Glucose-Lowering Medications Linked to Reduced COPD Exacerbation Risk

Recent research indicates that specific glucose-lowering medications may significantly lower the risk of exacerbations in patients suffering from both type 2 diabetes (T2D) and chronic obstructive pulmonary disease (COPD). A study published in JAMA Internal Medicine on February 10, 2025, highlights that sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are associated with a decreased incidence of moderate to severe COPD flare-ups when compared to dipeptidyl peptidase 4 inhibitors (DPP-4is).

Researchers from Brigham and Women's Hospital and Harvard Medical School in Boston conducted a comprehensive comparative effectiveness study involving patients aged 40 and older who had both T2D and active COPD. The study evaluated those who started treatment with SGLT-2is against those on DPP-4is, GLP-1 RAs against DPP-4is, and SGLT-2is against GLP-1 RAs, involving a total of 27,991, 32,107, and 36,218 pairs of patients, respectively.

The findings revealed that patients treated with SGLT-2is experienced a lower risk of moderate or severe COPD exacerbations compared to those treated with DPP-4is, with an incidence rate of 9.26 versus 11.4 per 100 person-years, yielding a hazard ratio of 0.81. Similarly, those on GLP-1 RAs also showed a reduced risk, with rates of 9.89 versus 11.49 per 100 person-years (hazard ratio, 0.86). Minimal differences were noted between patients treated with SGLT-2is and GLP-1 RAs, suggesting both treatment options may offer similar benefits.

The authors of the study emphasized that these results advocate for the consideration of SGLT-2is and GLP-1 RAs as preferable options over DPP-4is for managing glucose levels in patients dealing with T2D and active COPD. However, they also cautioned that the observational nature of the study could introduce potential residual or unmeasured confounding factors. Further research through similar clinical studies and trials is necessary to confirm these findings.

It is important to note that several authors of the study disclosed affiliations with the pharmaceutical industry, and one even mentioned serving as an expert witness in legal matters involving inhaler manufacturers.

For more detailed insights, refer to the original study: Avik Ray et al, Glucose-Lowering Medications and Risk of Chronic Obstructive Pulmonary Disease Exacerbations in Patients With Type 2 Diabetes, published in JAMA Internal Medicine.