Nature communicationsSep 21, 2026

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

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Sep 23, 2026

Abstract

Use of glucagon-like peptide-1 receptor agonists is associated with a lower risk of tuberculosis compared to other glucose-lowering medications.

Incidence rates of tuberculosis in patients using glucagon-like peptide-1 receptor agonists are 0.68 per 1,000 person-years, significantly lower than 1.67 with sulfonylureas.
Patients on glucagon-like peptide-1 receptor agonists have a hazard ratio of 0.53 for tuberculosis compared to those on sulfonylureas.
The incidence rate for metformin users is 1.31 per 1,000 person-years, with a hazard ratio of 0.60 for glucagon-like peptide-1 receptor agonists.
Dipeptidyl peptidase-4 inhibitors show an incidence rate of 1.71 per 1,000 person-years, with a hazard ratio of 0.49 for glucagon-like peptide-1 receptor agonists.
Users of sodium-glucose cotransporter-2 inhibitors have an incidence rate of 1.02 per 1,000 person-years, with a hazard ratio of 0.82 for glucagon-like peptide-1 receptor agonists.

Simplified

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.