The Potential of Antidiabetic Medications in the Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease in Subjects with Type 2 Diabetes Mellitus.

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.