The effect of metformin on culture conversion in tuberculosis patients with diabetes mellitus

Ye-Jin Lee, Sung Koo Han, Ju Hee Park, Jung Kyu Lee, Deog Keom Kim, Hee Soon Chung, Eun Young Heo, Ye-Jin Lee, Sung Koo Han, Ju Hee Park, Jung Kyu Lee, Deog Keom Kim, Hee Soon Chung, Eun Young Heo

Abstract

Background/aims: Patients with diabetes mellitus (DM) and tuberculosis (TB) have increased morbidity and a high risk of treatment failure or recurrence. It is important to manage both diseases simultaneously. Among anti-diabetic drugs, metformin inhibits intracellular growth of mycobacteria. Therefore, we examined the effects of metformin on TB treatment, especially in patients with DM.

Methods: This retrospective cohort study included patients with culture-positive pulmonary TB diagnosed between 2011 and 2012. The primary study outcome was sputum culture conversion after 2 months of treatment.

Results: Of 499 patients diagnosed with culture-positive pulmonary TB, 105 (21%) had DM at diagnosis. Among them, 62 (59.5%) were treated with metformin. Baseline characteristics, except for the presence of chronic renal disease, were not significantly different between the metformin and non-metformin groups. Metformin treatment had no significant effect on sputum culture conversion (p = 0.60) and recurrence within 1 year after TB treatment completion (p = 0.39). However, metformin improved the sputum culture conversion rate in patients with cavitary pulmonary TB, who have higher bacterial loads (odds ratio, 10.8; 95% confidence interval, 1.22 to 95.63).

Conclusion: Among cavitary pulmonary TB patients with DM, metformin can be an effective adjunctive anti-TB agent to improve sputum culture conversion after 2 months of treatment.

Keywords: Diabetes mellitus; Metformin; Tuberculosis.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1.
Figure 1.
Flow chart. BRMH, Seoul Metropolitan Government Seoul National University Boramae Medical Center; SNUH, Seoul National University Hospital; TB, tuberculosis; AFB, acid-fast bacilli. a Misdiagnosed: NTM (n = 20), no TB (n = 10), sarcoidosis (n = 6), b Etc.: cutaneous TB (n =2), renal TB (n = 5), CNS TB (n =3), adrenal TB (n = 1), prostate TB (n = 1), TB arthritis (n = 2), TB pericarditis (n = 2), TB spondylitis (n = 5).

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