Prevalence and predictors of tuberculosis among patients with diabetes mellitus: A cross-sectional hospital-based study.

Dr. V. Gopi Krishna; Dr. Paladugu  Swetha; Dr. R. Srikanth  Chandra

doi:10.51168/sjhrafrica.v6i12.2195

Authors

Dr.Vadla Gopi Krishna Assistant Professor, Department of Respiratory Medicine, Gandhi Medical College, Secunderabad, Telangana, India.
Dr. Paladugu Swetha 2Civil Assistant Surgeon, Department of Pulmonary Medicine, ESI Hospital, Nacharam, Telangana, India
Dr. Rangu Srikanth Chandra Assistant Professor, Department of Anaesthesiology, Government Maternity Hospital, Sultan Bazaar, Hyderabad, Telangana, India.

DOI:

https://doi.org/10.51168/sjhrafrica.v6i12.2195

Keywords:

Diabetes mellitus, Tuberculosis, Prevalence, Predictors, Glycemic control, BMI, HIV co-infection

Abstract

Background
Diabetes mellitus (DM) is increasingly recognized as a significant risk factor for tuberculosis (TB), particularly in developing countries where both conditions are highly prevalent. The coexistence of these diseases complicates clinical outcomes and challenges TB control efforts. This study aimed to determine the prevalence of TB among diabetic patients and to identify the major predictors associated with its occurrence.

Methods

A hospital-based cross-sectional study was conducted over 18 months (April 2024–September 2025). A total of 100 adult patients with type 2 diabetes mellitus were enrolled. Detailed demographic, clinical, and laboratory data were recorded. Tuberculosis was diagnosed based on clinical findings, radiological evidence, sputum smear microscopy, GeneXpert assay, and histopathological confirmation when necessary. Statistical analysis included descriptive statistics and chi-square tests to identify significant predictors.

Results
The overall prevalence of TB among diabetic patients was 14%, with pulmonary TB (11%) being more frequent than extrapulmonary TB (3%). The mean age of participants was 54.7 ± 10.8 years, and 58% were male. Univariate analysis revealed that age ≥ 60 years (p=0.02), duration of diabetes >10 years (p=0.002), poor glycemic control (HbA1c ≥8%, p=0.02), low BMI (<18.5 kg/m², p=0.003), and HIV co-infection (p=0.02) were significant predictors of TB. Smoking and gender were not statistically significant.

Conclusion
The prevalence of TB among diabetic individuals remains considerably high, underscoring the bidirectional link between chronic hyperglycemia and infection risk.

Recommendations
Routine TB screening should be integrated into diabetes clinics, and strict glycemic control with nutritional support is essential to reduce TB risk. Interdisciplinary collaboration between TB and diabetes programs is strongly recommended. Early screening for TB should be prioritized among diabetics with prolonged disease duration, poor glycemic control, or low BMI.

Author Biographies

Dr.Vadla Gopi Krishna, Assistant Professor, Department of Respiratory Medicine, Gandhi Medical College, Secunderabad, Telangana, India.

is currently serving as Assistant Professor, Department of Respiratory Medicine, Gandhi Medical College, Secunderabad, Telangana. He obtained his MBBS from Kakatiya Medical College, Warangal (2008–2014) and completed his MD in Pulmonary Medicine from Osmania Medical College, Hyderabad (2016–2019). He subsequently worked as a Senior Resident at Government Medical College, Siddipet (2019–2020) before joining Gandhi Medical College as faculty. His areas of clinical and research interest include tuberculosis, interstitial lung diseases, and respiratory critical care. He is actively involved in postgraduate teaching and academic research in pulmonary medicine. ORCID iD: https://orcid.org/0009-0007-9403-5544

Dr. Paladugu Swetha, 2Civil Assistant Surgeon, Department of Pulmonary Medicine, ESI Hospital, Nacharam, Telangana, India

is currently serving as a Civil Assistant Surgeon in the Department of Pulmonary Medicine, ESI Hospital, Nacharam, Telangana. She completed her MBBS from Mediciti Institute of Medical Sciences, Hyderabad (2009–2015) and obtained her MD in Pulmonary Medicine from Osmania Medical College, Hyderabad (2016–2019). Her professional interests include tuberculosis, asthma, chronic obstructive pulmonary disease (COPD), and respiratory infections. She is actively involved in patient care, community respiratory health programs, and public health initiatives focusing on early diagnosis and management of pulmonary diseases. ORCID iD:https://orcid.org/0009-0000-4971-1151

Dr. Rangu Srikanth Chandra, Assistant Professor, Department of Anaesthesiology, Government Maternity Hospital, Sultan Bazaar, Hyderabad, Telangana, India.

is currently serving as an Assistant Professor in the Department of Anaesthesiology, Government Maternity Hospital, Sultan Bazaar, Hyderabad. He completed his MBBS from Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, and earned his MD in Anaesthesiology from SVS Medical College, Mahabubnagar. He also worked as a Senior Resident at SVS Medical College, Mahabubnagar, where he gained extensive clinical experience in obstetric and general anaesthesia. His professional interests include obstetric anaesthesia, airway management, and perioperative patient safety. He is actively engaged in clinical teaching, research, and evidence-based anaesthetic practice.ORCID iD: https://orcid.org/0009-0000-8901-3008

References

Kokiwar PR, Soodi Reddy AK. Diabetes Mellitus as a Risk Factor for Tuberculosis: A Community-Based Case-Control Study. Indian J Community Med. 2024 Jul-Aug;49(4):617-621. doi:10.4103/ijcm.ijcm_86_23. PMID: 39291114; PMCID: PMC11404417. https://doi.org/10.4103/ijcm.ijcm_86_23 PMid:39291114 PMCid:PMC11404417

Vaishya R, Misra A, Vaish A, Singh SK. Diabetes and tuberculosis syndemic in India: A narrative review of facts, gaps in care and challenges. J Diabetes. 2024 May;16(5):e13427. doi:10.1111/1753-0407.13427. PMID: 37292055; PMCID: PMC11070841. https://doi.org/10.1111/1753-0407.13427 PMid:37292055 PMCid:PMC11070841

Gautam JK, Thanvi A, Soni P, Anand PK. Estimation of the Proportion and Determinants of Diabetes Mellitus Among Notified Tuberculosis Patients in Jaipur, Rajasthan, India. Cureus. 2025 Mar 10;17(3):e80319. doi:10.7759/cureus 80319. PMID: 40206911; PMCID: PMC11980007. https://doi.org/10.7759/cureus.80319

Damtie S, Legese B, Fentie A, Solomon Y, Erkihun M, Molla T, et al. Diabetes mellitus and its determinants among tuberculosis patients in South Gondar Zone health facilities, Northwest Ethiopia. Sci Rep. 2025 Feb 17;15(1):5813. doi:10.1038/s41598-025-90441-1. PMID: 39962284; PMCID: PMC11833058.

https://doi.org/10.1038/s41598-025-90441-1 PMid:39962284 PMCid:PMC11833058

Rupani MP, Vyas S. A sequential explanatory mixed-methods study on costs incurred by patients with tuberculosis comorbid with diabetes in Bhavnagar, western India. Sci Rep. 2023 Jan 4;13(1):150. doi:10.1038/s41598-023-27494-7. PMID: 36600031; PMCID: PMC9811877. https://doi.org/10.1038/s41598-023-27494-7 PMid:36600031 PMCid:PMC9811877

Cornejo-Báez AA, Zenteno-Cuevas R, Luna-Herrera J. Association Between Diabetes Mellitus-Tuberculosis and the Generation of Drug Resistance. Microorganisms. 2024;12(12):2649. doi:10.3390/microorganisms12122649. https://doi.org/10.3390/microorganisms12122649 PMid:39770852 PMCid:PMC11728438

Boadu AA, Yeboah-Manu M, Osei-Wusu S, Yeboah-Manu D. Tuberculosis and diabetes mellitus: The complexity of the comorbid interactions. Int J Infect Dis. 2024 Sep;146:107140. doi:10.1016/j.ijid.2024.107140. PMID: 38885832. https://doi.org/10.1016/j.ijid.2024.107140 PMid:38885832

Guo S, Lei S, Li J, Li L, Chen H, Chongsuvivatwong V. Gradient association between pulmonary tuberculosis and diabetes mellitus among households with a tuberculosis case: a contact tracing-based study. Sci Rep. 2022 Feb 3;12(1):1854. doi:10.1038/s41598-022-05417-2. PMID: 35115583; PMCID: PMC8814182. https://doi.org/10.1038/s41598-022-05417-2 PMid:35115583 PMCid:PMC8814182

Ekeke N, Ukwaja KN, Chukwu JN, Nwafor CC, Meka AO, Egbagbe EE, et al. Screening for diabetes mellitus among tuberculosis patients in Southern Nigeria: a multi-centre implementation study under programme settings. Sci Rep. 2017 Mar 10;7:44205. doi:10.1038/srep44205. PMID: 28281682; PMCID: PMC5345020.https://doi.org/10.1038/srep44205 PMid:28281682 PMCid:PMC5345020

Alemu A, Seid G, Diriba G, Hailu M, Dange B, Moga S et al. Prevalence and associated factors of tuberculosis among diabetic patients attending public health facilities in Ethiopia: a multicenter study. Arch Public Health. 2025 Feb 14;83(1):40. doi:10.1186/s13690-025-01530-6. PMID: 39953616; PMCID: PMC11827250. https://doi.org/10.1186/s13690-025-01530-6 PMid:39953616 PMCid:PMC11827250

Bisht MK, Dahiya P, Ghosh S, Mukhopadhyay S. The cause-and-effect relation of tuberculosis on incidence of diabetes mellitus. Front Cell Infect Microbiol. 2023 Jun 26;13:1134036. doi:10.3389/fcimb..2023.1134036. PMID: 37434784; PMCID: PMC10330781. https://doi.org/10.3389/fcimb.2023.1134036 PMid:37434784 PMCid:PMC10330781

Zahid M, Afaq S, Shafique K, Qazi FK, Ashfaq U, Asim M, et al. Effect of glycemic control on tuberculosis treatment outcomes among patients with tuberculosis and diabetes mellitus: A systematic review and meta-analysis. Trop Med Int Health. 2025 Aug;30(8):749-762. doi:10.1111/tmi.14140. PMID: 40551384; PMCID: PMC12318439. https://doi.org/10.1111/tmi.14140 PMid:40551384 PMCid:PMC12318439