Objective：This study aims to investigate the effect of blood glucose control on tuberculosis risk. Methods：A 6- year cohort study was conducted on 60 283 subjects in Nanjing，Jiangsu Province. After excluding active tuberculosis patients identified during baseline screening，subjects were matched with the tuberculosis patient management information in Nanjing to identify active tuberculosis cases. The Cox proportional hazards models were employed to compare tuberculosis incidence risk between diabetes and non-diabetes patients，adjusting for age，gender，and other factors. Additionally，the incidence of tuberculosis was compared between groups with good and poor blood glucose control. Results：During the 6-year follow-up，79 cases of active tuberculosis were identified， yielding an incidence density of 25.6（95% CI：20.4 to 31.7）per 100 000 person-years. In a group of 79 patients，diabetes accounted for 21.5%（17/79），with an incidence density of tuberculosis at 58.8（95% CI：35.4 to 92.2）per 100 000 person-years. Non-diabetic patients accounted for 78.5%（62/79），with an incidence density of tuberculosis at 22.1（95% CI：17.1 to 28.2）per 100 000 person-years. In the well-controlled blood glucose group，the incidence density of active tuberculosis was 29.6（95% CI：21.4 to 33.1）per 100 000 person-years，while in the poorly controlled blood glucose group，the incidence density of active tuberculosis was 63.5（95% CI：39.3 to 96.8）per 100 000 person-years. The risk of tuberculosis in diabetes patients was 3.057 times higher than that in the general population （HR=3.057，95% CI：1.770 to 5.281，P < 0.001）. The risk of tuberculosis was 3.766 times higher in the group with poor blood glucose control than in the group with good blood glucose control（HR=3.766，95% CI：2.054 to 6.906，P < 0.001）. Conclusion：This large-scale cohort study demonstrates that diabetes patients with poor blood glucose control have an increased risk of tuberculosis. Enhanced screening of diabetes patients with poor blood glucose control may facilitate early detection of tuberculosis，potentially reducing its incidence and prevalence in China.