Glycemic status as a modifier of tuberculosis presentation: Evidence from a cross-sectional study

Objectives This study aims to investigate the clinical spectrum of tuberculosis (TB) in patients with diabetes mellitus (DM) and analyze its relationship with glycemic status. Materials and Methods A cross-sectional study of 372 patients with concurrent TB and DM was conducted at a tertiary care hospital. Glycemic control was categorized based on hemoglobin A1C levels as good (≤7%), moderate (7.1–9%), and poor (>9%). Clinical presentations, radiological findings, and laboratory parameters were analyzed. Results The mean age was 44.3 ± 8.7 years, with male predominance (71.2%). Pulmonary TB was predominant (65.3%), while extrapulmonary TB comprised 34.7% of cases. Sputum positivity rates increased significantly with poorer glycemic control: 42.3% in good control versus 76.2% in poor control ( P < 0.001). Poor glycemic control was associated with higher rates of lower zone involvement (67.9%), bilateral disease (58.4%), and cavity formation (45.3%). Among extrapulmonary manifestations in poorly controlled patients, disseminated TB (45.5%) and lymph node TB (28.0%) were most common. Conclusion Poor glycemic control is associated with higher sputum positivity, atypical radiological presentations, and increased risk of disseminated TB. These findings emphasize the importance of glycemic control in TB-DM patients and suggest the need for more aggressive screening and monitoring in this population.