Exploring the impact of chronic obstructive pulmonary disease (COPD) on diabetes control in diabetes patients: a prospective observational study in general practice

Abstract

Background:Little is known about the association between COPD and diabetes control parameters.Aims:To explore the association between comorbid COPD and longitudinal glycaemic control (HbA1C) and systolic blood pressure (SBP) in a primary care cohort of diabetes patients.Methods:This is a prospective cohort study of type 2 diabetes patients in the Netherlands. In a mixed model analysis, we tested differences in the 5-year longitudinal development of HbA1C and SBP according to COPD comorbidity (present/absent). We corrected for relevant covariates. In subgroup effect analyses, we tested whether potential differences between diabetes patients with/without COPD were modified by age, sex, socio-economic status (SES) and body mass index (BMI).Results:We analysed 610 diabetes patients. A total of 63 patients (10.3%) had comorbid COPD. The presence of COPD was not significantly associated with the longitudinal development of HbA1C (P=0.54) or SBP (P=0.33), but subgroup effect analyses showed significant effect modification by SES (P<0.01) and BMI (P=0.03) on SBP. Diabetes patients without COPD had a flat SBP trend over time, with higher values in patients with a high BMI. For diabetes patients with COPD, SBP gradually increased over time in the middle- and high-SES groups, and it decreased over time in those in the low-SES group.Conclusions:The longitudinal development of HbA1C was not significantly associated with comorbid COPD in diabetes patients. The course of SBP in diabetes patients with COPD is significantly associated with SES (not BMI) in contrast to those without COPD. Comorbid COPD was associated with longitudinal diabetes control parameters, but it has complex interactions with other patient characteristics. Further research is needed.

Metabolic Determinants of Impaired Pulmonary Function in Patients with Newly Diagnosed Type 2 Diabetes Mellitus

“…In line with this finding, previous studies showed an association between prediabetes and lung function [26,27]. However, progression of lung diseases, such as COPD, may predispose to impairment of glycemic control, though not reported by all studies [28]. Likewise, in a metabolically healthy population, an increase in HbA 1c within the normal range was associated with a decline in pulmonary function [29].…”

The Effect of Comorbidity on Glycemic Control and Systolic Blood Pressure in Type 2 Diabetes: A Cohort Study with 5 Year Follow-Up in Primary Care

“…Other studies already highlighted SES as an important patient characteristic in comorbidity [ 6 ] and in diabetes research [ 16 ] but little has been reported on its role as effect modifier as described here. Further subgroup effect analysis from our own data showed that SES also modifies the effect of long-term SBP control compared between diabetes patients with and without comorbid COPD [ 34 ]. The explorative design of the current study does not allow us to give possible explanations, such as patients’ delay (to visit a doctor) or greater ability for long term risk factor control among specific SES groups.…”

“…This paper describes the main results from a larger research project, studying the effects of a number of comorbid diseases on long-term diabetes control parameters. Description of the effects of some specific types of comorbidity on diabetes control parameters in complex interaction models fell beyond the scope of the current paper and will be reported separately [ 34 ].…”

Relationship between pulmonary function and elevated glycated hemoglobin levels in health checkups: A cross-sectional observational study in Japanese participants

“…This was surprising because previous studies have indicated that the prevalence of DM and COPD comorbidity in patients with high glucose (as indicated by elevated FPG and HbA 1c ) was >10% and that these patients had significantly reduced pulmonary function. 28 , 29 , 30 …”