Published in PLOS One on 2025-12-15, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Emelia Konadu Danso, Prince Asare, Amanda Yaa Tetteh, Phillip Tetteh, Augustine Asare Boadu, Ivy Naa Koshie Lamptey, Augustina Angelina Sylverken, Kwasi Obiri-Danso, Jane Sandra Afriyie-Mensah, Abraham Adjei, Dorothy Yeboah-Manu
Source: PLOS One • DOI 10.1371/journal.pone.0338498
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Drug-resistant (DR) tuberculosis (TB) and diabetes mellitus (DM) are intersecting epidemics that complicate management of both diseases and worsen patient outcomes. We conducted a prospective cohort study of 758 GeneXpert-confirmed pulmonary TB patients, of whom 75 had DM. Demographic, clinical, radiographic, and anthropometric data were collected at baseline. Sputum samples were cultured for mycobacterial isolation, and the obtained isolates were characterized for Mycobacterium tuberculosis complex (MTBC) lineage and drug-susceptibility testing using spoligotyping and microplate alamar blue assay. The TB-diabetes (TB-DM) comorbid cohort was older [TB-DM: 53/75 (70.7%) vs. 241/683 (35.3%) aged 41–60 years) (p < 0.001), included a higher proportion of females [TB-DM: 31/75 (41.3%) vs. TB-only: 150/683 (22.0%), p < 0.001], and had greater mean BMI (TB-DM: 23.36 ± 0.99 vs. TB-only: 19.97 ± 0.45 kg/m², p = 0.003). Analysis of 501 (TB-only: 448, TB-DM: 53) MTBC isolates revealed that TB-DM patients are more likely to get TB caused by L6 [TB-DM: 10/53 (18.9%) vs. TB-only: 37/448 (8.3%), p = 0.022] compared to the general TB population Lineage 4 [TB-DM: 36/53 (67.9%) vs. TB-only: 362/448 (80.8%), p = 0.046], Mycobacterial strains from TB-DM exhibited higher isoniazid mono-resistance [TB-DM: 15/50 (30.0%) vs. 42/288 (14.6%), p = 0.012] and harbored more multidrug-resistant TB [TB-DM: 5/50 (10.0%) vs. TB-only: 16/288 (5.6%), p = 0.215] although this did not reach statistical significance. These findings indicate that DM not only predisposes individuals to TB but may also shift the spectrum of infecting lineages and promotes the emergence of DR strains. Integrated TB-DM screening, lineage-aware diagnostics, and tailored treatment protocols are urgently needed in high-burden settings to address this dual threat.
Introduction
Drug-resistant (DR) mycobacterial strains present a significant challenge to the global tuberculosis (TB) control efforts. In 2023, the World Health Organization (WHO) reported an estimated 400,000 cases of multidrug-resistant TB (MDR-TB), highlighting the ongoing threat posed by resistant strains [1]. Concurrently, the global burden of diabetes mellitus (DM) is increasing, particularly in regions with a high TB prevalence [2]. Epidemiological studies suggest that DM is not only a risk factor for TB development but also DR-TB [3,4].
DM has been associated with increased TB severity due to impaired immune responses, including dysfunctional macrophage activity, altered cytokine production, and chronic hyperglycaemia, all of which contribute to delayed bacterial clearance [5–7]. Moreover, TB patients with DM have been found to exhibit higher rates of treatment failure, relapse, and mortality compared to non-diabetic TB patients [8]. Recent meta-analyses indicate that DM nearly doubles the risk of MDR-TB, suggesting a possible link between hyperglycaemia and the selection of DR Mycobacterium tuberculosis complex (MTBC) strains [9,10].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider technology & industry desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2025 Emelia Konadu Danso, Prince Asare, Amanda Yaa Tetteh, Phillip Tetteh, Augustine Asare Boadu, Ivy Naa Koshie Lamptey, Augustina Angelina Sylverken, Kwasi Obiri-Danso, Jane Sandra Afriyie-Mensah, Abraham Adjei, Dorothy Yeboah-Manu. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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