Background and aim: The prevalence of Tuberculosis (TB) among diabetics, especially in those with poor glycemic control, is higher than in non-diabetic population.In 2019, just over 15% of people with TB were estimated to have diabetes globally. Diabetes may alter the clinical presentation of tuberculosis and it takes longer time to diagnose tuberculosis in DM Patients.The purpose of this study was to observe the various presentation of tuberculosis with diabetes mellitus now days, as with the passage of time (decades) presentations could be changed. Materials and methods: The study was a prospective study conducted from January 2017 to February2018. 55 pulmonary tuberculosis patients who were sputum smear positive with diabetes mellitus and 50 sputum smear positive patients who did not have diabetes mellitus were included in this study. Result: Hemoptysis was present in significantly more number while weight loss was in significantly less number of pulmonary tuberculosis patients with diabetes mellitus(p<0.002). Thick walled cavity with ragged internal margin was present in 15% patient in study group, which was significantly high (p=0.01).than control group (4.4%). Significantly least common presentation was unilateral lesions any extent with any size cavity with upper and middle zone preponderance (8.3%) (p<0.01). Conclusion: In tuberculosis patients with and diabetes there waspredominantly lower lung field involvement, thick walled cavity and cavity/consolidation lesion merging with the hilum were more common than tuberculosis patients without diabetes and least common wasunilateral lesions with any size cavity with upper and middle zone preponderance.