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On World TB Day, WHO, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Stop TB Partnership are calling on world leaders to step up their commitment and contributions to meet the goal of diagnosing and treating one million people with multi drug-resistant tuberculosis (MDR-TB) between 2011 and 2015. 

Today WHO has released a report, Towards universal access to diagnosis and treatment of MDR-TB and XDR-TB by 2015, which presents progress in the MDR-TB response in the countries with the highest burden of drug-resistant TB. "Many countries have made progress, but despite the recent scale up in efforts, the world needs to do much more to get care to all MDR-TB patients who need it," says Dr Margaret Chan, WHO Director-General. "We cannot allow MDR-TB to spread unchecked." 

Leaving MDR-TB untreated increases the risk of spread of drug resistant strains of TB. WHO estimates there will be more than 2 million new cases of MDR-TB between 2011 and 2015. 

Programmes financed by the Global Fund and following WHO treatment standards are expected to diagnose and treat about 200 000 people for MDR-TB by 2015, a fourfold increase from those 50 000 patients who are currently undergoing treatment. 

It is anticipated that the Global Fund will provide 84% of all international investments in TB in 2011. However, both domestic and international resources need to be scaled up to cope with MDR-TB and continue to make progress in the fight against TB. 

"MDR-TB is a threat to all countries as it is difficult and expensive to treat. Unless we make an extraordinary effort to tackle this problem our ability to finance and secure continued progress against TB in general will be threatened" says Professor Michel Kazatchkine, Executive Director of the Global Fund. 

"It is time for countries with rapidly growing economies and a heavy burden of MDR-TB to step up their commitment and financing for their own MDR-TB programmes. Several have the capacity to show new leadership on south-south cooperation and aid to neighbouring countries that are also affected," says Dr Jorge Sampaio, the UN Secretary-General's Special Envoy to Stop TB. 

Since 2009, the 23 countries most heavily affected by TB drug resistance have nearly doubled their budgets for MDR-TB. From 2002 through 2010, Global Fund-financed TB programmes around the world have provided treatment to 7.7 million people and saved the lives of 4.1 million. 

"The Global Fund's success can be measured in the number of lives that have been saved through care provided by the TB pro-grammes it finances," says Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership. "Every TB patient should have access to proper care. We advocate on behalf of millions of patients worldwide and our strong partners such as WHO and the Global Fund. To reach a million people with effective care for MDR-TB over the next five years, we will need to work closely with all partners, especially with affected communities." 

MDR-TB is a form of TB that fails to respond to standard first-line drugs. In 2009, WHO reported that 9.4 million people became ill with TB and 1.7 million died, including 380 000 people with HIV-associated TB. There were some 440 000 cases of MDR-TB and 150 000 deaths in 2008, the latest year for which estimates are available.

A pill taken once a day in the morning prevented type 2diabetes in more than 70 percent of individuals whose obesity, ethnicity and other markers put them at highest risk for the disease, U.S. scientists have reported. 

The team also noted a 31 percent decrease in the rate of thickening of the carotid artery, the major vessel that supplies blood to the brain. The study, which enrolled 602 participants through The University of Texas Health Science Center San Antonio and seven collaborating centers, is described in the New England Journal of Medicine and has direct implications for the care of 40 million Americans who are pre-diabetic. 

"It's a blockbuster study," said senior author Ralph DeFronzo, M.D., professor in the School of Medicine and chief of the diabetes division at the UT Health Science Center San Antonio. "The 72 percent reduction is the largest decrease in the conversion rate of pre-diabetes to diabetes that has ever been demonstrated by any intervention, be it diet, exercise or medication." 

Dr. DeFronzo led the trial of pioglitazone, which is marketed as Actos® by Takeda Pharmaceutical Co. Ltd. The Japanese company provided an independent investigator grant to Dr. DeFronzo to conduct the ACT Now study. Some patients were followed for as long as four years; the average follow-up was 2.4 years. 

Pioglitazone is widely used as an insulin sensitizer in patients with type 2 diabetes. In the ACT Now study, participants were chosen because of their high risk for diabetes, including obesity, family history and impaired glucose tolerance as demonstrated by a glucose test. 

"The drug shows outstanding results," said Robert R. Henry, M.D., president, medicine and science, of the American Diabetes Association. "It is the most efficacious method we have studied to date to delay or prevent the onset of type 2 diabetes." A study co-investigator, Dr. Henry is professor of medicine at the University of California, San Diego, and chief of the section of endocrinology and diabetes at the VA San Diego Healthcare System. 

Robert Chilton, D.O., FACC, a UT Health Science Center San Antonio cardiologist who was not involved with the study, said the slowing of carotid artery thickness indicated that the participants' glucose was well controlled, preventing blood vessel damage that leads to heart attacks, strokes and peripheral vascular disease.