Tuberculosis Risk in Type 2 Diabetes Medications

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Clinicians should consider initiating metformin therapy in patients with high risk for tuberculosis unless contraindicated.
Clinicians should consider initiating metformin therapy in patients with high risk for tuberculosis unless contraindicated.

Patients with type 2 diabetes (T2D) treated with sulfonylureas may be at a higher risk of contracting tuberculosis (TB) compared with patients treated with metformin, according to a study published in CHEST.

The researchers identified 40,179 individuals with T2D from the Taiwan National Heath Insurance Research Database and conducted a retrospective, nationwide population-based cohort study placing individuals studied in 2 groups: metformin-majors (receiving metformin ≥60 cumulative defined daily dose [cDDD] and sulfonylureas <15 cDDD) and sulfonylurea-majors (sulfonylureas ≥60 cDDD and metformin <15 cDDD). Individuals in both groups were matched 1:1 by propensity score and retrospectively followed for at least 2 years.

Study results demonstrated a lower TB risk in metformin majors compared with sulfonylurea majors both before and after being matched by propensity score (adjusted hazard ratio [aHR], 0.477 [95% CI, 0.268-0.850] and aHR, 0.337 [95% CI, 0.169-0.673]; matched n=3161 pairs). In addition, the reference group had a dose-dependent TB risk compared with those treated with metformin (60-219 cDDD; aHR, 0.860 [95% CI, 0.637-1.161]; 220-479 cDDD; aHR, 0.706 [95% CI, 0.485-1.028]; ≥480 cDDD; aHR, 0.319 [95% CI, 0.118-0.863]).

The researchers concluded that T2D treatment in the first 2 years with metformin was associated with a decreased risk for TB compared with treatment with sulfonylureas. In addition, the dosage of metformin, not sulfonylureas, was found to be independently associated with a decreased risk for TB. Therefore, clinicians should first consider the use of metformin for the initial treatment of T2D in high-risk individuals unless contraindicated.

Reference

Pan SW, Yen YF, Kou YR, et al. The risk of tuberculosis disease in type 2 diabetes patients initiating metformin versus sulfonylureas [published online December 16, 2017]. CHEST. doi:10.1016/j.chest.2017.11.040

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