REVIEW article
Front. Public Health
Sec. Infectious Diseases: Epidemiology and Prevention
This article is part of the Research TopicWorld TB Day 2025: Yes! We Can End TB: Commit, Invest, DeliverView all 15 articles
Addressing the Challenge of Tuberculosis Screening in Diabetic Populations: A Narrative Review of Methods and Strategies
Provisionally accepted
- 1Dalian Medical University, Dalian, China
- 2Dalian Public Health Clinical Center, Dalian, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
The comorbidity of diabetes and tuberculosis (TB) poses a major public health challenge. Patients with diabetes have impaired immune function, increasing their risk of contracting TB. They often present with atypical clinical symptoms after infection, which can lead to delayed diagnosis. Therefore, TB screening in the diabetic patients is essential. This study systematically reviews advances in TB screening strategies for diabetic patients by searching databases including PubMed, WHO Global Index Medicus, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang Data Knowledge Service Platform (search period: 2000–2025). We compare the efficacy of various screening techniques and strategies, discuss their suitable scenarios, advantages, and disadvantages, and provide recommendations for post-screening case management and cohort studies of screened populations. Our review found that novel screening technologies are gaining traction for TB screening in diabetes. AI-based imaging significantly improves the accuracy and efficiency of traditional radiological diagnosis. Oral swab testing and urine-based lipoarabinomannan (LAM) testing help overcome the challenge of specimen collection in individuals who have difficulty producing sputum. Recombinant fusion protein ESAT6-CPF10 (EC) skin test shows good accuracy and cost-effectiveness for latent tuberculosis infection (LTBI) screening. However, some techniques still require large-scale validation specifically in diabetic patients. The choice of TB screening strategy should consider local TB prevalence, prioritizing screening for high-risk subgroups among diabetic patients is cost-effective. The therapeutic management of patients with concurrent diabetes and tuberculosis is challenging. Successful treatment depends on the appropriate management of drug interactions, improved medication adherence, effective glycemic control, and timely drug susceptibility testing to adjust anti-TB regimens. Preventive treatment regimens for patients with diabetes and LTBI require further research. This study aims to provide evidence-based references for public health policymakers to help develop more targeted TB screening systems for diabetic patients, thereby improving early diagnosis and treatment rates, and reducing TB incidence and transmission risk.
Keywords: Tuberculosis, diabetes, co-morbidity of diabetes and tuberculosis, Screening methods, Effectiveness evaluation
Received: 12 Sep 2025; Accepted: 18 Nov 2025.
Copyright: © 2025 Ma, Lu, Cao, Lv and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xiwei Lu, yiluxiwei@126.com
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.