The Efficacy of Vitamin D in Pulmonary Tuberculosis Patients with Diabetes Mellitus Comorbidity after the Intensive Phase on Bacteriological Conversion, Clinical Condition, And Nutritional Status

Abstract

Introduction.
Pulmonary tuberculosis (TB) accompanied by diabetes mellitus (DM) presents substantial therapeutic challenges due to impaired immune responses and delayed clinical recovery. Vitamin D is known to enhance macrophage activity and antimicrobial peptide production, which may contribute to improved TB outcomes. However, evidence regarding its clinical benefit in TB-DM patients remains limited.

Objectives.
This study aimed to evaluate the effect of vitamin D supplementation on bacteriological conversion, clinical symptom improvement, and nutritional status in TB patients with DM after the intensive phase of anti-tuberculosis therapy.

Methods.
A pre-experimental cohort study was conducted at Dr. Wahidin Sudirohusodo Hospital, Makassar. Forty TB-DM patients were allocated into intervention (vitamin D supplementation) and control groups. Serum vitamin D levels, acid-fast bacilli (AFB) smear status, clinical symptoms, and body mass index (BMI) were assessed at baseline and after two months of intensive treatment. Data were analyzed using paired statistical tests and multivariate logistic regression to identify factors associated with AFB conversion and changes in vitamin D levels.

Results.
Baseline characteristics were comparable between groups. The increase in serum vitamin D was significantly greater in the intervention group (+15.1 ± 4.2 ng/mL) compared with the control group (+5.2 ± 2.9 ng/mL; p < 0.001). AFB smear conversion occurred more frequently in the supplemented group (60%) than in controls (30%) (p = 0.021). Improvement in clinical symptoms was significantly more pronounced in the intervention group (p < 0.05). Nutritional recovery, indicated by greater gains in body weight and BMI, was also superior among patients receiving vitamin D (p < 0.05). Multivariate analysis identified vitamin D supplementation (OR = 3.25, p = 0.021) and increased serum vitamin D levels (OR = 1.18 per 1 ng/mL increase, p = 0.004) as independent predictors of AFB conversion.

Conclusion.
Vitamin D supplementation in TB patients with DM significantly improves serum vitamin D levels, accelerates sputum conversion, enhances clinical recovery, and supports nutritional status. These findings suggest that vitamin D is a safe and effective adjunctive therapy to standard anti-tuberculosis treatment in this high-risk population.