We conducted a retrospective cohort study among individuals with rifampicin-resistant tuberculosis and diabetes to determine the association between metformin use and tuberculosis treatment outcomes. We found that individuals with metformin use had a significantly lower risk of poor tuberculosis treatment outcomes (adjusted RR=0.25, 95%CI 0.06 – 0.95) compared to those without.

The authors have declared no competing interest.

This work was supported in part by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health [R03AI133172, R03AI139871], Fogarty International Center (FIC) [D43TW007124, R21TW011157] as well as grant from the Emory Global Health Institute. ADS was supported by a Vanderbilt Emory Cornell Duke (VECD) Global Health Fellowship, funded by the FIC of the NIH [D43TW009337]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study was submitted to, reviewed, and approved by the Institutional Review Boards (IRBs) at Georgia State University and Emory University, Atlanta, USA and the ethics committee at National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia (FWA00020831). Waiver of informed consent was obtained from IRBs and ethics committee listed above as no human interactions occurred during the study process.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data that support the findings were collected for surveillance and treatment monitoring purposes; thus only accessible to investigators upon request to Georgia's National TB Program and Statistics Office. Individuals included in this cohort did not give written consent for their data to be shared publicly, and since the full data contain sensitive information including individuals' private health information (e.g., name and date of birth for matching purposes), the full dataset are not made publicly available. However, de-identified individual data, will be made available upon request to corresponding authors (ADS).