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

Marupuru, Srujitha; Senapati, Padmanav; Pathadka, Swathi; Miraj, Sonal Sekhar; Unnikrishnan, Mazhuvancherry Kesavan; Manu, Mohan K

doi:10.1016/j.bjid.2017.01.001

Cited by 73 publications

(64 citation statements)

References 19 publications

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“…Recently, in a case–control study in India, Marupuru et al . showed that metformin use was associated with a 3.9‐fold reduction in TB incidence among diabetic patients . However, they did not adjust for comorbidities or diabetic complications in the TB and non‐TB groups; these factors may be associated with TB development .…”

Section: Discussionmentioning

confidence: 65%

Metformin is associated with a lower risk of active tuberculosis in patients with type 2 diabetes

Lin

et al. 2018

Respirology

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Section: Discussionmentioning

confidence: 65%

Metformin is associated with a lower risk of active tuberculosis in patients with type 2 diabetes

Lin

et al. 2018

Respirology

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“…In the study from India with 451 patients-with and without tuberculosis, receiving and not receiving metformin-the use of metformin was significantly associated with decreased risk of tuberculosis (OR = 0.92) by a factor of 4. 9 In the study from Taiwan of 2416 patients with culture confirmed, drug susceptible pulmonary tuberculosis, there was a decrease in mortality among those who were using metformin compared to those who were not using metformin (HR = 0.56, CI = 0.39-0.82). 10 Despite extensive research, the incidence of sepsis is rising.…”

Section: Human Studiesmentioning

confidence: 99%

Is metformin poised for a second career as an antimicrobial?

Malik

Mehdi

Ali

et al. 2018

Diabetes Metabolism Res

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Metformin, a widely used antihyperglycaemic, has a good safety profile, reasonably manageable side-effects, is inexpensive, and causes a desirable amount of weight loss. In 4 studies of patients with tuberculosis (1 prospective and 3 retrospective), metformin administration resulted in better outcomes. In mice with several models of endotoxemia, metformin diminished levels of proinflammatory cytokines and improved survival. Laboratory studies showed effectiveness of the drug on multiple pathogens, including Trichinella spiralis, Staphylococcus aureus, Pseudomonas aeruginosa, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus. Metformin administration in humans and mice produced major changes in the composition of the gut microbiota. These recently discovered microbe-modulating properties of the drug have led investigators to predict wide therapeutic utility for metformin. The recent easing in United States Food and Drug Administration (FDA) guidelines regarding administration of metformin to patients with kidney disease, and reduced anxiety about patient safety in terms of lactic acidosis, increase the probability of broadening of metformin's usage as a treatment of infectious agents. In this text we review articles pertinent to metformin's effects on microorganisms, both pathogens and commensals. We highlight the possible role of metformin in a wide range of infectious diseases and a possible expansion of its therapeutic profile in this field. A systematic review was done of PubMed indexed articles that examined the effects of metformin on a wide range of pathogens. Metformin was found to have efficacy as an antimicrobial agent in patients with tuberculosis. Mice infected with Trypanosomiasis cruzi had higher survival when also treated with metformin. The drug in vitro was active against T. spiralis, S. aureus, P. aeruginosa, and hepatitis B virus. In addition there is emerging literature on its role in sepsis. We conclude that metformin may have a potential role in the therapy for multiple infectious diseases. Metformin, in addition to its traditional effects on glucose metabolism, provides anti-microbial benefits in patients with tuberculosis and in a very wide range of other infections encounters in vitro and in vivo.

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“…efficacy of anti TB reduce in immunology phase, which the host body starts limit M. 36. inhibiting the production of hepatic glucose; 2) reducing intestinal glucose absorption; and 37. 3) improving glucose uptake and utilization 5,7,8 . MET is known affecting inflammation 38. mediators, both pro-inflammation, such IFN-γ, IL-β and also anti-inflammation such IL-10 39.…”

Section: Mycobacterium Tuberculosis (M Tuberculosis) Infection or Knmentioning

confidence: 99%

“…MET is known affecting inflammation 38. mediators, both pro-inflammation, such IFN-γ, IL-β and also anti-inflammation such IL-10 39. [8][9][10] . Interferon (IFN)-γ is a potent cytokine that indicates antimicrobial effect and also 40. modulates the production or activities of several cytokines and chemokines [11][12][13] …”

Section: Mycobacterium Tuberculosis (M Tuberculosis) Infection or Knmentioning

confidence: 99%

Metformin associated inflammation levels regulation in type 2 diabetes mellitus-tuberculosis coinfection patients – A case report

Novita

Soediono

Nugraha

2018

Indian Journal of Tuberculosis

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

Abstract: 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.

Cited by 73 publications

References 19 publications

Metformin is associated with a lower risk of active tuberculosis in patients with type 2 diabetes

Metformin is associated with a lower risk of active tuberculosis in patients with type 2 diabetes

Is metformin poised for a second career as an antimicrobial?

Metformin associated inflammation levels regulation in type 2 diabetes mellitus-tuberculosis coinfection patients – A case report

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