Background: Patients with Tuberculosis (TB) are more likely to have Type 2 Diabetes Mellitus (T2DM). Individuals with insulin resistance (IR) with normal glucose may also be at risk for TB, but there are no data available. Methods:To explore whether T2DM and IR are risk factors for TB we enrolled patients receiving TB treatment in Saudi Arabia and healthy controls to assess the frequency of both conditions in both populations. Controls were adults attending the TB clinics to obtain a screening certificate for labour reasons. All participants were screened for fasting plasma glucose (FPG), insulin, glycated haemoglobin (HbA1c) and lipids. We assessed the severity of the clinical presentation of TB among patients with T2DM, IR and normal glucose.Results: 175 adults with pulmonary TB (cases) and 140 controls were recruited. Fifty-one (29%) of TB cases had T2DM and 27 (22%) normoglycemic IR compared to 39 (27.9%) and 26 (25.7%) of the controls, respectively. Six (3.3%) of cases and 12 (8.6%) of controls were unaware of their T2DM diagnosis. TB was associated with pre-diabetes (AOR 5.112, p = 0.032), low level of risky HDL Cholesterol (AOR 0.316, p = 0.001) and non-Saudi nationality (AOR 4.018, p ˂ 0.001). Cases were more likely to eat fast foods and to have a poor diet than controls (p ˂ 0.001). Conclusion:TB cases were more likely to be of non-Saudi nationality, to be male and to have T2DM and prediabetes, but were not more likely to have IR than controls.