The Brazilian Journal of Infectious Diseases The Brazilian Journal of Infectious Diseases
Braz J Infect Dis 2017;21:312-6 - Vol. 21 Num.3 DOI: 10.1016/j.bjid.2017.01.001
Original Article
Protective effect of metformin against tuberculosis infections in diabetic patients: an observational study of south Indian tertiary healthcare facility
Srujitha Marupurua, Padmanav Senapatia, Swathi Pathadkaa, Sonal Sekhar Miraja,, , , Mazhuvancherry Kesavan Unnikrishnana, Mohan K. Manub
a Manipal University, Manipal College of Pharmaceutical Sciences, Department of Pharmacy Practice, Manipal, India
b Manipal University, Kasturba Medical College Hospital, Department of Pulmonary Medicine, Manipal, India
Received 06 November 2016, Accepted 23 January 2017
Abstract
Background

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.

Objectives

To determine the protective effect of metformin against TB in DM patients and also, to investigate the relationship between poor glycemic control and TB.

Methods

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.

Results

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).

Conclusion

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.

Keywords
Diabetes, Metformin, Tuberculosis prevention
Braz J Infect Dis 2017;21:312-6 - Vol. 21 Num.3 DOI: 10.1016/j.bjid.2017.01.001