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A recent study published in JAMA Internal Medicine suggests that certain glucose-lowering medications may reduce the risk of moderate to severe exacerbations in patients with type 2 diabetes (T2D) and chronic obstructive pulmonary disease (COPD). The study indicates that sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are associated with a lower risk of COPD exacerbations compared to dipeptidyl peptidase 4 inhibitors (DPP-4is).
Study Overview
The study, led by Dr. Avik Ray from Brigham and Women’s Hospital and Harvard Medical School, analyzed data from patients aged 40 years and older with T2D and active COPD. The researchers conducted a comparative effectiveness study involving three treatment groups: SGLT-2is versus DPP-4is (27,991 pairs), GLP-1 RAs versus DPP-4is (32,107 pairs), and SGLT-2is versus GLP-1 RAs (36,218 pairs).
Key Findings
The findings revealed that patients treated with SGLT-2is had a lower risk of moderate or severe COPD exacerbation compared to those receiving DPP-4is (9.26 vs. 11.4 events per 100 person-years, hazard ratio 0.81). Similarly, GLP-1 RAs were associated with a reduced risk compared to DPP-4is (9.89 vs. 11.49 events per 100 person-years, hazard ratio 0.86). However, minimal differences were observed when comparing SGLT-2is and GLP-1 RAs directly.
The study results remained consistent across sensitivity and subgroup analyses, reinforcing the potential benefits of SGLT-2is and GLP-1 RAs over DPP-4is for patients managing both T2D and COPD.
Clinical Implications and Caution
The authors suggest that SGLT-2is and GLP-1 RAs could be preferable to DPP-4is for glucose-lowering treatment in patients with both conditions. However, they caution that, as an observational study, residual or unmeasured confounding factors may still be present. Further clinical trials are necessary to validate these findings and establish definitive clinical guidelines.
Potential Conflicts of Interest
Several study authors disclosed financial ties to the pharmaceutical industry, and one author reported serving as an expert witness in litigation against inhaler manufacturers.
Disclaimer
This article is for informational purposes only and should not be considered medical advice. Patients should consult their healthcare providers before making any changes to their treatment plans.
References:
- Ray, A. et al. (2025). Glucose-Lowering Medications and Risk of Chronic Obstructive Pulmonary Disease Exacerbations in Patients With Type 2 Diabetes, JAMA Internal Medicine. DOI: 10.1001/jamainternmed.2024.7811
- Stall, N. M. et al. (2025). Pleotropic Effects of Glucose-Lowering Medications—Need for Cautious Interpretation of Target Trial Emulation Studies, JAMA Internal Medicine. DOI: 10.1001/jamainternmed.2024.7812
