Insulin as Monotherapy and in Combination with Other Glucose-Lowering Drugs Is Related to Increased Risk of Diagnosis of Pneumonia: A Longitudinal Assessment over Two Years

Abstract

Objective: Patients with type 2 diabetes mellitus (T2DM) are at an increased risk of developing infectious diseases such as pneumonia. Hitherto, there has been uncertainty as to whether there is a relationship between different antidiabetic drug combinations and development of pneumonia in this specific cohort. Research Design and Methods: In this longitudinal retrospective study we used multiple logistic regression analysis to assess the odds ratios (ORs) of pneumonia during an observational period of 2 years in 31,397 patients with T2DM under previously prescribed stable antidiabetic drug combinations over a duration of 4 years in comparison to 6568 T2DM patients without drug therapy over 4 years adjusted for age, sex and hospitalization duration. Results: Of the 37,965 patients with T2DM, 3720 patients underwent stable monotherapy treatment with insulin (mean age: 66.57 ± 9.72 years), 2939 individuals (mean age: 70.62 ± 8.95 y) received stable statin and insulin therapy, and 1596 patients were treated with a stable combination therapy of metformin, insulin and statins (mean age: 68.27 ± 8.86 y). In comparison to the control group without antidiabetic drugs (mean age: 72.83 ± 9.96 y), individuals undergoing insulin monotherapy (OR: 2.07, CI: 1.54–2.79, p < 0.001); insulin and statin combination therapy (OR: 2.24, CI: 1.68–3.00, p < 0.001); metformin, insulin and statin combination therapy (OR: 2.27, CI: 1.55–3.31, p < 0.001); statin, insulin and dipeptidyl peptidase-4 inhibitor (DPP-IV inhibitor) combination therapy (OR: 4.31, CI: 1.80–10.33, p = 0.001); as well as individuals treated with metformin and sulfonylureas (OR: 1.70, CI: 1.08–2.69, p = 0.02) were at increased risk of receiving a diagnosis of pneumonia. Conclusions: Stable monotherapy with insulin, but also in combination with other antidiabetic drugs, is related to an increased risk of being diagnosed with pneumonia during hospital stays in patients with type 2 diabetes mellitus compared to untreated controls.

Need for improving immunization status and preventive care in diabetes mellitus patients

“…The higher frequency of influenza shots in the DM population could result from more frequent visits to the general practitioner. Current literature shows that individuals with DM have a higher incidence for influenza and pneumonia and further are at higher risk for influenza-mediated and pneumonia-related morbidity and mortality [ 10 , 15 ]. Due to the higher influenza-related morbidity and mortality in individuals with diabetes mellitus the general practitioner could be more likely to suggest the annual flu shot to DM individuals.…”

“…In addition, diabetes mellitus can alter the immune system and therefore increase the risk of infections. For example, an Austrian study investigated higher risk for pneumonia in a cohort with diabetes mellitus [ 10 ]. In particular the high blood glucose levels in DM individuals alters the immune system and impairs the immune response [ 11 ].…”

Advances in the Preparation of Nanofiber Dressings by Electrospinning for Promoting Diabetic Wound Healing

“…Glucose-lowering drugs lower blood sugar by restoring the insulin inhibition of adenylyl cyclase, inhibiting the intestinal absorption of glucose, reducing hepatic glucose output, improving insulin sensitivity, increasing glucose uptake and utilization by peripheral tissues, muscle and fat, and promoting anaerobic glycolysis. Recent clinical and animal research has confirmed that combination therapy with glucose-lowering drugs can effectively modify insulin resistance, oxidative stress and inflammatory response for the effective treatment of diabetes and its complications [ 170 , 171 , 172 ]. Therefore, the loading of hypoglycemic agents into fiber dressings for diabetic trauma therapy by electrospinning technology is of great significance.…”

Low Household Income Status and Death from Pneumonia in People with Type 2 Diabetes Mellitus: A Nationwide Study

“…Previously, we reported that insulin users, compared with nonusers, experienced 2.5-fold increased hazard of all-cause mortality during a mean 7.8 years in a nationwide cohort with recently-diagnosed T2DM [ 12 ]. Leutner et al [ 13 ] also reported that stable monotherapy with insulin and insulin in combination with other antidiabetic medications were associated with increased risk of pneumonia in people with T2DM compared to untreated controls.…”