to 9.5 percent of the non-diabetics.

The story in Reuters does not address why people with TB and type 2 diabetes do not respond as well to TB treatment. Tuberculosis is a serious infectious disease. Over one-third of the world carries the TB bacterium, and one in ten latent infections will progress to active TB disease. Untreated, active TB is a real threat, it kills more than half of its victims. Experts are examining how rising rates of type 2 are impacting TB control and prevention worldwide.

I just finished reading an excellent book about Dr. Paul Farmer's inspirational work treating tuberculosis in impoverished communities worldwide -- Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World -- masterfully written by Tracy Kidder. I wonder what Dr. Farmer has to say about people with type 2 and TB.

In my previous post, I looked at a RAND Corporation study of undiagnosed diabetes - something that continues to be a big problem. Now I want to zero in on one aspect of that study that really caught my eye. According to the sole author, James P. Smith, talk of a type 2 diabetes epidemic is over-exaggerated.

Hang on a minute. Aren't we always hearing about the so-called epidemic proportions of diabetes' spread in the US and globally? And aren't cities like New York taking steps to track the spread of diabetes, keeping tabs on its growth just as you'd do with a contagious epidemic outbreak of, say, tuberculosis? Well, yes. But Smith isn't buying it.

During the twenty-five-year period included in the study, Smith says diagnosis of men with diabetes more than doubled. However, it's a tricky thing to take diagnosis rates and translate them into prevalence rates. That is, more people being diagnosed with a disease may simply mean we're getting better at diagnosing the problem. We may think we're seeing astronomical growth rates in diabetes when in fact it's probably a combination of increased diabetes and more efficient diagnosis.

Which is not to say Smith is denying that the spread of type 2 diabetes is a serious issue: "Diabetes is one of the major health challenges faced across the United States," he says, "but these finding suggest that the prevalence of the disease is not growing as rapidly as often claimed."

James P. Smith is RAND's corporate chair of labor market and demographic studies. RAND is a nonprofit research organization.

The New York City diabetes database, created to track the growth of (type 2) diabetes amongst the city's residents, has raised the ire of some who claim it violates their right to privacy. A reporter for the Staten Island Advance quotes resident Melissa: "Every time I go to have my blood sugar checked, my test results are being wired to the (city) Health Department. The idea of your privacy being taken away from you goes across all bounds." Melissa also says she doesn't think the city has justification to track patient records for something like diabetes, which is not contagious like, for example, tuberculosis.

My first instinct on reading this: cry me a river, Melissa. Residents should be aware their blood sugar levels are being sent to the health department, and they should be aware of why it is being done. But, really, isn't it a tad paranoid to worry too much about privacy? I mean, why should anyone care about your blood sugar levels out of all the thousands of others out there? If this is a way to gauge how type 2 diabetes is spreading in the NYC area, and if this data can help (as the city claims) determine how best to spend public money on containing the problem, I say go for it.

On the other hand, protecting peoples' privacy should be a factor for consideration, says Dr. Peter Sheehan, of the Mount Sinai School of Medicine and board member of the American Diabetes Association. "We applaud this kind of work," says Dr. Sheehan, but "we're somewhat concerned about the privacy of the individual." This concern is shared by the people entrusted with maintaining the database, says Dr. Diana K. Berger of the Health Department: "We are so careful to protect people's privacy," says Dr. Berger. She adds that only a handful of people have access to the room in which the data is stored, and data is encrypted as it makes its way from laboratories to the city.

All-in-all, it's a slightly unsettling case of weighing priorities: public good versus the right to privacy.