Novel antihyperglycaemic drugs and prevention of chronic obstructive pulmonary disease exacerbations among patients with type 2 diabetes: population based cohort study

Nov 1, 2022BMJ (Clinical research ed.)

New blood sugar drugs and their link to fewer lung flare-ups in people with type 2 diabetes

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Abstract

GLP-1 receptor agonists were associated with a 30% decreased risk of severe exacerbations of chronic obstructive pulmonary disease compared to sulfonylureas.

Compared to sulfonylureas, GLP-1 receptor agonists showed a hazard ratio of 0.70 for severe exacerbations, indicating a potential protective effect.
SGLT-2 inhibitors were associated with a 38% decreased risk of severe exacerbations, with a hazard ratio of 0.62.
DPP-4 inhibitors demonstrated a modest reduction in severe exacerbation risk, but confidence intervals included the null value, indicating uncertainty.
No significant association was found between DPP-4 inhibitors and moderate exacerbations of chronic obstructive pulmonary disease.
Moderate exacerbations were not significantly affected by SGLT-2 inhibitors, with a hazard ratio close to 1.

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OBJECTIVE: To determine whether the use of glucagon-like peptide 1 (GLP-1) receptor agonists, dipeptidyl peptidase 4 (DPP-4) inhibitors, and sodium-glucose co-transporter-2 (SGLT-2) inhibitors, separately, is associated with a decreased risk of exacerbations of chronic obstructive pulmonary disease among patients with chronic obstructive pulmonary disease and type 2 diabetes.

DESIGN: Population based cohort study using an active comparator, new user design.

SETTING: The United Kingdom Clinical Practice Research Datalink linked with the Hospital Episode Statistics Admitted Patient Care and Office for National Statistics databases.

PARTICIPANTS: Three active comparator, new user cohorts of patients starting the study drugs (GLP-1 receptor agonists, DPP-4 inhibitors, or SGLT-2 inhibitors) or sulfonylureas with a history of chronic obstructive pulmonary disease. The first cohort included 1252 patients starting GLP-1 receptor agonists and 14 259 starting sulfonylureas, the second cohort included 8731 patients starting DPP-4 inhibitors and 18 204 starting sulfonylureas, and the third cohort included 2956 patients starting SGLT-2 inhibitors and 10 841 starting sulfonylureas.

MAIN OUTCOME MEASURES: Cox proportional hazards models with propensity score fine stratification weighting were fitted to estimate hazard ratios and 95% confidence intervals of severe exacerbation of chronic obstructive pulmonary disease (defined as hospital admission for chronic obstructive pulmonary disease), separately for GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT-2 inhibitors. Whether these drugs were associated with a decreased risk of moderate exacerbation (defined as a co-prescription of an oral corticosteroid and an antibiotic along with an outpatient diagnosis of acute chronic obstructive pulmonary disease exacerbation on the same day) was also assessed.

RESULTS: Compared with sulfonylureas, GLP-1 receptor agonists were associated with a 30% decreased risk of severe exacerbation (3.55.0 events per 100 person years; hazard ratio 0.70, 95% confidence interval 0.49 to 0.99) and moderate exacerbation (0.63, 0.43 to 0.94). DPP-4 inhibitors were associated with a modestly decreased incidence of severe exacerbation (4.6. 5.1 events per 100 person years; hazard ratio 0.91, 0.82 to 1.02) and moderate exacerbation (0.93, 0.82 to 1.07), with confidence intervals including the null value. Finally, SGLT-2 inhibitors were associated with a 38% decreased risk of severe exacerbation (2.43.9 events per 100 person years; hazard ratio 0.62, 0.48 to 0.81) but not moderate exacerbation (1.02, 0.83 to 1.27). v v v

CONCLUSIONS: In this population based study, GLP-1 receptor agonists and SGLT-2 inhibitors were associated with a reduced risk of severe exacerbations compared with sulfonylureas in patients with chronic obstructive pulmonary disease and type 2 diabetes. DPP-4 inhibitors were not clearly associated with a decreased risk of chronic obstructive pulmonary disease exacerbations.

Key numbers

30%

Decrease in severe exacerbation risk with GLP-1 receptor agonists

Compared to sulfonylureas in patients with COPD and type 2 diabetes.

38%

Decrease in severe exacerbation risk with SGLT-2 inhibitors

Compared to sulfonylureas in patients with COPD and type 2 diabetes.

0.91

DPP-4 inhibitors' effect on severe exacerbation risk

Hazard ratio compared to sulfonylureas.

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Novel antihyperglycaemic drugs and prevention of chronic obstructive pulmonary disease exacerbations among patients with type 2 diabetes: population based cohort study

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