This systematic review and meta-analysis examines the association between diabetes mellitus (DM) and active tuberculosis (TB). The study found that DM is associated with an increased risk of TB, regardless of study design, population characteristics, or background TB incidence. The relative risk (RR) for TB in individuals with DM was 3.11 (95% CI 2.27–4.26) in cohort studies, with higher risks observed in younger individuals, populations with higher background TB incidence, and non-North American populations. The findings suggest that interventions targeting DM may help control TB, and that efforts to diagnose and treat DM could have a beneficial impact on TB control. The study highlights the need for further research to understand the relationship between DM and TB, particularly in different regions and ethnic groups.This systematic review and meta-analysis examines the association between diabetes mellitus (DM) and active tuberculosis (TB). The study found that DM is associated with an increased risk of TB, regardless of study design, population characteristics, or background TB incidence. The relative risk (RR) for TB in individuals with DM was 3.11 (95% CI 2.27–4.26) in cohort studies, with higher risks observed in younger individuals, populations with higher background TB incidence, and non-North American populations. The findings suggest that interventions targeting DM may help control TB, and that efforts to diagnose and treat DM could have a beneficial impact on TB control. The study highlights the need for further research to understand the relationship between DM and TB, particularly in different regions and ethnic groups.