Association of Glucagon-like Peptide-1 Receptor Agonists Versus Dipeptidyl Peptidase-4 Inhibitors with Tuberculosis and Mortality in Adults with Diabetes
5 affiliations
- 1Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
- 2Doctoral Program of Clinical and Experimental Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung 804201, Taiwan
- 3Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
- 4School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung 804201, Taiwan
- 5Cancer Center, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
Abstract
Diabetes is associated with an increased risk of tuberculosis (TB), but whether the class of glucose-lowering therapy is associated with TB outcomes remains uncertain. We conducted a retrospective observational cohort study to examine the association between glucagon-like peptide-1 receptor agonist (GLP-1 RA) use versus dipeptidyl peptidase-4 inhibitor (DPP-4i) use and the risk of TB and mortality. We used de-identified records from the TriNetX Global Collaborative Network. Adults with diabetes who had a qualifying record for either a GLP-1 RA or a DPP-4i between 2016 and 2024 were eligible. Cohort entry was defined as the first qualifying drug-class record during this period. Patients with prior-year use of the comparator drug class, a history of TB, or death before cohort entry were excluded. Propensity score matching was performed at a 1:1 ratio. Outcomes assessed during days 1–365 included TB (ICD-10-CM A15–A19), the platform-defined death outcome, and a composite outcome of gastrointestinal and hepatobiliary diagnoses. After matching, 466,903 patients remained in each group. GLP-1 RA exposure was associated with fewer recorded TB events, deaths, and gastrointestinal/hepatobiliary events than DPP-4i exposure during the first year after cohort entry. TB was recorded in 155 GLP-1 RA users and 320 DPP-4i users (HR, 0.472; 95% CI, 0.390–0.572). The corresponding numbers for the platform-defined death outcome were 7575 and 14,572 (HR, 0.505; 95% CI, 0.492–0.520), and those for gastrointestinal/hepatobiliary diagnoses were 15,914 and 20,559 (HR, 0.750; 95% CI, 0.735–0.766). The analysis restricted to patients with type 2 diabetes (ICD-10-CM E11) yielded a similar association for TB. Residual imbalance in body mass index (BMI) and residual confounding, including confounding by indication, limit a causal interpretation.
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BibTeX
@article{hsu2026association,
title = {{Association of Glucagon-like Peptide-1 Receptor Agonists Versus Dipeptidyl Peptidase-4 Inhibitors with Tuberculosis and Mortality in Adults with Diabetes}},
author = {Chun-Hsiang Hsu and Renin Chang and Chiu-Fan Chen and Kuo-An Chu and You-Cheng Jiang and Wei-Cheng Hong and I-Yuan Chen and Min-Hsi Lin},
journal = {International Journal of Molecular Sciences},
year = {2026},
month = oct,
doi = {10.3390/ijms27209137},
url = {https://www.mdpi.com/1422-0067/27/20/9137},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association of Glucagon-like Peptide-1 Receptor Agonists Versus Dipeptidyl Peptidase-4 Inhibitors with Tuberculosis and Mortality in Adults with Diabetes
AU - Chun-Hsiang Hsu
AU - Renin Chang
AU - Chiu-Fan Chen
AU - Kuo-An Chu
AU - You-Cheng Jiang
AU - Wei-Cheng Hong
AU - I-Yuan Chen
AU - Min-Hsi Lin
PY - 2026
DA - 2026/10/01
JO - International Journal of Molecular Sciences
DO - 10.3390/ijms27209137
UR - https://www.mdpi.com/1422-0067/27/20/9137
AB - Diabetes is associated with an increased risk of tuberculosis (TB), but whether the class of glucose-lowering therapy is associated with TB outcomes remains uncertain. We conducted a retrospective observational cohort study to examine the association between glucagon-like peptide-1 receptor agonist (GLP-1 RA) use versus dipeptidyl peptidase-4 inhibitor (DPP-4i) use and the risk of TB and mortality. We used de-identified records from the TriNetX Global Collaborative Network. Adults with diabetes who had a qualifying record for either a GLP-1 RA or a DPP-4i between 2016 and 2024 were eligible. Cohort entry was defined as the first qualifying drug-class record during this period. Patients with prior-year use of the comparator drug class, a history of TB, or death before cohort entry were excluded. Propensity score matching was performed at a 1:1 ratio. Outcomes assessed during days 1–365 included TB (ICD-10-CM A15–A19), the platform-defined death outcome, and a composite outcome of gastrointestinal and hepatobiliary diagnoses. After matching, 466,903 patients remained in each group. GLP-1 RA exposure was associated with fewer recorded TB events, deaths, and gastrointestinal/hepatobiliary events than DPP-4i exposure during the first year after cohort entry. TB was recorded in 155 GLP-1 RA users and 320 DPP-4i users (HR, 0.472; 95% CI, 0.390–0.572). The corresponding numbers for the platform-defined death outcome were 7575 and 14,572 (HR, 0.505; 95% CI, 0.492–0.520), and those for gastrointestinal/hepatobiliary diagnoses were 15,914 and 20,559 (HR, 0.750; 95% CI, 0.735–0.766). The analysis restricted to patients with type 2 diabetes (ICD-10-CM E11) yielded a similar association for TB. Residual imbalance in body mass index (BMI) and residual confounding, including confounding by indication, limit a causal interpretation.
SN - 1422-0067
ER -