Division of Critical Care Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
Biomed Res Int. 2020 May 19;2020:8085106. doi: 10.1155/2020/8085106. eCollection 2020.
Diabetes mellitus (DM) and tuberculosis (TB) are major public health and economic burdens. DM increases Mycobacterium tuberculosis (M.tb) infection rates and treatment durations. This study evaluated the relationship between five classes of oral DM medications and TB infection risk in DM patients. We used longitudinal records from the Taiwan Longitudinal Health Insurance Research Database. DM patients were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 250 and A code A181. TB patients were identified using ICD-9-CM code 010.x-017.x. Oral DM medications were divided into five classes: sulfonylureas, biguanides, meglitinides, -glucosidase inhibitors (AGIs), and thiazolidinediones. Users were classified as nonusers, low-concentration users, and high-concentration users. The incidence rate ratio (IRR) was derived using multivariate Poisson regression to calculate the relative risk of TB infection. DM patients using low- and high-concentration AGIs had significantly lower TB infection risks compared with nonusers. The IRRs of the sulfonylureas and AGI users were [CI] 0.693-0.948) and (95% CI 0.651-0.995), respectively. The other four classes of medications exhibited no significant effect on TB infection risk in DM patients. Furthermore, DM patients using high-concentration AGIs had a significantly lower TB infection risk compared with those using low-concentration AGIs (IRR 0.918, 95% CI: 0.854-0.987). We noted a dose-response relationship in the effects of DM medications on TB risk. Accordingly, we suggest that DM patients use AGIs to benefit from their protective effect on TB infection risk.
糖尿病（DM）和结核病（TB）是主要的公共卫生和经济负担。DM 会增加结核分枝杆菌（M.tb）感染率和治疗时间。本研究评估了五类口服 DM 药物与 DM 患者 TB 感染风险之间的关系。我们使用了来自台湾纵向健康保险研究数据库的纵向记录。DM 患者使用国际疾病分类，第九修订版，临床修正（ICD-9-CM）代码 250 和 A 代码 A181 来识别。TB 患者使用 ICD-9-CM 代码 010.x-017.x 来识别。口服 DM 药物分为五类：磺酰脲类、二甲双胍类、格列奈类、-葡萄糖苷酶抑制剂（AGI）和噻唑烷二酮类。使用者分为非使用者、低浓度使用者和高浓度使用者。使用多变量泊松回归计算发病率比（IRR），以计算 TB 感染的相对风险。与非使用者相比，使用低浓度和高浓度 AGI 的 DM 患者的 TB 感染风险显著降低。磺酰脲类和 AGI 使用者的 IRR 分别为 [CI] 0.693-0.948）和（95% CI 0.651-0.995）。其他四类药物对 DM 患者的 TB 感染风险没有显著影响。此外，与使用低浓度 AGI 的 DM 患者相比，使用高浓度 AGI 的 DM 患者的 TB 感染风险显著降低（IRR 0.918，95% CI：0.854-0.987）。我们注意到 DM 药物对 TB 风险的影响存在剂量反应关系。因此，我们建议 DM 患者使用 AGI 以从其对 TB 感染风险的保护作用中受益。
