COMPARISON OF PULMONARY TUBERCULOSIS TREATMENT OUTCOME IN DIABETIC VERSUS NON-DIABETIC PATIENTS VISITING TERTIARY CARE HOSPITAL OF PESHAWAR: A CROSS-SECTIONAL STUDY

Abstract

Background: Pulmonary tuberculosis remains a major public health challenge in Pakistan, despite the availability of standardized treatment regimens. The rising prevalence of diabetes mellitus in tuberculosis-endemic regions has added complexity to disease control efforts. Diabetes alters host immune responses, influences disease severity, and may compromise treatment effectiveness. Understanding how diabetes affects tuberculosis presentation and outcomes is essential for improving patient management and strengthening control strategies in high-burden settings.

Objective: To compare the clinical presentation and treatment outcomes of pulmonary tuberculosis in diabetic and non-diabetic patients presenting to a tertiary care hospital.

Methods: A cross-sectional comparative study was conducted from January 2024 to December 2024 in a tertiary care hospital. A total of 135 newly diagnosed sputum smear–positive pulmonary tuberculosis patients were enrolled using non-probability consecutive sampling. Participants were categorized into diabetic (n = 65) and non-diabetic (n = 70) groups. Pulmonary tuberculosis was confirmed by sputum smear microscopy and chest radiography, while diabetes mellitus was identified through prior diagnosis or laboratory criteria. All patients received standard first-line anti-tuberculous therapy according to national guidelines. Clinical severity at presentation, sputum smear conversion at two months, and final treatment outcomes were recorded and compared between groups.

Results: Diabetic patients were older, with a mean age of 47 years compared with 32 years in non-diabetic patients. More severe clinical features were observed among diabetics, including prolonged cough (70.8% vs 42.9%), significant weight loss (75.4% vs 48.6%), and cavitary lung lesions (53.8% vs 25.7%). Delayed sputum smear conversion at two months was more frequent in diabetic patients (41.5%) than in non-diabetic patients (12.9%). Treatment success was achieved in 66.2% of diabetic patients compared with 90.0% of non-diabetic patients, while higher rates of treatment failure, loss to follow-up, and mortality were observed among diabetics.

Conclusion: Diabetes mellitus was associated with more severe pulmonary tuberculosis, delayed bacteriological response, and poorer treatment outcomes. Early identification of diabetes and integrated management of both conditions are critical to improving tuberculosis treatment success in high-burden populations.