Impact of metformin use among tuberculosis close contacts with diabetes mellitus in a nationwide cohort study
Journal
BMC Infectious Diseases
Journal Volume
19
Journal Issue
1
Pages
936
Date Issued
2019
Author(s)
Abstract
Background: The protective effect of metformin against active tuberculosis (TB) among TB close contacts is unknown. Methods: TB close contacts with diabetes mellitus (DM) and normal renal function were selected from the National Health Insurance Research Database of Taiwan. Metformin users were patients who received ?90 cumulative defined daily doses within 1 year before the index date. For each metformin user, a propensity-score matched metformin nonuser and an age- and sex-matched healthy TB close contact were selected. The outcome was incident TB, identified using previously validated diagnostic criteria. Independent predictors were investigated using stratified Cox regression analysis. Interaction analysis was also performed. Results: A total of 5846 TB close contacts who were metformin users, metformin non-users, and healthy contacts were analysed. The incidence of active TB was 755 (600-938), 1117 (927-1335), and 526 (393-689) cases per 100,000 person-years in each group, respectively. Multivariate analysis revealed that healthy contacts had the lowest risk of developing active TB (adjusted hazard ratio [aHR]: 0.42 [0.30-0.60]) and metformin use partially reversed the risk associated with DM (aHR: 0.73 [0.54-0.98]). Subpopulation analysis revealed a significant interaction between insulin use and metformin use. Conclusions: Metformin use is associated with a lower risk of developing active TB among TB close contacts with DM, especially for insulin users. It may be an alternative choice for primary prevention against active TB if no contraindications exist. However, prospective studies are needed to confirm the findings. ? 2019 The Author(s).
SDGs
Other Subjects
metformin; antidiabetic agent; metformin; adult; aged; Article; cohort analysis; contact examination; controlled study; diabetes mellitus; female; human; incidence; kidney function; major clinical study; male; propensity score; retrospective study; risk assessment; risk factor; Taiwan; tuberculosis; comorbidity; diabetes mellitus; factual database; follow up; isolation and purification; middle aged; Mycobacterium tuberculosis; proportional hazards model; tuberculosis; Adult; Aged; Comorbidity; Databases, Factual; Diabetes Mellitus; Female; Follow-Up Studies; Humans; Hypoglycemic Agents; Incidence; Male; Metformin; Middle Aged; Mycobacterium tuberculosis; Propensity Score; Proportional Hazards Models; Retrospective Studies; Risk Factors; Taiwan; Tuberculosis
Publisher
BioMed Central Ltd.
Type
journal article