EFFECT OF GLYCEMIC CONTROL ON CLINICO-RADIOLOGICAL PRESENTATIONS OF PULMONARY TUBERCULOSIS IN DIABETIC PATIENTS-AN OBSERVATIONAL STUDY

Background: Tuberculosis (TB) continues to be a major global health issue, particularly in low- and middle-income countries. The coexistence of diabetes mellitus (DM) has emerged as a signicant factor inuencing the incidence, presentation, and prognosis of TB. Diabetes not only increases the risk of developing active TB but also alters its clinical manifestations and radiological patterns, often resulting in more severe disease in those with poor glycemic control. Aim: This study aimed to evaluate the clinico-radiological proles of pulmonary TB among individuals with varying glycemic statuses—prediabetics, newly diagnosed diabetics, and known diabetics—and to analyze the correlation between glycemic control (as measured by HbA1c) and disease severity. Methods: This was a prospective, observational study conducted at the Department of Respiratory Medicine, Saraswathi Institute of Medical Sciences (SIMS), over a two-year period (January 2023 to February 2025). A total of 100 patients with microbiologically conrmed pulmonary TB and concurrent diabetes or prediabetes were enrolled. Patients were categorized into three groups based on glycemic status and further stratied by glycemic control (HbA1c <7% or ≥7%). Detailed clinical assessments, chest radiographs, and laboratory investigations including HbA1c were performed. The impact of glycemic control on symptom burden and radiographic ndings was systematically evaluated. Results: The study cohort comprised 102 patients: 28 prediabetics, 35 newly diagnosed diabetics, and 39 known diabetics. The mean age was 52 years, with a male predominance (72%). Nearly half of the participants were smokers. Prediabetic patients exhibited milder symptoms and classic upper lobe inltrates. In contrast, diabetics—particularly those with poorly controlled glycemia—had more atypical and severe presentations, including multizonal and bilateral disease, lower lobe involvement, and multiple cavities. Clinical symptoms such as breathlessness, chest pain, and hemoptysis were more common and pronounced in poorly controlled diabetics. Conclusion: Glycemic status signicantly inuences the clinical and radiological presentation of pulmonary TB. Early detection of diabetes and effective glycemic control are essential to mitigate TB severity and improve outcomes. These ndings underscore the importance of integrating TB and diabetes care, especially in high-burden regions like India.