Received : 18 April 2026
Accepted : 26 September 2026
Published : 28 September 2026
DOI: 10.30726/ijmrss/v13.i3.2026.13375
Treatment Outcomes in Pulmonary Tuberculosis with Comorbid Diabetes: Glycaemic Control, Sputum Conversion and Six Month Outcomes across 360 Patients
The convergence of pulmonary tuberculosis and diabetes mellitus poses an increasingly important clinical challenge in South Asian countries with rising diabetes prevalence and persistently high TB burden. Diabetes impairs cell-mediated immunity, alters the inflammatory response, and is associated with delayed sputum conversion, higher relapse rates, and increased mortality during TB treatment. We followed 360 adults with new smear-positive pulmonary TB at a tertiary TB clinic over 24 months, comparing 132 patients with concurrent diabetes (132 of 360, 36.7%) with 228 patients without diabetes. Diabetic patients showed higher baseline bacillary loads (28.8% with smear grade 3+ vs 16.7%), more frequent cavitary disease (56.1% vs 41.7%), and delayed sputum conversion. Median time to culture conversion was 58 days in non-diabetic patients, 72 days in well-controlled diabetic patients (HbA1c <7.5%), and 98 days in those with poor glycaemic control. Unfavourable treatment outcomes (treatment failure, death, or default) occurred in 18.2% of diabetic patients compared with 9.6% of non-diabetic patients, with the gap entirely attributable to the poorly-controlled diabetes subgroup. Structured TB-DM integrated care, with HbA1c monitoring, glycaemic optimisation during treatment, and nutritional support, offers a clear operational pathway for outcome improvement.[/mysc_spoiler]
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