Effect of Anthelmintic Treatment on Insulin Resistance: A Cluster-Randomized, Placebo-Controlled Trial in Indonesia

Clin Infect Dis. 2017 Sep 1;65(5):764-771. doi: 10.1093/cid/cix416.


Background: Emerging evidence suggests that helminth infections are associated with lower insulin resistance (IR). Current deworming programs might remove this helminth-associated protective effect. Therefore, we evaluated the anthelmintic treatment effect on changes in IR.

Methods: We conducted a double-blind, household-cluster-randomized, placebo-controlled clinical trial on Flores island, Indonesia, an area endemic for soil-transmitted helminths (STHs). All subjects received 4 rounds of albendazole or matching placebo with 3-month intervals, for 3 consecutive days. The primary outcome was the change in homeostatic model assessment of IR in those aged >16 years. An intention-to-treat analysis was performed involving all subjects and ad hoc in the helminth-infected subjects.

Results: We examined 797 (in 329 households) and 872 (in 353 households) subjects, who were assigned randomly into the albendazole and placebo arms, respectively. Albendazole was associated with a significant reduction in STH prevalence, total immunoglobulin E (IgE), and eosinophil count. Whereas albendazole had no effect on IR (estimated treatment effect, 0.006 [95% confidence interval, -.010 to .021]; P = .48) at the community level, it was associated with a significant increase in IR (estimated treatment effect, 0.031 [95% confidence interval, .004 to .059]; P = .04) (P value for interaction = .01) among helminth-infected subjects as detected by microscopy. Pathway analysis suggested that this might in part be due to an increased body mass index or a reduced eosinophil count.

Conclusions: Anthelmintic treatment reduces STH prevalence, total IgE, and eosinophil count but has no effect on IR at the community level. In helminth-infected subjects, treatment significantly increases IR, highlighting the need for metabolic health monitoring with ongoing deworming programs.

Clinical trials registration: ISRCTN 75636394.

Keywords: anthelmintic; deworming; diabetes; helminths; insulin resistance.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Albendazole / adverse effects
  • Albendazole / therapeutic use
  • Anthelmintics / adverse effects*
  • Anthelmintics / therapeutic use*
  • Diabetes Mellitus
  • Female
  • Helminthiasis / drug therapy*
  • Helminthiasis / epidemiology*
  • Humans
  • Indonesia
  • Insulin Resistance*
  • Male
  • Middle Aged
  • Prevalence


  • Anthelmintics
  • Albendazole