Advertisement

Type 2 diabetes: A protective factor for COPD?

      Highlights

      • People with T2DM have a reduced risk of developing COPD compared with matched controls.
      • This may be related to positive life style changes, including smoking cessation, in those with T2DM.
      • Diabetes duration, diabetic complications and anti-diabetic medications did not alter COPD risk.

      Abstract

      Background

      Chronic obstructive pulmonary disease (COPD) and type 2 diabetes (T2DM) are common comorbidities. COPD is a known risk factor for incident T2DM, however few studies have examined the relationship in reverse. The primary aim of this study was to compare the incidence of COPD in people with and without T2DM.

      Materials and methods

      We conducted a retrospective case-control study using a long-established English general practice network database (n = 894,646). We matched 29,217 cases of T2DM with controls, adjusting for age, gender, smoking status, BMI and social deprivation, to achieve 1:1 propensity matching and compared the rate of incident COPD over eight years of follow-up. We performed a secondary analysis to investigate the effect of insulin, metformin and sulphonylureas on COPD incidence.

      Results

      People with T2DM had a reduced risk of COPD compared to matched controls over the follow-up period (HR 0.89, 95%CI 0.79–0.93). 48.5% of those with T2DM were ex-smokers compared with 27.3% of those without T2DM. Active smoking rates were 20.4% and 23.7% respectively. Insulin, metformin and sulphonylureas were not associated with incident COPD.

      Conclusions

      People with T2DM are less likely to be diagnosed with COPD than matched controls. This may be due to positive lifestyle changes, such as smoking cessation in those with T2DM.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Primary Care Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cazzola M.
        • Bettoncelli G.
        • Sessa E.
        • Cricelli C.
        • Biscione G.
        Prevalence of comorbidities in patients with chronic obstructive pulmonary disease.
        Respiration. 2010; 80: 112-119
        • Rana J.S.
        • Mittleman M.A.
        • Sheikh J.
        • Hu F.B.
        • Manson J.E.
        • Colditz G.A.
        • et al.
        Chronic obstructive pulmonary disease, asthma, and risk of type 2 diabetes in women.
        Diabetes Care. 2004; 27: 2478-2484
        • Song Y.
        • Klevak A.
        • Manson J.E.
        • Buring J.E.
        • Liu S.
        Asthma, chronic obstructive pulmonary disease, and type 2 diabetes in the women’s health study.
        Diabetes Res. Clin. Pract. 2010; 90: 365-371
        • Rogliani P.
        • Luca G.
        • Lauro D.
        Chronic obstructive pulmonary disease and diabetes.
        COPD Res. Pract. 2015; 1: 0005
        • Suissa S.
        • Kezouh A.
        • Ernst P.
        Inhaled corticosteroids and the risks of diabetes onset and progression.
        Am. J. Med. 2010; 123: 1001-1006
        • Fabbri L.M.
        • Rabe K.F.
        From COPD to chronic systemic inflammatory syndrome?.
        Lancet. 2007; 370: 797-799
        • Ehrlich S.F.
        • Quesenberry Jr., C.P.
        • Van Den Eeden S.K.
        • Shan J.
        • Ferrara A.
        Patients diagnosed with diabetes are at increased risk for asthma, chronic obstructive pulmonary disease, pulmonary fibrosis, and pneumonia but not lung cancer.
        Diabetes Care. 2010; 33: 55-60
        • Lange P.
        • Groth S.
        • Mortensen J.
        • Appleyard M.
        • Nyboe J.
        • Schnohr P.
        • et al.
        Diabetes mellitus and ventilatory capacity: a five year follow-up study.
        Eur. Respir. J. 1990; 3: 288-292
        • Lazarus R.
        • Sparrow D.
        • Weiss S.T.
        Baseline ventilatory function predicts the development of higher levels of fasting insulin and fasting insulin resistance index: the Normative Aging Study.
        Eur. Respir. J. 1998; 12: 641-645
        • Kim H.J.
        • Lee J.Y.
        • Jung H.S.
        • Kim D.K.
        • Lee S.M.
        • Yim J.J.
        • et al.
        The impact of insulin sensitisers on lung function in patients with chronic obstructive pulmonary disease and diabetes.
        Int. J. Tuberc. Lung Dis. 2010; 14: 362-367
        • Sexton P.
        • Metcalf P.
        • Kolbe J.
        Respiratory effects of insulin sensitisation with metformin: a prospective observational study.
        COPD. 2014; 11: 133-142
        • de Lusignan S.
        Codes, classifications, terminologies and nomenclatures: definition, development and application in practice.
        Inform. Prim. Care. 2005; 13: 65-70
        • Correa A.
        • Hinton W.
        • McGovern A.
        • van Vlymen J.
        • Yonova I.
        • Jones S.
        • et al.
        Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) sentinel network: a cohort profile.
        BMJ Open. 2016; 6e011092
        • van den Berge M.
        • Aalbers R.
        The asthma-COPD overlap syndrome: how is it defined and what are its clinical implications?.
        J. Asthma Allergy. 2016; 9: 27-35
        • McGovern A.
        • Hinton W.
        • Correa A.
        • Munro N.
        • Whyte M.
        • de Lusignan S.
        Real-world evidence studies into treatment adherence, thresholds for intervention and disparities in treatment in people with type 2 diabetes in the UK.
        BMJ Open. 2016; 6e012801
        • Faulconer E.R.
        • de Lusignan S.
        An eight-step method for assessing diagnostic data quality in practice: chronic obstructive pulmonary disease as an exemplar.
        Inform. Prim. Care. 2004; 12: 243-254
      1. Government. DfCaL 2015, 2017. https://www.gov.uk/government/statistics/english-indices-of-deprivation-2015. (Accessed 8 August 2017).

      2. RStudio Team 2015, 2017. https://www.rstudio.com/. (Accessed 24 July 2017).

      3. T.M. Therneau, T. Lumley, 2017. http://cran.irsn.fr/web/packages/survival/survival.pdf. (Accessed 24 July 2017).

        • von Elm E.
        • Altman D.G.
        • Egger M.
        • Pocock S.J.
        • Gotzsche P.C.
        • Vandenbroucke J.P.
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        PLoS Med. 2007; 4e296
        • Qureshi H.
        • Sharafkhaneh A.
        • Hanania N.A.
        Chronic obstructive pulmonary disease exacerbations: latest evidence and clinical implications.
        Ther. Adv. Chronic Dis. 2014; 5: 212-227
        • Hine J.L.
        • de Lusignan S.
        • Burleigh D.
        • Pathirannehelage S.
        • McGovern A.
        • Gatenby P.
        • et al.
        Association between glycaemic control and common infections in people with type 2 diabetes: a cohort study.
        Diabet. Med. 2017; 34: 551-557
        • McKinlay J.
        • Marceau L.
        US public health and the 21st century: diabetes mellitus.
        Lancet. 2000; 356: 757-761
        • Kinney G.L.B.
        • Baker E.H.
        Type 2 diabetes mellitus and chronic obstructive pulmonary disease: need for a double-pronged approach.
        Diabetes Manage. 2014; 4: 307-310
        • Dei Cas A.
        • Khan S.S.
        • Butler J.
        • Mentz R.J.
        • Bonow R.O.
        • Avogaro A.
        • et al.
        Impact of diabetes on epidemiology, treatment, and outcomes of patients with heart failure.
        JACC Heart Fail. 2015; 3: 136-145
        • van den Borst B.
        • Gosker H.R.
        • Zeegers M.P.
        • Schols A.M.
        Pulmonary function in diabetes: a metaanalysis.
        Chest. 2010; 138: 393-406
        • Brashier B.
        • Salvi S.
        Obesity and asthma: physiological perspective.
        J. Allergy. 2013; 2013: 198068
        • Klonoff D.C.
        Afrezza inhaled insulin: the fastest-acting FDA-approved insulin on the market has favorable properties.
        J. Diabetes Sci. Technol. 2014; 8: 1071-1073
        • Borozan S.
        • Stankovic Z.
        • Subaric I.
        The impact of insulin sensitisation with metformin on lung function in patients with type 2 diabetes mellitus and chronic obstructive pulmonary disease.
        Endocr. Abstr. 2016; 41 (EP543)
        • Hitchings A.W.
        • Lai D.
        • Jones P.W.
        • Baker E.H.
        Metformin in severe exacerbations of chronic obstructive pulmonary disease: a randomised controlled trial.
        Thorax. 2016; 71: 587-593
      4. British Lung Foundation 2013, 2017. https://statistics.blf.org.uk/copd. (Accessed 12 June 2017).