Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Respirology. 2018 Nov;23(11):1063-1073. doi: 10.1111/resp.13338. Epub 2018 Jun 25.
Metformin is an oral anti-diabetic therapy (ADT) to manage type 2 diabetes mellitus (T2DM), and has been reported to have potential anti-tuberculosis (TB) effects. This study investigates the risk of active TB among persons with T2DM who were treated with various ADT and insulin therapies.
We conducted a nationwide population-based cohort study using the Taiwan Longitudinal Health Insurance Database, including 49 028 T2DM patients who were metformin users (n = 44 002) or non-users (n = 5026). A total of 5026 propensity score-matched pairs of metformin users and non-users with T2DM were evaluated from 1998 to 2010. The data were analysed using Cox proportional hazard models.
Patients with T2DM had a significantly higher rate of incident TB than did the control subjects (adjusted hazard ratio: 2.01; 95% confidence interval (95% CI): 1.80-2.25). After adjusting for comorbidities, diabetes complications, ADT type and statin use, metformin use was an independent factor for predicting a reduced risk of active TB (adjusted relative risk (aRR): 0.24; 95% CI: 0.18-0.32). The association between metformin use and active TB risk was also consistent in most subgroup analyses, except for patients with metabolic disorders (aRR: 0.46; 95% CI: 0.11-1.87). This protective effect of metformin was dose-dependent but diminished gradually in the elderly population.
Among all types of ADT and insulin therapies, metformin is the only agent with a decreased risk of active TB in the T2DM population. However, this effect was diminished in the elderly population and was not observed in patients with metabolic disorders.
二甲双胍是一种用于治疗 2 型糖尿病（T2DM）的口服抗糖尿病药物（ADT），并已被报道具有潜在的抗结核（TB）作用。本研究旨在调查接受各种 ADT 和胰岛素治疗的 T2DM 患者中，发生活动性 TB 的风险。
我们使用台湾纵向健康保险数据库进行了一项全国性的基于人群的队列研究，纳入了 49028 名 T2DM 患者，其中二甲双胍使用者（n=44002）和非使用者（n=5026）。从 1998 年至 2010 年，共评估了 5026 对具有 T2DM 的二甲双胍使用者和非使用者的倾向评分匹配对。使用 Cox 比例风险模型进行数据分析。
T2DM 患者的 TB 发生率明显高于对照组（调整后的危险比：2.01；95%置信区间[95%CI]：1.80-2.25）。调整合并症、糖尿病并发症、ADT 类型和他汀类药物使用后，二甲双胍的使用是预测活动性 TB 风险降低的独立因素（调整后的相对风险[aRR]：0.24；95%CI：0.18-0.32）。二甲双胍的使用与活动性 TB 风险之间的关联在大多数亚组分析中也是一致的，除了代谢紊乱患者（aRR：0.46；95%CI：0.11-1.87）。二甲双胍的这种保护作用是剂量依赖性的，但在老年人群中逐渐减弱。
在所有类型的 ADT 和胰岛素治疗中，二甲双胍是唯一一种降低 T2DM 人群活动性 TB 风险的药物。然而，这种效果在老年人群中减弱，在代谢紊乱患者中未观察到。
