GLP-1 RAs Linked to Lower TB Risk in Type 2 Diabetes

Glucagon-like peptide-1 receptor agonist (GLP-1RA) use was associated with a lower risk of tuberculosis (TB) than four other glucose-lowering drug classes among patients with type 2 diabetes, according to a multicenter cohort study published in Nature Communications.

The retrospective analysis used TriNetX electronic health records from 143 healthcare organizations across multiple countries. It included new users of GLP-1RAs, sulfonylureas, metformin, dipeptidyl peptidase-4 (DPP-4) inhibitors, or sodium-glucose cotransporter-2 (SGLT2) inhibitors from 2017 through 2025. Patients were matched 1:1 by propensity score, and incident TB was assessed over as long as 5 years. Each matched comparison included more than 350,000 patients per group.

TB incidence rates per 1,000 person-years were lower with GLP-1RAs than with sulfonylureas (0.68 vs 1.67; hazard ratio [HR], 0.53; 95% CI, 0.47-0.59), metformin (0.65 vs 1.31; HR, 0.60; 95% CI, 0.51-0.70), DPP-4 inhibitors (0.73 vs 1.71; HR, 0.49; 95% CI, 0.43-0.56), and SGLT2 inhibitors (0.89 vs 1.02; HR, 0.82; 95% CI, 0.72-0.92).

The lower-risk associations persisted across all four comparisons in an exposure-restricted sensitivity analysis. In a US-only analysis, however, the association remained statistically significant versus sulfonylureas, metformin, and DPP-4 inhibitors but was attenuated and not significant versus SGLT2 inhibitors (HR, 0.94; 95% CI, 0.83-1.06).

The authors noted that the database lacked TB contact history, latent infection status, radiographic findings, disease severity, medication dosage, and adherence data, and residual socioeconomic, geographic, and time-related confounding could not be excluded. One exposure-restricted sensitivity analysis also introduced immortal time bias. The investigators called for mechanistic studies and prospective clinical research to validate the findings.

Source: Liao KM, Wu JY, Lai CC. Glucagon-like peptide-1 receptor agonists and risk of tuberculosis in type 2 diabetes. Nat Commun. Published online August 22, 2026. doi:10.1038/s41467-026-77068-0