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World J Exp Med. Sep 20, 2026; 16(3): 122305
Published online Sep 20, 2026. doi: 10.5493/wjem.122305
Culture conversion and drug susceptibility in drug-resistant pulmonary tuberculosis with type 2 diabetes mellitus on oral regimens
Yogita Vats, Ajay Kumar Verma, Jyoti Bajpai, Surya Kant, Parul Jain, Darshan Bajaj, Anand Srivastava, Ram Avadh Singh Kushwaha, Santosh Kumar, Rajiv Garg, Ankit Kumar, Akshyaya Pradhan
Yogita Vats, Ajay Kumar Verma, Jyoti Bajpai, Surya Kant, Darshan Bajaj, Anand Srivastava, Ram Avadh Singh Kushwaha, Santosh Kumar, Rajiv Garg, Ankit Kumar, Department of Respiratory Medicine, King George’s Medical University, Lucknow 226003, Uttar Pradesh, India
Parul Jain, Department of Microbiology, King George’s Medical University, Lucknow 226003, Uttar Pradesh, India
Akshyaya Pradhan, Department of Cardiology, King George’s Medical University, Lucknow 226003, Uttar Pradesh, India
Co-first authors: Yogita Vats and Jyoti Bajpai.
Author contributions: Vats Y, Verma AK, and Bajpai J conceived the project and performed the data analysis; Kant S, Bajaj D, and Garg R contributed to the study protocol; Vats Y, Bajpai J, Jain P, and Kumar A performed the data collection; Srivastava A, Kushwaha RAS, and Pradhan A performed the literature review; Verma AK and Bajpai J prepared the first draft of the manuscript; Bajaj D, Kumar S, and Garg R critically reviewed the manuscript; and Verma AK, Bajpai J, and Pradhan A selected the target journal and submitted the manuscript; Vats Y and Bajpai J contributed equally to the conception, manuscript drafting and revision and these collective contributions underlie their merit as co-first authors.
AI contribution statement: No AI tools were used in the preparation of this manuscript.
Institutional review board statement: Ethical approval was obtained from the Institutional Ethics Committee of King George’s Medical University, Lucknow 226003, Uttar Pradesh (Letter No. 2967/Ethics/2025).
Informed consent statement: Informed consent was obtained from all participants.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: Data are available from the corresponding author and can be made available upon reasonable request.
Corresponding author: Jyoti Bajpai, MD, FCCP, Associate Professor, Department of Res
piratory Medicine, King George’s Medical University, Shahmina Road, Chowk, Lucknow 226003, Uttar Pradesh, India.
jyotibajpai33@gmail.com
Received: April 15, 2026
Revised: June 2, 2026
Accepted: July 2, 2026
Published online: September 20, 2026
Processing time: 158 Days and 13.5 Hours
BACKGROUND
The simultaneous existence of multidrug-resistant pulmonary tuberculosis (MDR-PTB) and type 2 diabetes mellitus (T2DM) represents a rising threat in high-burden countries such as India. Diabetes has been associated with impaired immune responses and delayed bacteriological clearance, thereby compromising treatment outcomes in patients with multidrug-resistant tuberculosis receiving all-oral longer regimens.
AIM
Impact of T2DM on clinical profile, radiological severity, drug resistance patterns, and sputum culture conversion in MDR-PTB.
METHODS
This prospective observational study included 264 adults with microbiologically confirmed MDR-PTB treated at a tertiary care center in North India over a 12-month period. The participants were classified as diabetic, pre-diabetic, or non-diabetic according to the American Diabetes Association 2023 criteria. Clinical, radiological, microbiological, and drug susceptibility data were analyzed. Time to culture conversion and treatment outcomes were compared across groups using appropriate statistical tests.
RESULTS
Patients with diabetes were older and had higher rates of dyspnea and hemoptysis. Radiologically, they demonstrated significantly higher rates of bilateral lung involvement and lower zone involvement. A higher bacillary load and increased prevalence of inhA and katG mutations were observed among patients with diabetes. Mean time to sputum culture conversion was significantly prolonged in patients with diabetes (132.9 ± 22.3 days) compared with pre-diabetic patients (112.6 ± 7.6 days) and non-diabetic patients (96.9 ± 10.8 days) (P < 0.001).
CONCLUSION
T2DM adversely affects bacteriological response, radiological severity, and treatment outcomes in patients with MDR-PTB on all-oral longer regimens.
Core Tip: This study explores how type 2 diabetes mellitus influences the clinical course and treatment response of patients with multidrug-resistant pulmonary tuberculosis receiving an all-oral longer regimen. It demonstrates that patients with diabetes present with more severe disease, a higher bacillary burden, and distinct drug resistance patterns. A key finding is the significantly delayed sputum culture conversion in patients with diabetes compared with the pre-diabetic and non-diabetic groups. This delay is associated with poorer treatment outcomes and higher mortality. Overall, the study highlights the critical need for integrated tuberculosis-diabetes management to improve patient outcomes in high-burden settings.
