Metformin a promising adjunctive, host-therapy in diabetic patients with TB
Metformin may improve survival during tuberculosis (TB) treatment in patients with diabetes mellitus—a condition which particularly carries an increased risk of adverse TB treatment outcomes, a study has found.
The retrospective cohort study included 2,416 patients aged >13 years who were undergoing treatment for culture-confirmed, drug susceptible pulmonary TB. Assessments included the effect of diabetes on mortality during TB treatment, sputum culture conversion at 2 months, as well as the effect of metformin on survival during TB treatment.
Among the patients, those with diabetes had greater odds of death during anti-TB therapy (odds ratio [OR], 1.91; 95 percent CI, 1.51 to 2.40) and of remaining culture-positive at 2 months (OR, 1.72; 1.25 to 2.38). These results were adjusted for age, sex, chronic kidney disease, cancer, hepatitis C, tobacco use, cavitary disease and treatment adherence.
Importantly, the use of metformin in patients with diabetes led to a significant reduction in mortality during anti-TB therapy (hazard ratio, 0.56; 0.39 to 0.82). Mortality was similar between metformin users and patients without diabetes.
In light of the improved survival associated with metformin, researchers pointed out the potential role of the glucose-lowering drug as an adjunctive, host-directed therapy in diabetic patients with TB.
Diabetes mellitus has been shown to be an important risk factor for TB, affecting disease presentation and treatment response. Additionally, the infectious disease may induce glucose intolerance and worsen glycaemic control in diabetic patients. [Lancet Infect Dis 2009;9:737–46]