Metformin Use Reverses the Increased Mortality Associated with Diabetes Mellitus during Tuberculosis Treatment
Journal
Clinical Infectious Diseases
Journal Volume
66
Journal Issue
2
Pages
198-205
Date Issued
2018
Author(s)
Abstract
Background The global type 2 diabetes mellitus (DM) epidemic threatens progress made in reducing tuberculosis (TB)-related mortality worldwide. Previous clinical studies have not fully evaluated potential confounding variables in addressing the impact of DM on TB treatment outcomes. The antidiabetic agent metformin regulates autophagy and may play a role as a host-directed therapeutic adjuvant to antitubercular treatment. Methods We conducted a retrospective cohort study comprising patients aged ?13 years undergoing treatment for culture-confirmed, drug-susceptible pulmonary TB. We assessed the effect of DM on mortality during TB treatment and 2-month TB sputum-culture conversion. We also evaluated the effect of metformin use on survival during TB treatment. Results Among 2416 patients undergoing TB treatment, after adjusting for age, sex, chronic kidney disease, cancer, hepatitis C, tobacco use, cavitary disease, and treatment adherence, patients with DM had 1.91 times higher odds (95% confidence interval [CI], 1.51-2.40) of death during TB treatment than patients without DM, and 1.72 (95% CI, 1.25-2.38) times higher odds of remaining culture-positive at 2 months. Metformin use in patients with DM was significantly associated with decreased mortality during TB treatment (hazard ratio, 0.56 [95% CI,.39-.82]), and metformin users had similar mortality as patients without DM. Conclusions This study suggests that despite multiple potential confounding variables, DM poses an increased risk of adverse TB treatment outcomes. 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. ? The Author(s) 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
SDGs
Other Subjects
metformin; antidiabetic agent; metformin; adult; age; aged; Article; chronic kidney failure; cohort analysis; comorbidity; confidence interval; demography; diabetes mellitus; female; gender; hazard ratio; hepatitis C; human; lung tuberculosis; major clinical study; male; malignant neoplasm; mortality; patient compliance; priority journal; retrospective study; sputum culture; tobacco use; adolescent; complication; middle aged; non insulin dependent diabetes mellitus; survival analysis; treatment outcome; tuberculosis; very elderly; young adult; Adolescent; Adult; Aged; Aged, 80 and over; Diabetes Mellitus, Type 2; Female; Humans; Hypoglycemic Agents; Male; Metformin; Middle Aged; Retrospective Studies; Survival Analysis; Treatment Outcome; Tuberculosis; Young Adult
Publisher
Oxford University Press
Type
journal article