α-Glucosidase Inhibitor Can Effectively Inhibit the Risk of Tuberculosis in Patients with Diabetes: A Nested Case-Control Study

Abstract

Diabetes mellitus (DM) and tuberculosis (TB) are major public health and economic burdens. DM increases Mycobacterium tuberculosis (M.tb) infection rates and treatment durations. This study evaluated the relationship between five classes of oral DM medications and TB infection risk in DM patients. We used longitudinal records from the Taiwan Longitudinal Health Insurance Research Database. DM patients were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 250 and A code A181. TB patients were identified using ICD-9-CM code 010.x-017.x. Oral DM medications were divided into five classes: sulfonylureas, biguanides, meglitinides, α-glucosidase inhibitors (AGIs), and thiazolidinediones. Users were classified as nonusers, low-concentration users, and high-concentration users. The incidence rate ratio (IRR) was derived using multivariate Poisson regression to calculate the relative risk of TB infection. DM patients using low- and high-concentration AGIs had significantly lower TB infection risks compared with nonusers. The IRRs of the sulfonylureas and AGI users were [CI] 0.693-0.948) and (95% CI 0.651-0.995), respectively. The other four classes of medications exhibited no significant effect on TB infection risk in DM patients. Furthermore, DM patients using high-concentration AGIs had a significantly lower TB infection risk compared with those using low-concentration AGIs (IRR 0.918, 95% CI: 0.854-0.987). We noted a dose-response relationship in the effects of DM medications on TB risk. Accordingly, we suggest that DM patients use AGIs to benefit from their protective effect on TB infection risk.

Figure 1

Flow chart of participant selection.

Figure 2

Poisson regression model. (a) Adjusted for meglitinides, biguanides, α-glucosidase inhibitor, TZDs, sex, age, urbanization level, length of hospital stay, low income, and comorbidity. (b) Adjusted for sulfonylureas, biguanides, α-glucosidase inhibitor, TZDs, sex, age, urbanization level, length of hospital stay, low income, and comorbidity. (c) Adjusted for sulfonylureas, meglitinides, α-glucosidase inhibitor, TZDs, sex, age, urbanization level, length of hospital stay, low income, and comorbidity. (d) Adjusted for sulfonylureas, meglitinides, biguanides, TZDs, sex, age, urbanization level, length of hospital stay, low income, and comorbidity. (e) Adjusted for sulfonylureas, meglitinides, biguanides, α-glucosidase inhibitor, sex, age, urbanization level, length of hospital stay, low income, and comorbidity.