Impact of Type 2 Diabetes on Lung Damage and Outcomes in treatment-naïve pulmonary tuberculosis

Impact of Type 2 Diabetes on Lung Damage and Outcomes in treatment-naïve pulmonary tuberculosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Type 2 Diabetes on Lung Damage and Outcomes in treatment-naïve pulmonary tuberculosis Zongyu Li, Mingping Xun, Shujian Wu, Yongmei Yu, Jianghua Yang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8686372/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Objective: To assess the impact of type 2 diabetes mellitus (T2DM) on risk and severity of structural lung disease (SLD) in treatment-naïve pulmonary tuberculosis (TB) patients, identify early predictors, and develop a prediction model for timely clinical intervention. Methods: We retrospectively studied 296 newly diagnosed pulmonary TB patients (201 males and 95 females; mean age 53.8 ± 18.0 years) between December 2021 and December 2024. Patients were categorized into SLD and non-SLD groups based on chest CT findings assessed using integrated visual CT scoring and quantitative image analysis. Baseline demographics, symptoms, and laboratory parameters were compared between groups. Multivariate logistic regression identified independent predictors of SLD; receiver operating characteristic (ROC) analysis evaluated the diagnostic performance of the clinical prediction model. Results: SLD patients were older, predominantly male, and had higher T2DM prevalence (P<0.05). A combined five-parameter model incorporating sex, T2DM, C-reactive protein (CRP), fasting plasma glucose, and erythrocyte sedimentation rate (ESR) demonstrated excellent diagnostic performance with an AUC of 0.881 (95% CI: 0.855–0.927), sensitivity of 91.2%, and specificity of 72.5%. Internal Bootstrap validation (1000 iterations) confirmed model robustness with optimal calibration (Brier score: 0.1352). Among SLD patients, T2DM was independently associated with higher BMI, increased symptom burden, elevated inflammatory markers, and more severe CT abnormalities (P<0.05). Critically, new-onset SLD during 6-month therapy occurred in 63.0% of T2DM patients versus 21.4% without T2DM (P<0.001). Conclusion: T2DM significantly increases structural lung disease risk, severity, and progression in treatment-naïve TB patients. A clinical prediction model incorporating sex, T2DM, C-reactive protein, fasting plasma glucose, and erythrocyte sedimentation rate demonstrates good diagnostic performance (AUC 0.881) for early SLD identification. T2DM was independently associated with higher inflammatory markers and more severe radiological abnormalities. These findings highlight the importance of intensive monitoring, optimal glycemic control, and early diabetes screening to prevent SLD progression and improve TB treatment outcomes in this high-risk population. pulmonary infection metabolic disorder lung injury imaging assessment prognosis Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 19 Mar, 2026 Reviewers agreed at journal 05 Mar, 2026 Reviewers agreed at journal 04 Mar, 2026 Reviewers agreed at journal 03 Mar, 2026 Reviewers invited by journal 24 Feb, 2026 Editor assigned by journal 23 Feb, 2026 Editor invited by journal 03 Feb, 2026 Submission checks completed at journal 03 Feb, 2026 First submitted to journal 03 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8686372","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":596785487,"identity":"d9b14c7a-2686-4ea9-903e-67c399cf8fb4","order_by":0,"name":"Zongyu Li","email":"","orcid":"","institution":"First Affiliated Hospital of Wannan Medical College","correspondingAuthor":false,"prefix":"","firstName":"Zongyu","middleName":"","lastName":"Li","suffix":""},{"id":596785488,"identity":"da144426-b99b-4e04-a214-9f7926cdebec","order_by":1,"name":"Mingping Xun","email":"","orcid":"","institution":"First Affiliated Hospital of Wannan Medical 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Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"pulmonary infection, metabolic disorder, lung injury, imaging assessment, prognosis","lastPublishedDoi":"10.21203/rs.3.rs-8686372/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8686372/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjective: To assess the impact of type 2 diabetes mellitus (T2DM) on risk and severity of structural lung disease (SLD) in treatment-naïve pulmonary tuberculosis (TB) patients, identify early predictors, and develop a prediction model for timely clinical intervention.\u003c/p\u003e\n\u003cp\u003eMethods: We retrospectively studied 296 newly diagnosed pulmonary TB patients (201 males and 95 females; mean age 53.8 ± 18.0 years) between December 2021 and December 2024. Patients were categorized into SLD and non-SLD groups based on chest CT findings assessed using integrated visual CT scoring and quantitative image analysis. Baseline demographics, symptoms, and laboratory parameters were compared between groups. Multivariate logistic regression identified independent predictors of SLD; receiver operating characteristic (ROC) analysis evaluated the diagnostic performance of the clinical prediction model.\u003c/p\u003e\n\u003cp\u003eResults: SLD patients were older, predominantly male, and had higher T2DM prevalence (P\u0026lt;0.05). A combined five-parameter model incorporating sex, T2DM, C-reactive protein (CRP), fasting plasma glucose, and erythrocyte sedimentation rate (ESR) demonstrated excellent diagnostic performance with an AUC of 0.881 (95% CI: 0.855–0.927), sensitivity of 91.2%, and specificity of 72.5%. Internal Bootstrap validation (1000 iterations) confirmed model robustness with optimal calibration (Brier score: 0.1352). Among SLD patients, T2DM was independently associated with higher BMI, increased symptom burden, elevated inflammatory markers, and more severe CT abnormalities (P\u0026lt;0.05). Critically, new-onset SLD during 6-month therapy occurred in 63.0% of T2DM patients versus 21.4% without T2DM (P\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eConclusion: T2DM significantly increases structural lung disease risk, severity, and progression in treatment-naïve TB patients. A clinical prediction model incorporating sex, T2DM, C-reactive protein, fasting plasma glucose, and erythrocyte sedimentation rate demonstrates good diagnostic performance (AUC 0.881) for early SLD identification. T2DM was independently associated with higher inflammatory markers and more severe radiological abnormalities. These findings highlight the importance of intensive monitoring, optimal glycemic control, and early diabetes screening to prevent SLD progression and improve TB treatment outcomes in this high-risk population.\u003c/p\u003e","manuscriptTitle":"Impact of Type 2 Diabetes on Lung Damage and Outcomes in treatment-naïve pulmonary tuberculosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-26 15:07:48","doi":"10.21203/rs.3.rs-8686372/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-03-19T15:34:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253451328204097803369901056752177160006","date":"2026-03-05T15:00:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"168169431600797518378320597304041672602","date":"2026-03-04T14:52:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"162932888191676159916980790869228520761","date":"2026-03-03T07:52:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-24T11:36:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-23T14:22:25+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-03T10:53:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-03T07:23:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2026-02-03T07:04:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e99ad25e-cd47-492a-bd9b-717fb6aa91a7","owner":[],"postedDate":"February 26th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-26T15:07:48+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-26 15:07:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8686372","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8686372","identity":"rs-8686372","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}