|Title:||Metformin use is associated with a low risk of tuberculosis among newly diagnosed diabetes mellitus patients with normal renal function: A nationwide cohort study with validated diagnostic criteria||Authors:||Lee M.-C.
|Issue Date:||2018||Publisher:||Public Library of Science||Journal Volume:||13||Journal Issue:||10||Source:||PLoS ONE||Abstract:||
Human studies on the use of metformin as host-directed therapy (HDT) for tuberculosis (TB) are rare. We performed a nationwide cohort study to evaluate the effect of metformin on mitigating the risk of active TB among patients with diabetes mellitus (DM). Among newly diagnosed DM patients identified in the Taiwan National Health Insurance Research Database, metformin users, defined on the basis of >90 cumulative defined daily doses within 1 year, and propensity-score-matched metformin nonusers were selected. The primary outcome was incident TB, identified using diagnostic criteria validated by real patient data at a medical center. Independent predictors were investigated using Cox regression analysis. Similar analysis was performed in a subpopulation without a history of hypertensive nephropathy and renal replacement therapy. A total of 88,866 metformin users and 88,866 propensityscore-matched nonusers were selected. Validation results showed that the TB diagnostic criteria had a sensitivity of 99.13% and specificity of 99.90%. During follow-up, 707 metformin users and 807 nonusers developed active TB. Metformin use was independently associated with a lower risk of incident TB (hazard ratio [HR]: 0.84 [0.74-0.96]). TB risk was lower in high-dose metformin users than in low-dose users (HR: 0.83 [0.72-0.97]). The effect of metformin remained when analysis was restricted in the subpopulation without renal function impairment. Newly diagnosed diabetic patients without contraindication should receive metformin as an anti-diabetic medication, with potential additional benefit against TB. ? 2018 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
|ISSN:||1932-6203||DOI:||10.1371/journal.pone.0205807||SDG/Keyword:||antidiabetic agent; metformin; adult; biopsy; female; human; incidence; isolation and purification; longitudinal study; lung tuberculosis; male; microbiology; middle aged; Mycobacterium tuberculosis; non insulin dependent diabetes mellitus; propensity score; proportional hazards model; retrospective study; risk factor; sputum; Taiwan; validation study; Adult; Biopsy; Diabetes Mellitus, Type 2; Female; Humans; Hypoglycemic Agents; Incidence; Longitudinal Studies; Male; Metformin; Middle Aged; Mycobacterium tuberculosis; Propensity Score; Proportional Hazards Models; Retrospective Studies; Risk Factors; Sputum; Taiwan; Tuberculosis, Pulmonary
|Appears in Collections:||醫學系|
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