A recent study analyzed the impact of glucose-lowering medications on COPD exacerbations in patients with type 2 diabetes, focusing on SGLT-2, GLP-1RA, and DPP-4i.

Using data from three U.S. insurance claims databases, SGLT-2is were compared with DPP-4is, GLP-1RAs with DPP-4is, and SGLT-2is with GLP-1RAs, noted investigators in JAMA Internal Medicine. The primary outcome was the first occurrence of a moderate or severe COPD exacerbation, defined as a filled prescription for oral glucocorticoids associated with an outpatient visit or hospitalization.

In the SGLT-2i versus DPP-4i comparison, 27,991 matched pairs were analyzed. SGLT-2i use was associated with 9.26 COPD exacerbations per 100 PYs, compared to 11.4 for DPP-4i users.

For the GLP-1RA versus DPP-4i comparison, 32,107 matched pairs were studied. GLP-1RA initiators had an incidence rate of 9.89 per 100 person-years, while DPP-4i initiators had a rate of 11.49 per 100 person-years. 

In the SGLT-2i versus GLP-1RA analysis, which included 36,218 matched pairs, the incidence rates were 9.47 per 100 person-years for SGLT-2i initiators and 10 per 100 person-years for GLP-1RA initiators. 

"These findings suggest that SGLT-2is and GLP-1RAs may be preferable to DPP-4is when deciding among glucose-lowering medications for patients with T2D and active COPD," said Avik Ray, M.D. of the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston. "However, given the observational nature of the study, there is potential for residual or unmeasured confounding, and findings from similar clinical studies and clinical trials will help corroborate these results."

The authors declared no competing interests.