Association of GLP-1 Receptor Agonists with Chronic Obstructive Pulmonary Disease Exacerbations among Patients with Type 2 Diabetes

Aug 30, 2023American journal of respiratory and critical care medicine

Links between diabetes drugs that activate GLP-1 receptors and flare-ups of chronic lung disease in people with type 2 diabetes

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Abstract

1,642 patients with COPD were analyzed to compare exacerbation rates among different diabetes treatments.

GLP-1 receptor agonist (GLP-1RA) users had lower unadjusted COPD exacerbation counts.
DPP-4 inhibitors were associated with a 48% higher rate of exacerbations compared to GLP-1RAs.
Sulfonylurea users experienced a 109% higher exacerbation rate than GLP-1RA users.
GLP-1RA use was linked to a significantly reduced risk of severe exacerbations compared to DPP-4 inhibitors and sulfonylureas.
Moderate exacerbation risk was lower in GLP-1RA users compared to DPP-4 inhibitor users after adjusting for clinical factors.
No significant difference in exacerbation outcomes was found between GLP-1RA and SGLT2 inhibitor users.

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Patients with chronic obstructive pulmonary disease (COPD) and type 2 diabetes (T2D) have worse clinical outcomes compared with patients without metabolic dysregulation. GLP-1 (glucagon-like peptide 1) receptor agonists (GLP-1RAs) reduce asthma exacerbation risk and improve FVC in patients with COPD.To determine whether GLP-1RA use is associated with reduced COPD exacerbation rates, and severe and moderate exacerbation risk, compared with other T2D therapies.A retrospective, observational, electronic health records-based study was conducted using an active comparator, new-user design of 1,642 patients with COPD in a U.S. health system from 2012 to 2022. The COPD cohort was identified using a previously validated machine learning algorithm that includes a natural language processing tool. Exposures were defined as prescriptions for GLP-1RAs (reference group), DPP-4 (dipeptidyl peptidase 4) inhibitors (DPP-4is), SGLT2 (sodium-glucose cotransporter 2) inhibitors, or sulfonylureas.Unadjusted COPD exacerbation counts were lower in GLP-1RA users. Adjusted exacerbation rates were significantly higher in DPP-4i (incidence rate ratio, 1.48 [95% confidence interval, 1.08-2.04]; = 0.02) and sulfonylurea (incidence rate ratio, 2.09 [95% confidence interval, 1.62-2.69]; < 0.0001) users compared with GLP-1RA users. GLP-1RA use was also associated with significantly reduced risk of severe exacerbations compared with DPP-4i and sulfonylurea use, and of moderate exacerbations compared with sulfonylurea use. After adjustment for clinical covariates, moderate exacerbation risk was also lower in GLP-1RA users compared with DPP-4i users. No statistically significant difference in exacerbation outcomes was seen between GLP-1RA and SGLT2 inhibitor users.Prospective studies of COPD exacerbations in patients with comorbid T2D are warranted. Additional research may elucidate the mechanisms underlying these observed associations with T2D medications. Rationale: Objectives: Methods: Measurements and Main Results: Conclusions: P P

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Association of GLP-1 Receptor Agonists with Chronic Obstructive Pulmonary Disease Exacerbations among Patients with Type 2 Diabetes

Abstract

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