Glucose-Lowering Medications and Risk of Chronic Obstructive Pulmonary Disease Exacerbations in Patients With Type 2 Diabetes
Authors' conclusion
The results of this comparative effectiveness research study suggest that SGLT-2is and GLP-1RAs were associated with a reduced risk of moderate or severe COPD exacerbations compared with DPP-4i in adults with T2D and active COPD. This may inform prescribing of glucose-lowering medications among patients with T2D and active COPD.
Study context
- Population
- Patients ≥40 years with T2D and active chronic obstructive pulmonary disease (COPD); Optum Clinformatics (2013–2023), IBM MarketScan (2013–2021), Medicare fee for service (2013–2020)27,991, 32,107, 36,218 matched pairs
- Comparison
- SGLT2i vs DPP-4i, GLP-1 RA vs DPP-4i, and SGLT2i vs GLP-1 RA
- Outcome
- First moderate or severe COPD exacerbation (filled oral glucocorticoid prescription with outpatient COPD visit, or COPD hospitalization)
- Follow-up
- Median 145 (IQR, 61-355) days
Methodological details3 propensity score-matched cohorts emulating target trials, target trial emulation, 3 US insurance claims databases, Data analysis January to June 2024
- 3 propensity score-matched cohorts emulating target trials
- Target trial emulation
- 3 US insurance claims databases
- Data analysis January to June 2024
Main finding
As reported in the abstract
Moderate or severe COPD exacerbation · median 145 days
Hazard ratio (95% CI)
SGLT-2isvs DPP-4is9.26 vs 11.4 per 100 PYs
0.81(0.76–0.86)
GLP-1RAsvs DPP-4is9.89 vs 11.49 per 100 PYs
0.86(0.81–0.91)
SGLT-2isvs GLP-1RAs9.47 vs 10.00 per 100 PYs; minimal differences
0.94(0.89–1.00)
- SGLT-2is vs DPP-4is
- IRD/100 PYs −2.20 (95% CI −2.83 to −1.58)
- GLP-1RAs vs DPP-4is
- IRD/100 PYs −1.60 (95% CI −2.18 to −1.02)
- SGLT-2is vs GLP-1RAs
- IRD/100 PYs −0.55 (95% CI −1.09 to −0.01)
Further findings
- Results were consistent across sensitivity and subgroup analyses
Original publication
Glucose-Lowering Medications and Risk of Chronic Obstructive Pulmonary Disease Exacerbations in Patients With Type 2 Diabetes. JAMA Intern Med. Published 1 April 2025. doi:10.
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