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The Effect of Metformin Versus Sulfonylurea on the Risk of Tuberculosis Disease in Patients with Type 2 Diabetes Mellitus: A Population-Based Cohort Study
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A4316 - The Effect of Metformin Versus Sulfonylurea on the Risk of Tuberculosis Disease in Patients with Type 2 Diabetes Mellitus: A Population-Based Cohort Study
Author Block: W. Su1, S. Pan1, Y. Yen2, V. Su3, P. Chuang4, J. Feng5; 1Chest Department, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming University, Taipei, Taiwan, 2Section of Infectious Diseases, Taipei City Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan, Taipei, Taiwan, 3Department of Internal Medicine, Taipei City Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan, Taipei, Taiwan, 4Center for Prevention and Treatment of Occupational Injury and Diseases, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Taipei, Taiwan, 5Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan, Taipei, Taiwan.
Rationale: Metformin and sulfonylureas are common initial antidiabetic agents; the former has anti-TB action in in vitro and animal studies. The effects of these drugs on TB risk in the type 2 diabetes mellitus (T2DM) population remains unclear. Objective: To investigate the impact of metformin versus sulfonylurea on TB development in T2DM patients Methods: A sample of 47,740 T2DM patients without chronic kidney disease and matched controls (1:1) in the Taiwan National Health Insurance Research Database were identified from 2005 to 2013 and observed for TB until December 2013 or withdrawal from insurance. Diabetic severity was assessed by the adapted diabetes complication severity index (aDCSI). Metformin initiators with ≥15 defined daily dose (DDD) of metformin in the initial year and the propensity-score matched sulfonylureas initiators (1:1) were compared for TB risk using Cox regression analysis and censored until endpoints. Measurements and Main Results: TB incidences in non-DM controls and T2DM patients with aDCSI of 0, 1 and ≥2 scores were 98, 129, 172 and 263 per 100,000 person-years. In the T2DM cohort, the independent predictors for TB were older age (10-year increase, adjusted HR 1.291 [1.182-1.412]), male (3.752 [2.851-4.938]), low income (1.636 [1.138-2.351]) and metformin use (time-varying mean DDD within each 90-day interval, 0.952 [0.938-0.966]) after adjustment by aDCSI and cofactors. Metformin initiators (n =8157) had a significantly lower TB risk than sulfonylurea initiators (0.329 [0.174-0.625]) after adjustment. Conclusions: Metformin use carried a decreased risk for TB development, and metformin initiators had a 67% reduced risk compared to sulfonylurea competitors.
Author Block: W. Su1, S. Pan1, Y. Yen2, V. Su3, P. Chuang4, J. Feng5; 1Chest Department, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming University, Taipei, Taiwan, 2Section of Infectious Diseases, Taipei City Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan, Taipei, Taiwan, 3Department of Internal Medicine, Taipei City Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan, Taipei, Taiwan, 4Center for Prevention and Treatment of Occupational Injury and Diseases, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Taipei, Taiwan, 5Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan, Taipei, Taiwan.
Rationale: Metformin and sulfonylureas are common initial antidiabetic agents; the former has anti-TB action in in vitro and animal studies. The effects of these drugs on TB risk in the type 2 diabetes mellitus (T2DM) population remains unclear. Objective: To investigate the impact of metformin versus sulfonylurea on TB development in T2DM patients Methods: A sample of 47,740 T2DM patients without chronic kidney disease and matched controls (1:1) in the Taiwan National Health Insurance Research Database were identified from 2005 to 2013 and observed for TB until December 2013 or withdrawal from insurance. Diabetic severity was assessed by the adapted diabetes complication severity index (aDCSI). Metformin initiators with ≥15 defined daily dose (DDD) of metformin in the initial year and the propensity-score matched sulfonylureas initiators (1:1) were compared for TB risk using Cox regression analysis and censored until endpoints. Measurements and Main Results: TB incidences in non-DM controls and T2DM patients with aDCSI of 0, 1 and ≥2 scores were 98, 129, 172 and 263 per 100,000 person-years. In the T2DM cohort, the independent predictors for TB were older age (10-year increase, adjusted HR 1.291 [1.182-1.412]), male (3.752 [2.851-4.938]), low income (1.636 [1.138-2.351]) and metformin use (time-varying mean DDD within each 90-day interval, 0.952 [0.938-0.966]) after adjustment by aDCSI and cofactors. Metformin initiators (n =8157) had a significantly lower TB risk than sulfonylurea initiators (0.329 [0.174-0.625]) after adjustment. Conclusions: Metformin use carried a decreased risk for TB development, and metformin initiators had a 67% reduced risk compared to sulfonylurea competitors.
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