Metformin Use in Type 2 Diabetes Mellitus Tuberculosis Co-infection and the Risk of Lactic Acidosis: A Case Risk-Study

Abstract

Metformin (MET) has possibilities to be utilized as an adjunct of TB therapy in controlling the growth of Mycobacterium tuberculosis (Mtb). MET enhances the production of mitochondrial reactive oxygen species and facilitates phagosome-lysosome fusion, those mechanism are important in Mtb elimination. Moreover, MET associated lactic acidosis (MALA) needs to be considered and the incidence of MALA in patients with type 2 DM-TB co-infection remains unknown. This result contributes much to our understanding about the clinical effect of MET use in type 2 DM-TB co-infection. An observational clinical study was done in type 2 DM newly TB co-infection outpatients at Surabaya Paru Hospital. Patients were divided into two groups. First group was MET group, whom was given MET accompanying insulin and TB treatment regimens, the golden standard therapy of DM-TB co-infection. MET therapy was given for at least 2 months. Second group was non MET group, were given insulin and TB treatment regimens. The lactate levels in both group were measured after 2 months. From 42 participants, there was no case of lactic acidosis during this study period. Data was normal distribution, thus we continued analysis the difference using paired t-test with 95% confidence. There was no difference in lactate levels (p=0.396) after MET therapy compared to non MET group. In this study, there is no evidence that MET therapy is induced lactic acidosis event nor increased of lactate blood level. Thus we concluded that MET use in type 2 DM-TB co-infection not induced lactic acidosis.