SODIUM-GLUCOSE cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) are associated with a reduced risk of moderate or severe chronic obstructive pulmonary disease (COPD) exacerbations compared to dipeptidyl peptidase 4 inhibitors (DPP-4i) in patients with Type 2 diabetes (T2D) and active COPD. This finding highlights the potential benefits of these medications beyond glucose control, particularly for patients managing both T2D and COPD.
Recent studies have suggested that SGLT-2is, GLP-1RAs, and DPP-4is may offer benefits for patients with COPD, but clinical evidence comparing their effectiveness in reducing COPD exacerbations in patients with T2D remains limited. This study aimed to address this gap by comparing the risk of moderate or severe COPD exacerbations among these three medication classes. Using data from three US insurance claims databases the study analysed 1:1 propensity score-matched cohorts of patients aged 40 or older with T2D and active COPD who initiated treatment with SGLT-2is, GLP-1RAs, or DPP-4is.
The study included 27,991, 32,107, and 36,218 matched pairs for SGLT-2is vs DPP-4is, GLP-1RAs vs DPP-4is, and SGLT-2is vs GLP-1RAs, respectively. Over a median follow-up of 145 days, the risk of moderate or severe COPD exacerbations was significantly lower for SGLT-2is compared to DPP-4is (9.26 vs 11.4 per 100 person-years [PY]; hazard ratio [HR], 0.81; 95% CI, 0.76-0.86) and for GLP-1RAs compared to DPP-4is (9.89 vs 11.49 per 100 PYs; HR, 0.86; 95% CI, 0.81-0.91). The difference between SGLT-2is and GLP-1RAs was minimal (9.47 vs 10.00 per 100 PYs; HR, 0.94; 95% CI, 0.89-1.00). Sensitivity and subgroup analyses confirmed these findings.
These results suggest that SGLT-2is and GLP-1RAs may offer additional benefits for reducing COPD exacerbations in patients with T2D and active COPD, potentially influencing clinical prescribing practices. Future research should explore the mechanisms underlying these associations and evaluate long-term outcomes to further guide treatment decisions for this patient population.
Katheeja Imani, EMJ
Reference
Ray A et al. Glucose-Lowering Medications and Risk of Chronic Obstructive Pulmonary Disease Exacerbations in Patients With Type 2 Diabetes. JAMA Intern Med. 2025. DOI:10.1001/jamainternmed.2024.7811.
