Diabetes risks and outcomes in chronic obstructive pulmonary disease patients: Two nationwide population-based retrospective cohort studies

Abstract

ObjectiveThe relationship between chronic obstructive pulmonary disease (COPD) and diabetes remains incompletely understood. This study evaluated diabetes risk and post-diabetes outcomes in COPD patients with and without exacerbations.MethodsWe identified 4671 adults newly diagnosed with COPD exacerbations and 9342 adults newly diagnosed with COPD without exacerbations during 2000–2008 using Taiwan’s National Health Insurance Research Database. A comparison cohort of 18684 adults without COPD, matched by age and sex, was randomly selected from the same dataset for the control group. Diabetes events during 2000–2013 were ascertained from medical claims during the follow-up period. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of diabetes associated with COPD with or without exacerbations were calculated. We conducted another nested cohort study of 395516 patients with diabetes hospitalization during 2002–2013 and calculated adjusted odds ratios (ORs) and 95% CIs of histories of COPD and COPD exacerbations associated with adverse events after diabetes admission.ResultsDuring the follow-up period, the incidences of diabetes for patients without COPD and for patients with COPD without or with exacerbations were 3.4, 4.1 and 7.4 per 1000 person-years, respectively (P < 0.0001). Increased risk of diabetes for patients with COPD without exacerbations (HR 1.09, 95% CI 1.02–1.17) and COPD with exacerbations (HR 2.18, 95% CI 1.88–2.52) was noted. Post-diabetes pneumonia (OR 3.28, 95% CI 3.13–3.43), intensive care admission (OR 1.32, 95% CI 1.26–1.39) and mortality (OR 2.06, 95% CI 1.88–2.25) were associated with COPD exacerbations.ConclusionPrevention and intervention strategies for diabetes and post-diabetes outcomes are needed for this susceptible population.

Analysis of curative effect of adjuvant therapy with bronchoalveolar lavage on COPD patients complicated with pneumonia

“…The results showed that bronchoalveolar lavage could effectively improve the lung function and increase the pulmonary ventilation of COPD patients complicated with pneumonia. Lung function is a necessary condition for the diagnosis of COPD, in which FEV1/FVC and other indexes can determine whether the airflow is obstructed, so the detection of lung function is an important means of evaluating the treatment effect on COPD ( 13 , 14 ). Studies have found that bronchoalveolar lavage can effectively remove the lung mucus and reduce the lung and airway resistance ( 15 , 16 ).…”

<p>Do Benefits Outweigh Risks for Corticosteroid Therapy in Acute Exacerbation of Chronic Obstructive Pulmonary Disease in People with Diabetes Mellitus?</p>

“…In a large retrospective cohort study comparing 9,342 patients with COPD without exacerbations and 4,671 patients with newly diagnosed AECOPD, it was found that the incidence of DM was higher in those patients who suffer exacerbations compared to those with stable COPD during the follow-up years. 48 It is difficult to draw firm conclusions from this association; however, the increased incidence of diabetes could be attributed, at least in part, to the shared phenotype theory and the frequent courses of oral high-dose corticosteroids given at each episode of AECOPD. Similar observations were reported with inhaled corticosteroids in a cohort study involving 388,584 patients with respiratory diseases, where inhaled corticosteroids were associated with 34% increased risk of development of DM and worsening of pre-existing diabetes, necessitating insulin therapy.…”

Diabetes Mellitus and Chronic Obstructive Pulmonary Disease: An Overview

“…T2DM in COPD patients T2DM may co-exist with COPD [15,16]. Indeed, patients with COPD have an increased risk of developing T2DM compared with controls [17][18][19].…”

“…High doses of corticosteroids have been associated with an increased rate of DM-related hospitalisations [26]. The presence of COPD may also raise the risk for admission to intensive care, longer hospital stays and higher mortality post-discharge in DM-related hospitalisations [15]. These negative effects of COPD in DM patients may be attributed, at least partly, to increased systemic inflammation and oxidative stress.…”