Lipid profile alterations in pulmonary tuberculosis patients with and without diabetes mellitus: a systematic review and meta-analysis

This systematic review and meta-analysis explored lipid alterations associated with tuberculosis-diabetes comorbidity. We quantitatively synthesised the lipid parameters, comparing high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, and total cholesterol among patients with TB-DM comorbidity, TB-only, and DM-only. Following PRISMA guidelines and a registered protocol (PROSPERO: CRD420261355915), we searched PubMed ( n = 150), Scopus ( n = 679), and Google Scholar ( n = 70) through April 7, 2026. Observational studies reporting lipid parameters were included. Methodological quality was appraised using the Newcastle-Ottawa Scale, and certainty of evidence was evaluated using GRADE. Pooled mean differences and pooled means were estimated using random-effects models, with between-study variance estimated by REML and Hartung-Knapp-adjusted confidence intervals. Heterogeneity was quantified using the I 2 statistic and τ 2 , and 95% prediction intervals were also calculated. Nine studies comprising 1,494 participants were included. Compared to the TB-only group, patients with TB-DM exhibited higher concentrations of LDL-C (MD = 14.99 mg/dL; 95% CI: 1.28–28.71), TG (MD = 30.13 mg/dL; 95% CI: 17.58–42.67), and TC (MD = 17.29 mg/dL; 95% CI: 5.42–29.16), while HDL-C showed no significant difference (MD = −1.15 mg/dL; 95% CI: −5.07–2.77). A principal sensitivity analysis showed that TG elevation remained robust, whereas LDL-C and TC findings lost statistical significance. In the secondary comparison, TB-DM patients exhibited significantly lower concentrations across all four lipid parameters relative to the DM-only group. Heterogeneity was substantial for the primary comparison (I 2 >70%) but ranged from 1% to 67% in the secondary comparison. Exploratory subgroup analyses showed statistical differences for LDL-C, TC, and TG, whereas no subgroup difference was found for confounder adjustment, geographic region, or study design. The overall certainty of evidence was rated as very low across all outcomes. The findings suggest that TB-DM may be associated with a higher TG concentration compared to patients with TB alone. Significant associations with LDL-C and TC were also observed but were not robust to sensitivity analyses, while no significant difference was found for HDL-C. Conversely, TB-DM may be associated with a relative reduction in HDL-C, LDL-C, TG, and TC compared to DM-only.