Prevalence and clinical impact of dysglycemia among hospitalized adults with tuberculosis in Lebanon: a 2013–2023 retrospective cohort study

The coexistence of tuberculosis (TB) and diabetes mellitus (DM) represents a threatening health challenge, creating a dangerous double burden, particularly in low- and middle-income countries. DM not only increases susceptibility to TB but also worsens clinical outcomes. To assess the prevalence and clinical impact of dysglycemia among hospitalized patients with TB and to identify associated factors. We conducted a retrospective study of 202 adults hospitalized with either active or latent TB at a tertiary hospital between 2013 and 2023. Dysglycemia was defined as fasting plasma glucose (FPG) or admission random glucose test (HGT) ≥ 100 mg/dL, including patient with pre-existing DM; all other patients were classified as euglycemic. Because fasting status and HbA1c were unavailable in most cases, American Diabetes Association (ADA) diagnostic thresholds for DM and prediabetes (Pre-DM) could not be applied. TB Treatment outcomes were categorized according to World Health Organization (WHO) definitions. Descriptive statistics, t-tests, chi-square tests, and multivariable logistic regression were used to compare dysglycemic and euglycemic patients and to assess adjusted associations with adverse outcomes. Dysglycemia was present in 77/202 patients (38.1%) including 7.4% with a prior diagnosis of DM. Patients with dysglycemia were older (45.19 vs. 35.58 years, p < 0.001) and had a higher prevalence of hypertension (23.4% vs. 2.4%, p < 0.001). Dysglycemia was independently associated with the need for intubation (adjusted odds ratio [aOR] 2.50; 95% CI 1.01–6.20), and these patients more frequently required invasive oxygen support (15.6% vs. 6.4%, p = 0.05). No significant differences were found in imaging or overall treatment outcomes between the two groups. Pulmonary TB predominated (94.1%), and 92.1% had active disease. Although mortality reached 13.4%, this might be underestimated, as 66.3% of patients were either discharged or followed up with their private physician. The adjusted association between dysglycemia and mortality was not statistically significant (aOR 1.15; 95% CI 0.55–2.40). A substantial proportion of TB patients had coexisting dysglycemia, associated with higher age, comorbid hypertension, and increased oxygen requirements. These findings highlight the need for integrated screening, early detection, and improved follow-up strategies for TB patients with dysglycemia in Lebanon.