Abstract

Background Tuberculosis (TB) remains a major public health challenge, with 10.8 million people developing TB in 2023. Diabetes mellitus (DM) is associated with an increased risk of TB and adverse TB outcomes. The prevalence of DM is rising, especially in regions of the world where TB is endemic. Early detection and proper management of DM in those with TB may improve outcomes. Methods We performed a systematic review and meta-analysis of the yield of screening and the prevalence of DM among people with TB. Databases searched included PubMed, Cochrane CENTRAL, CINAHL, Embase, Global Health, LILACS, and Web of Science between January 2000 and September 2025. We included studies on the yield and prevalence of DM determined through DM screening among people with TB, where TB was identified microbiologically. All records were independently screened by two reviewers and discrepancies resolved by discussion. Risk of bias (RoB) was assessed using the Hoy tool for prevalence studies. Studies were pooled using random-effects meta-analysis with inverse variance weighting and stratified by World Health Organization (WHO) region and age (over and under 40 years). This systematic review and meta-analysis is registered online on PROSPERO CRD42023425596. Findings Our search retrieved 7530 studies. After full-text screening we included 33 studies involving 19,581 individuals with TB from 21 countries. The overall pooled yield of DM screening in people with TB was 7.8% (95% CI: 5.1–11.1), ranging from 2.6% (95% CI: 1.5–4.0) in the Western Pacific region (3 studies from 1 country) to 31.6% (95% CI: 12.4–54.3) in the Eastern Mediterranean region (3 studies from 2 countries). Interpretation DM is common among people with TB. The yield of DM screening was greater in the Eastern Mediterranean and South-East Asia regions which had a higher prevalence of DM. Findings were limited by substantial heterogeneity across studies and lack of comparison groups without TB in included studies. Future studies are needed to optimize approaches to detect DM among people with TB. Funding The World Health Organization Department for HIV, Tuberculosis, Hepatitis and Sexually Transmitted Infections and the Department of Noncommunicable Diseases and Mental Health, and the Preventive Treatment of Latent Tuberculosis Infection in People with Diabetes Mellitus study.