Recent Advances in Biomarkers for Diabetes Mellitus and Tuberculosis Comorbidity: A Comprehensive Review

Background: Diabetes mellitus (DM) is a major risk factor for tuberculosis (TB) which increasing the risk of active disease threefold and worsening treatment outcomes. The dual burden of DM-TB comorbidity complicates global health, particularly in low and middle income countries. Recent evidence highlights the role of biomarkers in early detection, monitoring and prognosis of DM-TB co-infection. These biomarkers include inflammatory cytokines, metabolic signatures, genetic polymorphisms, transcriptomic markers and imaging-based indicators that provide insights into host-pathogen interactions. Objective: This review summarizes key advances in biomarker discovery and validation for DM-TB comorbidity, focusing on diagnostic, prognostic and therapeutic monitoring roles. Methodology: Literature was searched in PubMed, Scopus, Web of Science and WHO reports for studies published between 2020 to 2025 on biomarkers in D.M, T.B and their comorbidity. Both clinical and preclinical studies were analysed. Results: Significant advances include transcriptomic signatures validated for DM-TB populations, metabolic markers such as altered lipid and amino acid profiles and cytokine signatures including IL-6, TNF-αand IFN-γ correlating with disease severity. Epigenetic markers & circulating microRNAs such as miR-29 and miR-155 emerged as promising non-invasive diagnostic tools. Imaging biomarkers using PET-CT and AI-supported radiomics have improved disease monitoring. Conclusion: Biomarker discovery is reshaping DM-TB diagnosis and treatment. Integrated multi-omics and AI-assisted platforms promise personalized approaches though validation across diverse populations and affordable implementation remain challenges.