GLP-1 MEDICATION may be associated with a reduced risk of tuberculosis (TB) among people with type 2 diabetes, according to a new study.
The findings of the international research suggest that GLP-1RAs could have benefits extending beyond glucose control and weight management for patients with Type 2 diabetes, who are at increased risk of developing TB.
Researchers conducted a multicentre cohort study using electronic health records from the TriNetX network, including data from 143 healthcare organisations across multiple countries between 2017 and 2025.
Patients with Type 2 diabetes receiving GLP-1RAs were compared with those receiving four commonly prescribed alternatives: sulfonylureas, metformin, dipeptidyl peptidase-4 (DPP-4) inhibitors, and sodium-glucose cotransporter-2 (SGLT2) inhibitors.
Propensity score matching was used to balance measured characteristics between treatment groups, including age, sex, race, BMI, HbA1c, socioeconomic and lifestyle proxy variables, comorbidities, and relevant medications and patients were followed for up to 5 years.
Researchers found that the use of GLP-1RA medications was consistently associated with lower TB incidence across all four comparisons.
Compared with sulfonylureas, TB incidence was 0.68 versus 1.67 cases per 1,000 person-years, corresponding to a 47% lower risk among GLP-1RA users. Compared with metformin, incidence was 0.65 versus 1.31 cases per 1,000 person-years, representing a 40% lower risk.
A smaller but significant association was also observed compared with SGLT2 inhibitors, with rates of 0.89 and 1.02 cases per 1,000 person-years, respectively, representing an 18% lower risk in total.
The largest difference, however, was observed when GLP-1RAs were compared with DPP-4 inhibitors. TB incidence was 0.73 versus 1.71 cases per 1,000 person-years, corresponding to a 51% reduction in risk of developing TB.
Type 2 diabetes is recognised as an important risk factor for TB, with metabolic dysfunction and hyperglycaemia potentially impairing immune responses to Mycobacterium tuberculosis.
The researchers suggest that the same metabolic and anti-inflammatory effects associated with GLP-1RAs that contribute to cardiovascular and renal protection could potentially influence susceptibility to infection, although the mechanisms remain unclear.
However, the study was observational, meaning a causal relationship between GLP-1RA treatment and reduced TB risk cannot be established. Despite propensity score matching, unmeasured differences between patients receiving different treatments may have influenced the results.
The authors also acknowledged potential geographic and time-related confounding, highlighting the need for prospective clinical studies and further investigation into the mechanisms that could underpin the observed association.
Overall, the findings raise the possibility that GLP-1RAs may provide additional protection against TB in people with type 2 diabetes, alongside their already established metabolic benefits.
Reference
Liao KM, Wu JY, Lai CC. Glucagon-like Peptide-1 Receptor Agonists and Risk of Tuberculosis in Type 2 Diabetes. Nature Communications. 2026.
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