Metformin Lessens Impact of Diabetes on TB Outcomes

Metformin use helps lessen the risk of mortality in patients with tuberculosis (TB) and diabetes, a new study showed.

The presence of type 2 diabetes is known to worsen outcomes associated with TB treatment. To assess whether metformin use could mitigate the effects of diabetes on TB-related outcomes, the researchers evaluated 2416 patients aged 13 years or older who were undergoing treatment for culture-confirmed, drug-susceptible pulmonary TB.
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The researchers evaluated the impact of diabetes on mortality during TB treatment and 2-month TB sputum-conversion. They also assessed the effect of metformin use on survival during TB treatment. Results were adjusted for factors including age, sex, tobacco use, and treatment adherence.

Study findings revealed that TB patients with diabetes had a 1.91-fold higher risk of mortality during TB treatment and a 1.72-fold higher risk of remaining culture-positive at 2 months compared with patients without diabetes. However, results also indicated that metformin use in patients with diabetes and TB was associated with a significantly lower risk of mortality during TB treatment (hazard ratio 0.56).

The researchers noted that mortality was similar in patients taking metformin and those without diabetes.

“This study suggests that despite multiple potential confounding variables, [diabetes mellitus] poses an increased risk of adverse TB treatment outcomes,” the researchers wrote. “There was a significant association between metformin use and decreased mortality during TB treatment, suggesting a potential role for this agent as adjunctive, host-directed therapy.”

—Christina Vogt

Reference:

Degner NR, Wang JY, Golub JE, Karakousis PC. Metformin use reverses the increased mortality associated with diabetes mellitus during tuberculosis treatment. Clin Infect Dis. 2018;66(2):198-205. https://doi.org/10.1093/cid/cix819.