Diabetes Drugs May Help Lower COPD Flare-Up Risk, Study Finds

Diabetes Drugs May Help Lower COPD Flare-Up Risk, Study Finds

Certain glucose-lowering medications were associated with fewer moderate or severe COPD exacerbations in adults with type 2 diabetes

A current oneJAMA INTERNAL MEDICINEThe study conducted a comparative study to understand which glucose-lowering medications were associated with the risk of moderate or severe COPD exacerbations in adults with T2D.

background

Individuals with T2D and COPD experience higher medical cost burdens due to the greater likelihood of longer hospital stays and serious complications such as respiratory failure and sepsis. Most patients diagnosed with T2D are treated with glucose-lowering medications such as SGLT-2Is, GLP-1RAS, and DPP-4IS. It is important to understand how these medications affect people with COPD.

Many observational studies have shown that glucose-lowering medications improve lung functions, especially in patients with COPD. For example, SGLT-2Is treatment reduced COPD exacerbations, DPP-4Is reduced bronchial hyperresponsiveness, and GLP-1RAS improved obsessive vital capacity. However, these observational studies were limited by small sample size, unadjusted confounders (e.g., body mass index), and exclusion with moderate exacerbations.

Given that patients with COPD and T2D worldwide are at higher risk of morbidity and mortality, it is important to understand the precise impact of glucose-lowering medications on this group of patients.

About the study

The US population-based cohort study, based on the target study emulation framework, evaluated the association of SGLT-2Is, GLP-1RAS and DPP-4Is with COPD worsening risks. All relevant data were obtained from various medical databases, including IBM Health MarketScan research database, Optum Didentified Clinformatics Data Mart database, and Medicare for service claims data.

A target experiment was designed for pairwise comparisons of SGLT-2IS versus DPP-4IS, GLP-1RAS versus DPP-4IS, and SGLT2IS versus GLP-1RAS. Participants diagnosed with T2D and active COPD were recruited. In addition, they were required to be continuously enrolled in their health plans for at least 365 days, with a 30-day gap allowed. Pregnant individuals, younger than 40 years of age, and patients with end-stage renal disease were excluded.

The primary outcome assessed in this study was moderate COPD exacerbation and the secondary outcome was severe COPD. Individuals with moderate COPD had an oral glucocorticoid prescription with a 5- to 14-day supply, no hospitalization, and only clinic visits as outpatients. People with severe COPD require more intensive treatment and hospital care.

Study results

This study included a total of 143,696 patients for SGLT-2I vs. DPP-4I, 146,795 patients for GLP-1RA vs. DPP-4I, and 103,356 patients for SGLT-2I vs. GLP-1RA target study emulation groups. Using 1:1 propensity score (PS) matching based on logistic regression on 94 baseline covariates, 27,991 pairs for SGLT-2I versus DPP-4I, 32,107 pairs for GLP-1RA versus DPP-4I, and 36,218 pairs for SGLT-2I VS VS VS GLP-1RA were considered for analysis.

Each of the three cohorts showed a different pattern. For example, the GLP-1RA versus DPP-4I cohort included more women than the SGLT-2I versus DPP-4I cohort. Additionally, the SGLT-2I vs GLP-1RA cohort had more patients with sleep apnea and oxygen devices. A higher number of obese participants was found in GLP-1RA versus DPP-4I and SGLT-2I versus GLP-1RA cohorts compared to SGLT-2I versus DPP-4I.

People treated with SGLT2Is had a lower risk of moderate or severe COPD than those treated with DPP-4Is. This finding was also consistent across subgroup analyses. Greater benefit from SGLT-2Is was found in obese patients with active asthma or heart failure.

A lower incidence of intermediate COPD exacerbation outcome was found in those treated with GLP-1RA compared to those treated with DPP-4Is during intermediate follow-up. In the SGLT-2I vs GLP-1RA group analyses, treatment with SGLT-2Is was found to have slightly better primary and secondary outcomes than GLP-1RAS treatment. These observations were largely consistent across subgroup analyses.

Taken together, the current estimate found that patients treated with SGLT-2Is had a reduced risk of moderate or severe COPD exacerbations and a 29% reduction in severe exacerbations compared to patients treated with DPP-4Is. Additionally, compared to GLP-1RAS, those treated with SGLT-2Is had a 6% lower risk of moderate or severe COPD exacerbations and a 7% reduction in severe exacerbations.

Conclusions

Compared to GLP-1RAS and DPP-4IS, SGLT-2Is treatment was found to reduce the risk of moderate or severe COPD exacerbations in patients with T2D. GLP-1RAS treatment also showed favorable results but was slightly less effective than SGLT-2IS treatment. Similar clinical studies need to be conducted in the future to validate the results of the current study.

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