GLP-1 Drugs Linked to Lower Risk of Tuberculosis and Severe Infections: Study
Taiwan: Recent studies suggest that GLP-1 receptor agonists may provide infection-related benefits in people with type 2 diabetes. In an international cohort, GLP-1 users had an 18%–51% lower risk of developing active tuberculosis (TB) compared with patients taking DPP-4 inhibitors, sulfonylureas, metformin, or SGLT2 inhibitors.
A separate real-world study found that patients treated with tirzepatide had lower risks of infection-related hospitalization and death. These findings suggest that GLP-1–based therapies may have potential benefits beyond glucose and weight control, although further research is needed to establish causality and underlying mechanisms.
A new multicenter cohort study published in Nature Communications by Kuang-Ming Liao, Department of Internal Medicine, Chi Mei Hospital, Chiali, Taiwan, and colleagues, further examined the relationship between GLP-1 receptor agonist use and TB risk among people with type 2 diabetes.
TB remains a major global health concern, while type 2 diabetes is recognized as an important risk factor for developing active TB. However, whether the choice of glucose-lowering medication affects this risk remains uncertain.
For the study, researchers analyzed electronic health records from TriNetX, covering 143 healthcare organizations across multiple countries, between 2017 and 2025. Patients receiving GLP-1 receptor agonists were compared with individuals treated with sulfonylureas, metformin, DPP-4 inhibitors, or SGLT2 inhibitors.
Researchers used propensity-score matching to create comparable treatment groups and conducted time-to-event analyses during follow-up periods extending to 5 years. The primary focus was the incidence of TB among patients receiving GLP-1 receptor agonists compared with those using other commonly prescribed diabetes medications.
The key findings were as follows:
- GLP-1 receptor agonist users consistently had a lower incidence of tuberculosis (TB) than patients receiving other commonly used glucose-lowering medications.
- Compared with sulfonylureas, TB incidence was 0.68 vs 1.67 cases per 1,000 person-years, indicating a 47% lower risk with GLP-1 receptor agonists (HR, 0.53).
- Compared with metformin, TB incidence was 0.65 vs 1.31 cases per 1,000 person-years (HR, 0.60).
- Compared with DPP-4 inhibitors, TB incidence was 0.73 vs 1.71 cases per 1,000 person-years, corresponding to a 51% lower risk (HR, 0.49).
- Compared with SGLT2 inhibitors, TB incidence was 0.89 vs 1.02 cases per 1,000 person-years, representing an 18% lower risk (HR, 0.82).
The researchers noted that the findings demonstrate an association rather than proof that GLP-1 receptor agonists directly prevent TB. Potential biological mechanisms underlying the observed relationship require further investigation.
Overall, the study suggests that GLP-1 receptor agonist therapy may be associated with a lower risk of TB in people with type 2 diabetes compared with several widely used glucose-lowering medications. If confirmed in future research, this potential infection-related benefit could represent an additional consideration when selecting diabetes therapies.
Reference:
Liao, K. M., Wu, J. Y., & Lai, C. C. (2026). Glucagon-like Peptide-1 Receptor Agonists and Risk of Tuberculosis in Type 2 Diabetes. Nature Communications. https://doi.org/10.1038/s41467-026-77068-0
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