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Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-2567-7542
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The Potential of Antidiabetic Medications in the Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease in Subjects with Type 2 Diabetes Mellitus

Theodoros Panou
1   Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece (Ringgold ID: RIN112220)
,
Evanthia Gouveri
1   Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece (Ringgold ID: RIN112220)
,
Fotios Drakopanagiotakis
2   Department of Respiratory Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece (Ringgold ID: RIN112220)
,
Dimitrios Papazoglou
1   Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece (Ringgold ID: RIN112220)
,
Paschalis Steiropoulos
2   Department of Respiratory Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece (Ringgold ID: RIN112220)
,
Nikolaos Papanas 
1   Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece (Ringgold ID: RIN112220)
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Abstract

Type 2 diabetes mellitus (T2DM) is often recognised as a major comorbidity of chronic obstructive pulmonary disease (COPD) and is being increasingly linked with elevated risk of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Accordingly, the potential utility of antidiabetic medication, mostly in subjects suffering from both AECOPD and T2DM, has been investigated. The most widely studied medication is metformin. Although some studies showed no particular benefit, others assessed a diminished risk of AECOPD by up to 37% and reductions in hospitalisations, re-admissions, or the use of antibiotics and/or corticosteroids. The same holds true for sulfonylureas and thiazolidinediones. Conversely, dipeptidyl-peptidase 4 inhibitors (DPP-4is) were not associated with any benefit. Data on insulin use are scarce, but insulin in AECOPD management has been linked with adverse outcomes. The strongest effect has been shown with glucagon-like peptide 1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT-2is): the former limited severe exacerbations by 30% and the latter by 32–36%. With SGLT-2is, the incidence diminished by 46% compared with DPP-4is, while approximately three out of four emergency visits or hospitalisations were prevented. In conclusion, existing evidence suggests a benefit of antidiabetic medication in AECOPD-related outcomes, suggesting that this effect merits further investigation.

Keywords

type 2 diabetes mellitus - antidiabetic agents - chronic obstructive pulmonary disease - exacerbation


Publication History

Received: 03 February 2025

Accepted after revision: 26 March 2025

Accepted Manuscript online:
26 March 2025

Article published online:
05 May 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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