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This study analyzed TB risk in DM patients with and without SGLT2i use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using data from the Taiwan National Health Insurance Research Database between 2017 to 2020. DM patients treated with or without SGLT2i were identified, and propensity score (PS) matching was performed to balance baseline characteristics, including age, sex, comorbidities, and Diabetes Complications Severity Index (DCSI) between these two groups. TB incidence was assessed until December 31, 2021, and compared between groups. To consider death as a competing risk, a Cox regression model with the Fine and Gray approach was used to estimate the incidence of TB. Additionally, sensitivity analyses were conducted by excluding patients with concomitant antidiabetic medications and by redefining the exposure period based on the timing of SGLT2i initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After PS matching, 76,159 SGLT2i users and 152,318 non-users were included. The majority of enrolled patients were aged over 50\u00a0years (63.96%), with males predominant (61.92%). Over an average follow-up of 3.08\u00a0years, TB incidence was lower in SGLT2i users than in non-users (0.10% vs. 0.17%, SMD\u2009=\u20090.0192). The time to TB diagnosis was longer in SGLT2i users compared to non-users (2.56\u2009\u00b1\u20091.13 vs. 2.27\u2009\u00b1\u20090.02, SMD\u2009=\u2009-0.2853). Cox regression showed a reduced TB risk in SGLT2i users, with an adjusted hazard ratio of 0.43 (95% CI: 0.33\u20130.56). The protective effect persisted across age, gender and concomitant use of other antidiabetic drugs. A dose\u2013response relationship was observed, where patients receiving higher cumulated defined daily doses of SGLT2i exhibited progressively lower TB risk. Finally, sensitivity analyses reinforced the robustness of the findings and suggested a temporal association between SGLT2i exposure and a reduced risk of TB occurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study provides novel evidence that SGLT2i use is associated with a lower TB risk in DM patients, suggesting a potential host-directed therapeutic role warranting further investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12916-025-04460-w","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T18:10:29Z","timestamp":1763403029000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Sodium-glucose transport protein 2 inhibitor use in diabetes and its association with tuberculosis incidence"],"prefix":"10.1186","volume":"23","author":[{"given":"Chia-Jung","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuang-Ming","family":"Liao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung-Han","family":"Ho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chin-Chung","family":"Shu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,17]]},"reference":[{"key":"4460_CR1","volume-title":"Global tuberculosis report 2024","author":"World Health Organization","year":"2024","unstructured":"World Health Organization. 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