Protective effect of metformin against tuberculosis infections in diabetic patients: an observational study of south Indian tertiary healthcare facility

World Health Organization estimated that people with diabetes (DM) are at 2–3 times higher risk for tuberculosis (TB). Studies have shown that DM not only increases the risk of active TB, but also puts co-affected persons at increased risk of poor outcomes. To determine the protective effect of metf...

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Published in:	The Brazilian journal of infectious diseases Vol. 21; no. 3; pp. 312 - 316
Main Authors:	Marupuru, Srujitha, Senapati, Padmanav, Pathadka, Swathi, Miraj, Sonal Sekhar, Unnikrishnan, Mazhuvancherry Kesavan, Manu, Mohan K.
Format:	Journal Article
Language:	English
Published:	Brazil Elsevier Editora Ltda 01-05-2017 Contexto Elsevier Brazilian Society of Infectious Diseases
Subjects:	Analysis BCG Case-Control Studies Diabetes Diabetes Mellitus - drug therapy Diabetics Female Glycosylated hemoglobin Health aspects Humans Hypoglycemic agents Hypoglycemic Agents - therapeutic use India INFECTIOUS DISEASES Male Medical research Metformin Metformin - therapeutic use Middle Aged Original Public health Risk factors Tertiary Healthcare Tuberculosis Tuberculosis prevention Tuberculosis, Pulmonary - blood Tuberculosis, Pulmonary - etiology Tuberculosis, Pulmonary - prevention & control India Tuberculosis prevention Diabetes Metformin
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Summary:	World Health Organization estimated that people with diabetes (DM) are at 2–3 times higher risk for tuberculosis (TB). Studies have shown that DM not only increases the risk of active TB, but also puts co-affected persons at increased risk of poor outcomes. To determine the protective effect of metformin against TB in DM patients and also, to investigate the relationship between poor glycemic control and TB. A case–control study was conducted over 8 months, where cases and controls were selected based on the inclusion and exclusion criteria of the study. The diabetics diagnosed with TB were selected as study group (SG=152) and without TB were as control group (CG=299). Exposure status of metformin in both groups were analyzed. The mean (SD) age of both CG and SG were 55.54±11.82 and 52.80±11.75, respectively. Majority of the subjects in the study were males. The mean hospital stay of SG and CG were 7 days and 6 days, respectively. Poor glycemic control (HbA1c>8) observed in SG (51.7%) vs CG (31.4%). HbA1c value <7 is associated protective factor for TB occurrence [OR=0.52 (95% CI 0.29–0.93)]. The protective effect of metformin against TB was 3.9-fold in diabetics (OR=0.256, 0.16–0.40). Poor glycemic control among diabetics is a risk factor for TB occurrence. The result shows metformin use is a protective agent against TB infection in diabetics. Hence, incorporation of metformin into standard clinical care would offer a therapeutic option for the prevention of TB.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	1413-8670 1678-4391 1678-4391
DOI:	10.1016/j.bjid.2017.01.001