Table 2.

Advantages and disadvantages of the use of insulin analogs and metformin in multidrug-resistant tuberculosis patients treated with bedaquiline/delamanid

Clinical impact	Metformin	Insulin analogs
Advantages	No interaction at the ABCB1, CYP3A4, or protein-binding site levels	No interaction at the transporter or CYP3A4 levels
		Possible interaction at the protein-binding site (detemir, degludec)
	Anti-inflammatory properties	Anti-inflammatory, vasodilatory, and antioxidant properties
	No risk of QT prolongation	No risk of QT prolongation More predictable hypoglycemic effect in severe infection compared to metformin Allowed in renal and hepatic impairment
Disadvantages	Enhanced gastrointestinal toxicity
	Unpredictable hypoglycemic effect in severe infections	Possibly increased risk of hypertensive episodes and muscle damage (glargine)
	Not allowed with renal or hepatic impairment