reduced risk by 39% in patients with Type 2 diabetes.
Seven studies with 449,530 participants were analyzed for the effects of SGLT-2 inhibitors on COPD exacerbations in individuals with Type 2 diabetes.
The pooled analysis indicated a reduced risk of COPD exacerbations with SGLT-2 inhibitors, demonstrating a hazard ratio of 0.609.
Bayesian analysis corroborated a 31% reduction in exacerbation risk with a hazard ratio of 0.64.
Subgroup analyses revealed SGLT-2 inhibitors were more effective than DPP-4 inhibitors and sulfonylureas in reducing exacerbations.
No significant reduction in severe COPD exacerbations was observed, with a hazard ratio of 0.676.
High heterogeneity among studies was noted, but sensitivity analyses confirmed the robustness of the findings.
Simplified
BACKGROUND: Chronic obstructive pulmonary disease (COPD) and Type 2 diabetes mellitus (T2DM) frequently coexist, amplifying morbidity, mortality, and healthcare costs. COPD exacerbations are more frequent and severe in T2DM patients, necessitating therapies addressing both conditions. This systematic review and meta-analysis evaluates the impact of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) on COPD exacerbations in T2DM patients.
METHODS: Following PRISMA guidelines, we searched PubMed, Embase, and Web of Science until March 2025 for studies assessing SGLT-2i effects on COPD exacerbations in T2DM. Eligible studies included adults with T2DM-COPD overlap, reporting exacerbation outcomes. A random-effects meta-analysis and Bayesian hierarchical models were employed, with sensitivity and subgroup analyses.
RESULTS: Seven studies (449,530 participants) were included. SGLT-2i use reduced risk by 39% (pooled HR: 0.609, 95% CI: 0.431-0.858), with Bayesian analysis supporting a 31% reduction (HR: 0.64, 95% CrI: 0.40-0.88). Subgroup analyses showed superior efficacy vs DPP-4 inhibitors (HR: 0.618, 95% CI: 0.462-0.827) and sulfonylureas (HR: 0.620, 95% CI: 0.526-0.731), and modest benefit over GLP-1RAs (HR: 0.940, 95% CI: 0.890-0.992). Severe exacerbation reduction was non-significant (HR: 0.676, 95% CI: 0.340-1.344). Heterogeneity was high (I ≥ 97.9%), but sensitivity analyses confirmed robustness. 2
CONCLUSIONS: significantly reduce COPD exacerbations in T2DM patients, offering dual cardiometabolic and respiratory benefits. Their superiority over other antidiabetic agents supports prioritization in high-risk T2DM-COPD populations. Further trials are needed to validate effects on severe exacerbations and elucidate mechanisms.
Key numbers
39%
Reduction in Risk
Pooled hazard ratio for COPD exacerbations in T2DM patients using .
0.618
Pooled Hazard Ratio vs. DPP-4 Inhibitors
Hazard ratio comparing to DPP-4 inhibitors for COPD exacerbations.
0.620
Pooled Hazard Ratio vs. Sulfonylureas
Hazard ratio comparing to sulfonylureas for COPD exacerbations.
Full Text
We can’t show the full text here under this license.
The authors declare no conflict of interest. Approval of the research protocol: N/A. Informed consent: N/A. Registry and the registration no. of the study/trial: N/A (This is a review article and does not involve a clinical trial or study requiring registry). Animal Studies: N/A.
