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Background and objective Tuberculosis (TB) and diabetes mellitus frequently co-occur in India and complicate the management of both conditions. Nevertheless, there is limited evidence on adherence to antidiabetic therapy among adults receiving TB care at district-level public health facilities. This study aimed to assess the levels of medication adherence and identify patient-reported barriers among adults with TB and diabetes attending two TB facilities in Ratlam district, Madhya Pradesh, India. Methods The facility-based cross-sectional descriptive study was derived from a parent research project conducted between January 2023 and December 2023 at the District Tuberculosis Centre and the TB Clinic of Government Medical College, Ratlam. Consenting adults aged over 18 years with newly diagnosed TB and coexisting diabetes were eligible. A pretested, structured questionnaire containing adherence and self-management items was used to collect data, and the current manuscript presents descriptive statistics. Results Out of the 135 respondents, 88 (65.2%) were men. The largest age group was 61 to 70 years (41.5%). Adherence to antidiabetic therapy was found to be low (80 participants, 59.3%), moderate (35 participants, 25.9%), and high (20 participants, 14.8%). Financial constraints (36.1%), medication side effects (26.2%), and the complexity of treatment regimens (18.3%) were the most commonly reported barriers to adherence. The majority of the participants received antidiabetic medicines in government institutions (78.5%). Conclusions The lack of adherence to antidiabetic therapy was widespread among adults with TB and diabetes in this setting. The most common barriers reported were financial barriers, adverse effects, and regimen complexity. These results support the need for improved adherence measurement and practical assistance in combined TB-diabetes care, and larger analytical studies are needed to identify independent determinants of nonadherence.