Comparison of SGLT2 and DPP4 inhibitors on clinical outcomes in COPD patients with diabetes: A nationwide cohort study

Abstract

Background

This study aimed to evaluate the association between sodium-glucose cotransporter 2 inhibitor (SGLT2i) use and the risk of exacerbation and mortality among patients with chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM).

Methods

Taiwan’s National Health Insurance Research Database was used to select the COPD patients with DM and those prescribed SGLT2i and dipeptidyl peptidase-4 inhibitor (DPP4i). To reduce the selection and confounding bias, an active comparator new user design was used in current study to estimate the SGLT2i effects. The risk of COPD exacerbation and mortality was calculated using Cox regression model.

Results

We identified 188 SGLT2i-useres and 181 DPP4i users. SGLT2i use was associated with a significantly lower risk of overall COPD exacerbation (HR, 0.69; 95% CI, 0.52–0.92). In addition, SGLT2i users demonstrated a significantly lower risk of severe acute exacerbations with Hazard ratio of 0.35 (95% CI, 0.20–0.61) than DPP4i users. However, no significant differences in mortality were observed between groups (HR, 1.51, 95% CI, 0.53–4.25).

Conclusion

SGLT2i use in COPD patients with DM was associated with reduced risks of COPD exacerbation, particularly for severe acute exacerbation compared with DPP4i. This finding suggested that SGLT2i therapy may have a protective effect against severe exacerbations in COPD management.