Glucagon-like Peptide-1 Receptor Agonists and Risk of Tuberculosis in Type 2 Diabetes

Tuberculosis remains a leading cause of illness and death worldwide, and individuals with type 2 diabetes have an increased risk of developing this infection. However, whether different glucose-lowering medications influence this risk is unclear. Here we show that use of glucagon-like peptide-1 receptor agonists is associated with a lower risk of tuberculosis compared with several commonly prescribed alternatives. We conducted a multicenter cohort study using TriNetX electronic health records from 143 healthcare organizations across multiple countries between 2017-2025. Patients receiving glucagon-like peptide-1 receptor agonists were compared with those receiving sulfonylureas, metformin, dipeptidyl peptidase-4 inhibitors, or sodium-glucose cotransporter-2 inhibitors. Propensity score matching and time-to-event analyses were applied over up to 5 years of follow-up. Use of glucagon-like peptide-1 receptor agonists is consistently associated with reduced tuberculosis risk compared with other agents. Incidence rates per 1,000 person-years ae lower than with sulfonylureas (0.68 vs 1.67; hazard ratio 0.53, 95% confidence interval 0.47-0.59), metformin (0.65 vs 1.31; 0.60, 0.51-0.70), dipeptidyl peptidase-4 inhibitors (0.73 vs 1.71; 0.49, 0.43-0.56) and sodium-glucose cotransporter-2 inhibitors (0.89 vs 1.02; 0.82, 0.72-0.92). These findings suggest that this class of medications may provide additional protection against tuberculosis in patients with type 2 diabetes.