Diabetes mellitus and its association with tuberculosis clinical presentation and treatment outcomes: results from a prospective cohort study in Ghana

Background Tuberculosis (TB)-diabetes is a growing public health threat in TB-endemic settings. We aimed to determine diabetes prevalence among TB patients in Greater Accra and its association with TB clinical presentation and treatment outcomes. Methods We enrolled 204 adults (≥20 years) with bacteriologically confirmed pulmonary TB across 14 health facilities. At treatment initiation, participants were screened for diabetes using self-report, fasting plasma glucose, and glycated hemoglobin, following standard diagnostic criteria. Baseline characteristics were recorded, and participants were followed to determine TB treatment outcomes. Associations between diabetes, baseline characteristics and treatment outcomes were assessed using bivariate and multivariate analysis in STATA. Adjusted odds ratios (AORs) and risk ratios (RRs) were estimated with 95% confidence intervals (CIs). Results The median age of participants was 40.5 years (IQR 30.5-50.5), and 72.5% were male. The prevalence of baseline diabetes was 22.1% (45/204), including 30 newly diagnosed and 15 previously diagnosed participants on treatment. Among 166 chest X-rays, cavities were less frequent in TB-diabetes than TB-only participants (51.2% vs. 72.5%, P = 0.014). Diabetes was associated with age ≥60 years (AOR 5.7, 95% CI 1.7-19.3), body mass index ≥25 kg/m 2 (AOR 5.4, 95% CI 1.4-21.9), and family history of diabetes (AOR 3.7, 95% CI 1.5-9.4). Overall, 90.7% had favorable TB treatment outcomes, with unfavorable outcomes in 6.8% of TB-diabetes and 10.1% of TB-only participants (RR 0.68, 95% CI 0.2-2.2). Conclusion Diabetes was common among TB patients, with many previously undiagnosed. Despite similar treatment outcomes to TB-only participants, routine diabetes screening is recommended for early detection and management.