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Alanazi AH, Selim MS, Yendamuri MR, Zhang D, Narayanan SP, Somanath PR. The impact of diabetes mellitus on blood-tissue barrier regulation and vascular complications: Is the lung different from other organs? Tissue Barriers 2024:2386183. [PMID: 39072526 DOI: 10.1080/21688370.2024.2386183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 07/30/2024] Open
Abstract
Diabetes Mellitus presents a formidable challenge as one of the most prevalent and complex chronic diseases, exerting significant strain on both patients and the world economy. It is recognized as a common comorbidity among severely ill individuals, often leading to a myriad of micro- and macro-vascular complications. Despite extensive research dissecting the pathophysiology and molecular mechanisms underlying vascular complications of diabetes, relatively little attention has been paid to potential lung-related complications. This review aims to illuminate the impact of diabetes on prevalent respiratory diseases, including chronic obstructive pulmonary disease (COPD), acute respiratory distress syndrome (ARDS), idiopathic pulmonary fibrosis (IPF), tuberculosis (TB), pneumonia infections, and asthma, and compare the vascular complications with other vascular beds. Additionally, we explore the primary mechanistic pathways contributing to these complications, such as the expression modulation of blood-tissue-barrier proteins, resulting in increased paracellular and transcellular permeability, and compromised immune responses rendering diabetes patients more susceptible to infections. The activation of inflammatory pathways leading to cellular injury and hastening the onset of these respiratory complications is also discussed.
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Affiliation(s)
- Abdulaziz H Alanazi
- Clinical and Experimental Therapeutics, University of Georgia, Augusta, GA, USA
- Charlie Norwood VA Medical Center, Augusta, GA, USA
- Department of Clinical Practice, College of Pharmacy, Northern Border University, Rafha, Saudi Arabia
| | - Mohamed S Selim
- Clinical and Experimental Therapeutics, University of Georgia, Augusta, GA, USA
- Charlie Norwood VA Medical Center, Augusta, GA, USA
| | - Manyasreeprapti R Yendamuri
- Clinical and Experimental Therapeutics, University of Georgia, Augusta, GA, USA
- Charlie Norwood VA Medical Center, Augusta, GA, USA
| | - Duo Zhang
- Clinical and Experimental Therapeutics, University of Georgia, Augusta, GA, USA
- Charlie Norwood VA Medical Center, Augusta, GA, USA
| | - S Priya Narayanan
- Clinical and Experimental Therapeutics, University of Georgia, Augusta, GA, USA
- Charlie Norwood VA Medical Center, Augusta, GA, USA
| | - Payaningal R Somanath
- Clinical and Experimental Therapeutics, University of Georgia, Augusta, GA, USA
- Charlie Norwood VA Medical Center, Augusta, GA, USA
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2
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Gupta S, Mohta A, Lauinger A, Thameem D. The role of Sodium-Glucose Transporter-2 Inhibitors (SGLT-2i) in preventing chronic obstructive disease exacerbation in patients with diabetes and COPD: An electronic health database analysis. Heart Lung 2024; 68:191-194. [PMID: 39029439 DOI: 10.1016/j.hrtlng.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 07/06/2024] [Accepted: 07/08/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Sodium Glucose Transporter 2 inhibitor (SGLT-2i) medications reduce inflammation, improve glycemic control, and impart weight loss, all of which may play a role in chronic obstructive pulmonary disease (COPD) pathophysiology. OBJECTIVES The primary objective of our study was to explore the incidence of COPD exacerbation in patients with diabetes and COPD on SGLT-2i medications. The secondary objective was to assess the impact of SGLT-2i medications on COPD exacerbations needing hospitalization, ICU admission, and mechanical ventilation. METHODS This was a retrospective cohort analysis of COPD patients with diabetes enrolled in the COPD registry at a Mid-west Tertiary care teaching hospital from January 1, 2022, to December 31, 2022. We used Slicer-Dicer, a self-service cohort exploration tool embedded in EPIC for data extraction. RESULTS We had 31,411 patients registered with the COPD registry during the study period. Of these, 18,713 had diabetes, and 1295 patients were on SGLT-2i medication. The incidence of COPD exacerbation, including severe COPD exacerbation needing hospitalization, was significantly lower in the SGLT-2i medication group (3.16% vs 18.3%, p < 0.05; 1.2% vs 5.04%, p < 0.05). Also, there was a non-significant trend suggesting that the incidence of COPD exacerbation needing intensive care unit admission and intubation was lower in the SGLT-2i medication group (0.07% vs 3.4%; 0 vs 0.04%). SGLT-2i medication use was associated with reduced incidence of COPD exacerbation irrespective of underlying control of diabetes. CONCLUSIONS Our study suggests possible role of SGLT-2i in preventing COPD exacerbation. Randomized trials are needed in the future to confirm or refute these findings.
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Affiliation(s)
- Sushan Gupta
- Department of Internal Medicine, Carle Foundation Hospital. Medicine 611W Park St, Urbana, IL 61801, USA
| | - Avani Mohta
- Department of Internal Medicine, Carle Foundation Hospital. Medicine 611W Park St, Urbana, IL 61801, USA
| | - Alexa Lauinger
- University of Illinois Urbana-Champaign, (Carle Illinois College of Medicine) 506 S Mathews Ave, Urbana, IL 61801, USA
| | - Danish Thameem
- Department of Pulmonary and Critical Care Medicine, Carle Foundation Hospital, 611W Park St, Urbana, IL 61801, USA.
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3
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Liao LY, Chen KM, Cheng HR, Hsu HF. Factors of Influence on Diabetes Awareness in Older People With Chronic Obstructive Pulmonary Disease Comorbid With Type 2 Diabetes Mellitus. J Nurs Res 2024; 32:e323. [PMID: 38488165 DOI: 10.1097/jnr.0000000000000602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a common comorbidity in patients with chronic obstructive pulmonary disease (COPD) and has been associated with an increased risk of mortality in this population. PURPOSE This study was designed to investigate the predictive factors of diabetes awareness (DA), including diabetes knowledge (DK), and diabetes care behaviors (DCB) among older people with both COPD and T2DM. METHODS This was a cross-sectional descriptive correlation study. One hundred thirty-three older-age patients with COPD comorbid with T2DM receiving treatment at a chest hospital were enrolled as participants. Both DK and DCB were utilized to measure DA. The Diabetes Knowledge Questionnaire was utilized to measure DK, and the Summary of Diabetes Self-Care Activities was used to evaluate DCB. RESULTS The average glycated hemoglobin (HbA1c) was 7.68% ( SD = 1.55%), with 74 (55.6%) participants having a level > 7%. The average DA was 46.46% ( SD = 13.34%), the average DK was 53.42% ( SD = 18.91%), and the average DCB was 39.50% ( SD = 16.66%). In terms of demographic variables, age, diabetes education, diabetes shared care, and HbA1c were all significantly associated with DA, DK, and DCB (all p s < .05). The overall variance in DA was significantly explained by diabetes education and HbA1c (all p s < .05). The overall variance in DK was significantly explained by age, diabetes education, and HbA1c. The overall variance in DCB was significantly explained by diabetes education and HbA1c (all p s < .05). CONCLUSIONS/IMPLICATIONS FOR PRACTICE Our study findings indicate that older adult patients with COPD comorbid with T2DM are at elevated risks of poor glycemic control and low DA. Healthcare professionals should be aware of these issues and develop appropriate DA plans to prevent poor glycemic control in this population. Providing accurate information on diabetes to older adults with COPD comorbid with T2DM is important to improving their DK and promoting better DCB.
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Affiliation(s)
- Lin-Yu Liao
- PhD, RN, Head Nurse, Department of Nursing, Chest Hospital, Ministry of Health and Welfare, Taiwan
| | - Kuei-Min Chen
- PhD, RN, FAAN, Professor, College of Nursing, Center for Long-Term Care Research, Kaohsiung Medical University, and Department of Medical Research, Kaohsiung Medical University Hospital, Taiwan
| | - Hsiu-Rong Cheng
- PhD, RN, Associate Professor, Department of Nursing, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Hui-Fen Hsu
- PhD, Postdoctoral Fellow, College of Nursing, Kaohsiung Medical University, Taiwan
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4
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Theivasigamani K, Palaniappan S. An Overview of Pharmaceutical Care in Type II Diabetes Mellitus Patients: Current Position and Prospects. Curr Diabetes Rev 2024; 20:e050523216588. [PMID: 37151063 DOI: 10.2174/1573399819666230505123428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/17/2023] [Accepted: 02/02/2023] [Indexed: 05/09/2023]
Abstract
Diabetes mellitus is an ongoing disease that is related to a high mortality rate due to severe complications. Diabetes mellitus type 2 (DMT2) is a persistent metabolic deficiency and its prevalence has been increasing consistently worldwide. As a result, it is rapidly turning into a plague in some parts of the world, and the number of people affected is expected to double in the following decade due to an increase in the maturing populace, adding to the overall existing importance for medical service providers, particularly in the underdeveloped nations. Extensive diabetes care is an intricate task that takes a whole group of medical care experts, including drug specialists, to provide multidisciplinary care for the patients. The duty of drug experts has changed significantly in recent years, changing from conventional drug dispensing in the drug store to patient- centered clinical support services. Upgrading the medication treatment to accomplish better remedial results without causing drug-related issues has been considered the essential objective of treatment for diabetic patients. This review discusses the healthcare needs of patients with T2DM, the current evidence for the role of pharmacists in diabetes care, and insight into the upcoming role of pharmacists in its management. The advanced role of clinical pharmacists in diabetes control through drug treatment, diabetes care centers, and diabetes health counselor schooling, is also discussed in this review.
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Affiliation(s)
- Kumutha Theivasigamani
- Research Scholar, Karpagam Academy of Higher Education, Coimbatore, India
- Nandha College of Pharmacy, Erode, India
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Li M, Wan Y, Zhu Z, Luo P, Yu H, Su J, Hang D, Lu Y, Tao R, Wu M, Zhou J, Fan X. Association between glycated haemoglobin and the risk of chronic obstructive pulmonary disease: A prospective cohort study in UK biobank. Diabetes Obes Metab 2023; 25:3599-3610. [PMID: 37643990 DOI: 10.1111/dom.15255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023]
Abstract
AIMS To investigate the association between glycated haemoglobin (HbA1c) levels and chronic obstructive pulmonary disease (COPD) incidents in the general population, and the association between HbA1c levels and mortality in patients with COPD. MATERIALS AND METHODS We investigated the association of HbA1c levels with COPD risk in the general population in the UK Biobank, using data from 420 065 participants. Survival analysis was conducted for 18 854 patients with COPD. We used restricted cubic spline analysis to assess the dose-response relationship between HbA1c levels and COPD risk and survival. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS During a median follow-up of 12.3 years, 11 556 COPD cases were recorded. HbA1c had a non-linear relationship with COPD risk (p for non-linearity < .05). Compared with the quintile 2 (32.2-<34.3 mmol/mol), those with HbA1c levels above 38.7 mmol/mol (quintile 5) had a 22% (HR, 1.22, 95% CI: 1.15-1.30) higher risk of COPD. Compared with the HbA1c decile 2 (30.5-<32.2 mmol/mol), the HRs (95% CI) of COPD risk were 1.16 (1.03-1.30) and 1.36 (1.24-1.50) in the lowest HbA1c decile (<30.5 mmol/mol) and highest decile (≥41.0 mmol/mol), respectively. The increased COPD risk associated with HbA1c was more pronounced in younger, current smokers, passive smokers, and participants with a higher Townsend deprivation index (all p for interaction < .05). Among patients with COPD, 4569 COPD cases died (488 because of COPD) during a median follow-up of 5.4 years. Regarding COPD survival, HbA1c had a non-linear relationship with all-cause death (p for non-linearity < .05). Those with HbA1c quintile 5 (≥38.7 mmol/mol) had a 23% (HR, 1.23, 95% CI: 1.10-1.37) higher risk of all-cause death compared with the quintile 2 (32.2-<34.3 mmol/mol). Compared with the HbA1c decile 4 (33.3-<34.3 mmol/mol), those in the lowest HbA1c decile (<30.5 mmol/mol) and highest HbA1c decile (≥41.0 mmol/mol) had 22% (HR, 1.22; 95% CI: 1.01-1.47) and 28% (HR, 1.28; 95% CI: 1.11-1.48) higher risk for overall death. However, no significant association was observed between HbA1c levels and the risk of COPD-specific death. CONCLUSIONS Our findings indicated that lower and higher HbA1c levels were associated with a higher risk of COPD. In COPD cases, lower and higher HbA1c levels were associated with a higher COPD all-cause death risk.
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Affiliation(s)
- Mengyao Li
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yanan Wan
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Zheng Zhu
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Pengfei Luo
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Hao Yu
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Jian Su
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Dong Hang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yan Lu
- Department of Chronic Disease Prevention and Control, Suzhou City Centre for Disease Control and Prevention, Suzhou, China
| | - Ran Tao
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Ming Wu
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Jinyi Zhou
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Xikang Fan
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
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Cazzola M, Rogliani P, Ora J, Calzetta L, Lauro D, Matera MG. Hyperglycaemia and Chronic Obstructive Pulmonary Disease. Diagnostics (Basel) 2023; 13:3362. [PMID: 37958258 PMCID: PMC10650064 DOI: 10.3390/diagnostics13213362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) may coexist with type 2 diabetes mellitus (T2DM). Patients with COPD have an increased risk of developing T2DM compared with a control but, on the other side, hyperglycaemia and DM have been associated with reduced predicted levels of lung function. The mechanistic relationships between these two diseases are complicated, multifaceted, and little understood, yet they can impact treatment strategy. The potential risks and benefits for patients with T2DM treated with pulmonary drugs and the potential pulmonary risks and benefits for patients with COPD when taking antidiabetic drugs should always be considered. The interaction between the presence and/or treatment of COPD, risk of infection, presence and/or treatment of T2DM and risk of acute exacerbations of COPD (AECOPDs) can be represented as a vicious circle; however, several strategies may help to break this circle. The most effective approach to simultaneously treating T2DM and COPD is to interfere with the shared inflammatory substrate, thus targeting both lung inflammation (COPD) and vascular inflammation (DM). In any case, it is always crucial to establish glycaemic management since the reduction in lung function found in people with diabetes might decrease the threshold for clinical manifestations of COPD. In this article, we examine possible connections between COPD and T2DM as well as pharmacological strategies that could focus on these connections.
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Affiliation(s)
- Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome ‘Tor Vergata’, 00133 Rome, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome ‘Tor Vergata’, 00133 Rome, Italy
- Division of Respiratory Medicine, University Hospital Fondazione Policlinico Tor Vergata, 00133 Rome, Italy
| | - Josuel Ora
- Division of Respiratory Medicine, University Hospital Fondazione Policlinico Tor Vergata, 00133 Rome, Italy
| | - Luigino Calzetta
- Unit of Respiratory Disease and Lung Function, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Davide Lauro
- Unit of Endocrinology and Metabolic Diseases, Department of Systems Medicine, University of Rome ‘Tor Vergata’, 00173 Rome, Italy
- Division of Endocrinology and Diabetes, University Hospital Fondazione Policlinico Tor Vergata, 00133 Rome, Italy
| | - Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania ‘Luigi Vanvitelli’, 81138 Naples, Italy
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Mangold V, Boesing M, Berset C, Bridevaux PO, Geiser T, Joos Zellweger L, Kohler M, Lüthi-Corridori G, Maier S, Miedinger D, Thurnheer R, von Garnier C, Leuppi JD. Adherence to the GOLD Guidelines in Primary Care: Data from the Swiss COPD Cohort. J Clin Med 2023; 12:6636. [PMID: 37892775 PMCID: PMC10607923 DOI: 10.3390/jcm12206636] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/11/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Introduction: Chronic obstructive pulmonary disease (COPD) and its associated morbidity and mortality are a global burden on both affected patients and healthcare systems. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) issues guidelines with the aim of improving COPD management. Previous studies reported significant variability in adherence to these recommendations. The objective of this study was to evaluate Swiss primary practitioners' adherence to the GOLD guidelines for the pharmacological treatment of stable COPD. (2) Methods: We studied patients who were included in the Swiss COPD cohort study, an ongoing prospective study in a primary care setting, between 2015 and 2022. The key inclusion criteria are age ≥ 40 years, FEV1/FVC ratio < 70%, and a smoking history of at least 20 pack-years. Adherence to the GOLD guidelines was assessed per visit and over time. (3) Results: The data of 225 COPD patients (mean age 67 ± 9 years, 64% male) and their respective 1163 visits were analyzed. In 65% of visits (726/1121), treatment was prescribed according to the GOLD guidelines. Non-adherence was most common in GOLD groups A and B (64% and 33%) and mainly consisted of over-treatment (two long-acting bronchodilators in group A (98/195, 50%) and ICS in groups A (21/195, 11%) and B (198/808, 25%)). In group D, the prescriptions conformed with the guidelines in 99% of cases (109/108). Guideline adherence was associated with high symptom load (COPD Assessment Test) (OR 1.04, p = 0.002), high number of exacerbations (OR = 2.07, p < 0.001), asthma overlap (OR 3.36, p = 0.049), and diabetes mellitus (OR 2.82, p = 0.045). (4) Conclusion: These results confirm a conflict between the GOLD recommendations and primary practice, mainly concerning over-treatment in GOLD groups A and B. Patients with high symptom load, high exacerbation risk, asthma overlap, and diabetes mellitus are more likely to be treated in conformity with the guidelines. Further research is needed to uncover the reasons for the discrepancies and to design strategies for improvement.
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Affiliation(s)
- Veronika Mangold
- University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Maria Boesing
- University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Camille Berset
- University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | | | - Thomas Geiser
- Department of Pulmonary Medicine and Allergology, University Hospital, University of Bern, 3010 Bern, Switzerland
| | | | - Malcolm Kohler
- Department of Pneumology, University Hospital Zürich, 8091 Zürich, Switzerland
| | - Giorgia Lüthi-Corridori
- University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Sabrina Maier
- University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
| | - David Miedinger
- University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Robert Thurnheer
- Clinic of Medicine, Department of Pneumology, Cantonal Hospital Münsterlingen, 8596 Münsterlingen, Switzerland
| | - Christophe von Garnier
- Division of Pulmonology, Department of Medicine, University Hospital Lausanne, CHUV, University of Lausanne, 1011 Lausanne, Switzerland
| | - Jörg Daniel Leuppi
- University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
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8
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Raslan AS, Quint JK, Cook S. All-Cause, Cardiovascular and Respiratory Mortality in People with Type 2 Diabetes and Chronic Obstructive Pulmonary Disease (COPD) in England: A Cohort Study Using the Clinical Practice Research Datalink (CPRD). Int J Chron Obstruct Pulmon Dis 2023; 18:1207-1218. [PMID: 37332839 PMCID: PMC10276568 DOI: 10.2147/copd.s407085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023] Open
Abstract
Background Type 2 diabetes (T2D) and chronic obstructive pulmonary disease (COPD) are common non-communicable diseases. Both have an inflammatory nature and similar risk factors, and there is overlap and interaction between them. To date, there is a lack of research on outcomes in people that have both conditions. The aim of this study was to investigate whether the presence of COPD in people with T2D was associated with an increased risk of all-cause, respiratory-cause and cardiovascular-cause mortality. Methods A three-year cohort study (2017-19) was done using the Clinical Practice Research Datalink Aurum database. The study population was 121,563 people with T2D aged ≥40. The exposure was COPD status at baseline. Incident rates for all-cause, respiratory-cause and cardiovascular-cause mortality were calculated. Poisson models for each outcome were fitted to estimate rate ratios for COPD status adjusted for age, sex, Index of Multiple Deprivation, smoking status, body mass index, prior asthma and cardiovascular disease. Results COPD was present in 12.1% people with T2D. People with COPD had a higher all-cause mortality rate (448.7 persons per 1000 person years) compared with people without COPD (296.6 persons per 1000 person years). People with COPD also had substantially higher respiratory mortality incidence rates and moderately raised cardiovascular mortality rates. Fully adjusted Poisson models showed that people with COPD had a 1.23 (95% CI 1.21, 1.24) times higher rate of all-cause mortality as compared with those without COPD and a 3.03 (95% CI 2.89, 3.18) times higher rate of respiratory-cause mortality. There was no evidence of an association with cardiovascular mortality after adjusting for existing cardiovascular disease. Conclusion Co-morbid COPD in people with T2D was associated with increased mortality overall and particularly from respiratory causes. People with both COPD and T2D are a high-risk group who would benefit from particularly intensive management of both conditions.
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Affiliation(s)
- Abdul Sattar Raslan
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Jennifer K Quint
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sarah Cook
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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9
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Wang W, Mei A, Qian H, Li D, Xu H, Chen J, Yang H, Min X, Li C, Cheng L, Chen J. The Role of Glucagon-Like Peptide-1 Receptor Agonists in Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2023; 18:129-137. [PMID: 36815056 PMCID: PMC9939668 DOI: 10.2147/copd.s393323] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the common diseases of the respiratory system. As the disease recurs, damage to the airways and lung tissue gradually worsens, leading to a progressive decline in lung function, affecting the patient's workforce and quality of life, and causing a huge social and economic burden. Diabetes is a common comorbidity of COPD and patients with COPD are at increased risk of developing diabetes, while hyperglycemia can also reduce lung function and contribute to the progression and poor prognosis of COPD. Glucagon-like peptide-1 receptor agonist (GLP-1RA) is a new type of hypoglycemic agent that has been shown to regulate blood glucose levels, reduce inflammatory responses and oxidative stress, and regulate lipid metabolism, among other effects. GLP-1RAs may benefit COPD patients by acting directly on the lung from mechanisms such as reducing the inflammatory response, improving oxidative stress, regulating protease/anti-protease imbalance, improving airway mucus homeostasis, and reducing airway remodeling. This study provides a review of the potential role of GLP-1RAs in COPD and offers new ideas for the prevention and treatment of COPD.
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Affiliation(s)
- Wenwen Wang
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Hubei Key Laboratory of Wudang Local Chinese Medicine Research (Hubei University of Medicine), Shiyan, People’s Republic of China
| | - Aihua Mei
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Hubei Key Laboratory of Wudang Local Chinese Medicine Research (Hubei University of Medicine), Shiyan, People’s Republic of China
| | - Hang Qian
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Hubei Key Laboratory of Wudang Local Chinese Medicine Research (Hubei University of Medicine), Shiyan, People’s Republic of China
| | - Dongfeng Li
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Hubei Key Laboratory of Wudang Local Chinese Medicine Research (Hubei University of Medicine), Shiyan, People’s Republic of China
| | - Hao Xu
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Hubei Key Laboratory of Wudang Local Chinese Medicine Research (Hubei University of Medicine), Shiyan, People’s Republic of China
| | - Jishun Chen
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Hubei Key Laboratory of Wudang Local Chinese Medicine Research (Hubei University of Medicine), Shiyan, People’s Republic of China
| | - Handong Yang
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Hubei Key Laboratory of Wudang Local Chinese Medicine Research (Hubei University of Medicine), Shiyan, People’s Republic of China
| | - Xinwen Min
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Hubei Key Laboratory of Wudang Local Chinese Medicine Research (Hubei University of Medicine), Shiyan, People’s Republic of China
| | - Chunlei Li
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Hubei Key Laboratory of Wudang Local Chinese Medicine Research (Hubei University of Medicine), Shiyan, People’s Republic of China
| | - Li Cheng
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Hubei Key Laboratory of Wudang Local Chinese Medicine Research (Hubei University of Medicine), Shiyan, People’s Republic of China
| | - Jun Chen
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Hubei Key Laboratory of Wudang Local Chinese Medicine Research (Hubei University of Medicine), Shiyan, People’s Republic of China,Institute of Virology, Hubei University of Medicine, Shiyan, Hubei, 442000, People’s Republic of China,Correspondence: Jun Chen; Li Cheng, Sinopharm General Dongfeng Hospital, Hubei University of Medicine, 16 Daling Road, Shiyan, Hubei, 442000, People’s Republic of China, Email ;
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Frizzelli A, Aiello M, Calzetta L, Bertorelli G, Chetta A. The interplay between diabetes mellitus and chronic obstructive pulmonary disease. Minerva Med 2023; 114:68-73. [PMID: 35138076 DOI: 10.23736/s0026-4806.22.07742-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM) are common and chronic disorders. COPD is characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities and it is considered currently the fourth leading cause of death worldwide. DM is a systemic disease characterized by a chronic hyperglycemia associated with inflammation and oxidative stress. The relationship between the two conditions is not completely understood and conflicting results are reported in the literature. Many studies have investigated the mechanisms through with the respiratory disease is associated with an increased risk of metabolic condition or whether the incidence risk of COPD in individuals affected by DM is higher. The link between the two chronic conditions has relevant implications in the management of patients affected by the both of them. Respiratory patients should be screened for diabetes mellitus as a frequent comorbidity of lung disease since therapeutic options should be assessed about risk-to-benefit ratios associated with the indication for the steroid use. Furthermore, the role of hyperglycemia on pulmonary function (e.g. infection or inflammatory processes) should be evaluated in DM. Finally, in presence of both diseases potential treatment interactions should be considered. In this overview we explored the common aspects of both clinical chronic illnesses and investigated the interplay between the two conditions.
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Affiliation(s)
- Annalisa Frizzelli
- Unit of Respiratory Disease and Lung Function, Department of Medicine and Surgery, University of Parma, Parma, Italy -
| | - Marina Aiello
- Unit of Respiratory Disease and Lung Function, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Luigino Calzetta
- Unit of Respiratory Disease and Lung Function, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giuseppina Bertorelli
- Unit of Respiratory Disease and Lung Function, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alfredo Chetta
- Unit of Respiratory Disease and Lung Function, Department of Medicine and Surgery, University of Parma, Parma, Italy
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11
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Pradhan R, Lu S, Yin H, Yu OHY, Ernst P, Suissa S, Azoulay L. Novel antihyperglycaemic drugs and prevention of chronic obstructive pulmonary disease exacerbations among patients with type 2 diabetes: population based cohort study. BMJ 2022; 379:e071380. [PMID: 36318979 PMCID: PMC9623550 DOI: 10.1136/bmj-2022-071380] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine whether the use of glucagon-like peptide 1 (GLP-1) receptor agonists, dipeptidyl peptidase 4 (DPP-4) inhibitors, and sodium-glucose co-transporter-2 (SGLT-2) inhibitors, separately, is associated with a decreased risk of exacerbations of chronic obstructive pulmonary disease among patients with chronic obstructive pulmonary disease and type 2 diabetes. DESIGN Population based cohort study using an active comparator, new user design. SETTING The United Kingdom Clinical Practice Research Datalink linked with the Hospital Episode Statistics Admitted Patient Care and Office for National Statistics databases. PARTICIPANTS Three active comparator, new user cohorts of patients starting the study drugs (GLP-1 receptor agonists, DPP-4 inhibitors, or SGLT-2 inhibitors) or sulfonylureas with a history of chronic obstructive pulmonary disease. The first cohort included 1252 patients starting GLP-1 receptor agonists and 14 259 starting sulfonylureas, the second cohort included 8731 patients starting DPP-4 inhibitors and 18 204 starting sulfonylureas, and the third cohort included 2956 patients starting SGLT-2 inhibitors and 10 841 starting sulfonylureas. MAIN OUTCOME MEASURES Cox proportional hazards models with propensity score fine stratification weighting were fitted to estimate hazard ratios and 95% confidence intervals of severe exacerbation of chronic obstructive pulmonary disease (defined as hospital admission for chronic obstructive pulmonary disease), separately for GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT-2 inhibitors. Whether these drugs were associated with a decreased risk of moderate exacerbation (defined as a co-prescription of an oral corticosteroid and an antibiotic along with an outpatient diagnosis of acute chronic obstructive pulmonary disease exacerbation on the same day) was also assessed. RESULTS Compared with sulfonylureas, GLP-1 receptor agonists were associated with a 30% decreased risk of severe exacerbation (3.5 v 5.0 events per 100 person years; hazard ratio 0.70, 95% confidence interval 0.49 to 0.99) and moderate exacerbation (0.63, 0.43 to 0.94). DPP-4 inhibitors were associated with a modestly decreased incidence of severe exacerbation (4.6 v. 5.1 events per 100 person years; hazard ratio 0.91, 0.82 to 1.02) and moderate exacerbation (0.93, 0.82 to 1.07), with confidence intervals including the null value. Finally, SGLT-2 inhibitors were associated with a 38% decreased risk of severe exacerbation (2.4 v 3.9 events per 100 person years; hazard ratio 0.62, 0.48 to 0.81) but not moderate exacerbation (1.02, 0.83 to 1.27). CONCLUSIONS In this population based study, GLP-1 receptor agonists and SGLT-2 inhibitors were associated with a reduced risk of severe exacerbations compared with sulfonylureas in patients with chronic obstructive pulmonary disease and type 2 diabetes. DPP-4 inhibitors were not clearly associated with a decreased risk of chronic obstructive pulmonary disease exacerbations.
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Affiliation(s)
- Richeek Pradhan
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Sally Lu
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Hui Yin
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Oriana H Y Yu
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
- Division of Endocrinology, Jewish General Hospital, Montreal, QC, Canada
| | - Pierre Ernst
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Samy Suissa
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Laurent Azoulay
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada
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12
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Motamed B, Alavi Foumani A, Tangestaninezhad A, Almasi M, Faraji N, Jafarinezhad A. The relationship between glycated hemoglobin A1c levels and exacerbation status in the patients with chronic obstructive pulmonary disease. BMC Res Notes 2022; 15:326. [PMID: 36243756 PMCID: PMC9571465 DOI: 10.1186/s13104-022-06217-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study was performed in Razi Hospital, Rasht, Iran, between March 2016 and August 2018 on a population of chronic obstructive pulmonary disease (COPD) patients (56 as COPD exacerbation group and 56 as COPD stable group). Study variables include age, sex, occupation, body mass index (BMI), cigarette consumption, duration of COPD, annual hospitalization, dyspnea, glycated hemoglobin (HbA1c), FEV1, and FEV1/FVC indices. RESULT The mean age of the participants was 63.92 ± 10.75 years. There was a significant difference in the hospitalization between the patients with both exacerbation and normal state of COPD (P ≤ 0.001). HbA1c in the patients with exacerbation of COPD was significantly higher than stable status (P = 0.001). Logistic regression showed that HbA1c levels and hospitalization were predictors of exacerbation of COPD. HbA1c levels were statistically significant in terms of hospitalization in patients with COPD exacerbation. There was a significant difference between the HbA1c levels and MMRC in patients with COPD. The percentage of HbA1c was associated with exacerbation of COPD and HbA1c is a good predictor of disease severity in patients with COPD. It also shows that patients with COPD exacerbation and severe COPD are at the higher risk of hyperglycemia.
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Affiliation(s)
- Behrang Motamed
- grid.411874.f0000 0004 0571 1549Inflammatory Lung Diseases Research Center, Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Alavi Foumani
- grid.411874.f0000 0004 0571 1549Inflammatory Lung Diseases Research Center, Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Azita Tangestaninezhad
- grid.411874.f0000 0004 0571 1549Inflammatory Lung Diseases Research Center, Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Almasi
- grid.411874.f0000 0004 0571 1549Inflammatory Lung Diseases Research Center, Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Niloofar Faraji
- grid.411874.f0000 0004 0571 1549Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Alireza Jafarinezhad
- grid.411874.f0000 0004 0571 1549Inflammatory Lung Diseases Research Center, Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
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13
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Park SS, Perez Perez JL, Perez Gandara B, Agudelo CW, Rodriguez Ortega R, Ahmed H, Garcia-Arcos I, McCarthy C, Geraghty P. Mechanisms Linking COPD to Type 1 and 2 Diabetes Mellitus: Is There a Relationship between Diabetes and COPD? Medicina (B Aires) 2022; 58:medicina58081030. [PMID: 36013497 PMCID: PMC9415273 DOI: 10.3390/medicina58081030] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 01/09/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) patients frequently suffer from multiple comorbidities, resulting in poor outcomes for these patients. Diabetes is observed at a higher frequency in COPD patients than in the general population. Both type 1 and 2 diabetes mellitus are associated with pulmonary complications, and similar therapeutic strategies are proposed to treat these conditions. Epidemiological studies and disease models have increased our knowledge of these clinical associations. Several recent genome-wide association studies have identified positive genetic correlations between lung function and obesity, possibly due to alterations in genes linked to cell proliferation; embryo, skeletal, and tissue development; and regulation of gene expression. These studies suggest that genetic predisposition, in addition to weight gain, can influence lung function. Cigarette smoke exposure can also influence the differential methylation of CpG sites in genes linked to diabetes and COPD, and smoke-related single nucleotide polymorphisms are associated with resting heart rate and coronary artery disease. Despite the vast literature on clinical disease association, little direct mechanistic evidence is currently available demonstrating that either disease influences the progression of the other, but common pharmacological approaches could slow the progression of these diseases. Here, we review the clinical and scientific literature to discuss whether mechanisms beyond preexisting conditions, lifestyle, and weight gain contribute to the development of COPD associated with diabetes. Specifically, we outline environmental and genetic confounders linked with these diseases.
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Affiliation(s)
- Sangmi S. Park
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
| | - Jessica L. Perez Perez
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
| | - Brais Perez Gandara
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
| | - Christina W. Agudelo
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
| | - Romy Rodriguez Ortega
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
| | - Huma Ahmed
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
| | - Itsaso Garcia-Arcos
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
| | - Cormac McCarthy
- University College Dublin School of Medicine, Education and Research Centre, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland;
| | - Patrick Geraghty
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
- Correspondence: ; Tel.: +1-718-270-3141
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14
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Amirian B, Akhnoukh KM, Ashraf AM, Swiggett SJ, Rosato FE, Vakharia RM, Sadeghpour R, Razi AE. A nationwide analysis on the effects of chronic obstructive pulmonary disease following primary total shoulder arthroplasty for glenohumeral osteoarthritis. Shoulder Elbow 2022; 14:278-285. [PMID: 35599711 PMCID: PMC9121293 DOI: 10.1177/1758573221993828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/11/2021] [Accepted: 01/20/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease patients have been shown in orthopedic literature to have poorer outcomes and higher rates of complications from surgery. In this retrospective review, medical complications, length of stay, and costs were obtained to explore the effects of chronic obstructive pulmonary disease on patients undergoing primary total shoulder arthroplasty. METHODS Total shoulder arthroplasty cases from January 2005 to March 2014 were queried and analyzed from a nationwide database. Study patients were matched 1:5 to controls by age, sex, and medical comorbidities associated with chronic obstructive pulmonary disease. In-hospital length of stay, 90-day medical complications, day of surgery, and total global 90-day episode of care costs were obtained for comparison. RESULTS Chronic obstructive pulmonary disease patients were found to have higher incidence and odds (53.91 vs. 11.95%; OR: 3.58, 95%CI: 3.18-3.92, p < 0.0001) of 90-day medical complications, longer in-hospital length of stay (3 vs. 2 days, p < 0.0001), and significantly higher 90-day costs ($14,768.37 vs. $13,379.20, p < 0.0001) following primary total shoulder arthroplasty compared to matched controls. DISCUSSION Chronic obstructive pulmonary disease patients undergoing primary total shoulder arthroplasty have higher rates of medical complications, in-hospital length of stay, and costs of care. This represents an important factor that will allow orthopedic surgeons to adequately manage expectations and educate chronic obstructive pulmonary disease patients of the potential complications which may occur following total shoulder arthroplasty.
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Affiliation(s)
| | | | | | | | | | - Rushabh M Vakharia
- Rushabh M Vakharia, Department of
Orthopaedic Surgery, Maimonides Medical Center, 927 49 Street,
Brooklyn, NY 11219, USA.
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15
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Covantsev S, Corlateanu O, Volkov SI, Uzdenov R, Botnaru V, Corlateanu A. COPD and diabetes mellitus: down the rabbit hole. CURRENT RESPIRATORY MEDICINE REVIEWS 2022. [DOI: 10.2174/1573398x18666220411123508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract:
: One of the important comorbidities that has a longstanding research history in COPD is diabetes. Although there are multiple studies on COPD and diabetes the exact links between these two conditions is still controversial. The exact prevalence of diabetes in COPD varies between 2 and 37 %. The true nature of this relationship is complex and may be partially related to the traditional risk factors for diabetes such as smoking, cardiovascular disease and use of steroids. However, COPD is a disease that has multiple phenotypes and is no longer regarded as a homogeneous condition. It seems that some COPD patients who have overlap with asthma or the obese phenotype at a particular risk for T2DM. The aim of this review is to analyze the prevalence, risk factors and possible interactions between COPD and diabetes mellitus.
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Affiliation(s)
- Serghei Covantsev
- S.P. Botkin State Clinical Hospital, Moscow, Department of General Oncology, Moscow, Russian Federation
| | - Olga Corlateanu
- Nicolae Testemițanu State University of Medicine and Pharmacy, Department of Internal Medicine, Division of Pneumology and Allergology, Chisinau, Republic of Moldova
| | - Stanislav I. Volkov
- Russian Medical Academy of Continuous Postgraduate Education, Department of Endocrinology, Moscow, Russian Federation
| | - Rasul Uzdenov
- North-Caucasus Federal University, Department of Hospital Surgery with the Course of Anesthesiology and Intensive Care, Stavropol, Russian Federation
| | - Victor Botnaru
- Nicolae Testemițanu State University of Medicine and Pharmacy, Department of Internal Medicine, Division of Pneumology and Allergology, Chisinau, Republic of Moldova
| | - Alexandru Corlateanu
- Nicolae Testemițanu State University of Medicine and Pharmacy, Department of Internal Medicine, Division of Pneumology and Allergology, Chisinau, Republic of Moldova
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16
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Talpur AS, Kavanoor Sridhar K, Shabbir K, Amba-Ambaiowei EE, Hasan RM, Douedari Z, Hussain N, Bader S, Mirza S, Hafizyar F. Restrictive Pulmonary Disease in Diabetes Mellitus Type II Patients. Cureus 2022; 14:e23820. [PMID: 35530852 PMCID: PMC9067334 DOI: 10.7759/cureus.23820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/05/2022] Open
Abstract
Background The present study aimed to evaluate the proportion of restrictive pulmonary disease in individuals with diabetes mellitus type II patients. Methodology A cross-sectional study was performed at Liaquat University of Medical & Health Sciences between May 2020 and June 2021. All individuals aged between 40 and 65 years, irrespective of gender were included in the study. While those individuals with known obstructive lung diseases, blood disorders, or malignancy were excluded. Spirometry, total lung capacity (TLC), and carbon monoxide diffusing capacity (DLCO) measurements were conducted to obtain a pattern of restrictive disease in patients. Patients were divided into three main groups; i) prediabetes, ii) newly diagnosed cases of diabetes, iii) longstanding diabetes mellitus type II, and iv) control group. The parameters like the patients’ age, sex, medication, history of smoking, and cardiac diseases, among other demographics were recorded. The data collected was recorded on a predesigned proforma. Results The majority of the newly diagnosed cases, as well as long-standing diseases, were elderly males (p=0.014 and p<0.0001). Dyspnea was significantly correlated with longstanding diabetes mellitus type II as indicated by a higher mean score of 0.65 ± 0.10 (p=0.006). Smoking did not significantly correlate with diabetes mellitus type II. In patients with longstanding diabetes, 27 (14.4%) had a modified Medical Research Council (mMRC) score of greater than two while none of the controls had severe breathlessness. Reduced forced vital capacity (FVC) was detected in 16.0% of patients with longstanding diabetes and 12.8% in patients with newly diagnosed disease. Similar results were obtained for total lung capacity (TLC) and diffusing capacity (DLCO) (p=0.003 and p=0.02). Conclusion Diabetes mellitus type II is significantly associated with restrictive lung disease in patients as indicated by a high number of patients with longstanding diabetes in our study who were found to have restrictive lung disease and severe dyspnea. Screening for lung dysfunction could aid in optimum management of this debilitating disease.
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17
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Anker SD, Sander LE, Fitchett DH, Zinman B, Pernille Ofstad A, Wanner C, Vedin O, Lauer S, Verma S, Yaggi HK, Inzucchi SE. Empagliflozin in patients with type 2 diabetes mellitus and chronic obstructive pulmonary disease. Diabetes Res Clin Pract 2022; 186:109837. [PMID: 35314257 DOI: 10.1016/j.diabres.2022.109837] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/16/2022] [Accepted: 03/16/2022] [Indexed: 02/07/2023]
Abstract
AIMS Type 2 diabetes mellitus (T2DM) and chronic obstructive pulmonary disease (COPD) often co-exist, yielding increased risk of cardiovascular (CV) complications including heart failure (HF). We assessed risk of cardiorenal outcomes, mortality and safety in patients with versus without COPD in the EMPA-REG OUTCOME trial. METHODS Patients (n = 7,020) with T2DM and CV disease (CVD) were treated with empagliflozin (10 mg or 25 mg) or placebo. Cox regression was used to assess COPD subgroup (placebo only) associations with, and treatment effects of empagliflozin versus placebo on first hospitalization for HF (HHF), CV death, all-cause mortality, incident/worsening nephropathy, and all-cause hospitalization. RESULTS At baseline, patients with COPD (n = 707) had more HF and used insulin more frequently than those without COPD. During follow-up in the placebo group, those with baseline COPD had increased risk of HHF (HR 2.15 [95% CI 1.32, 3.49]), HHF/CV death (1.60 [1.10, 2.33]), incident/worsening nephropathy (1.68 [1.26, 2.24]), all-cause hospitalization (1.44 [1.19, 1.74]) and all-cause death (1.60 [1.09, 2.35]) compared to those without COPD. Empagliflozin consistently reduced all clinical outcomes, irrespective of COPD status (interaction p-values 0.14 to 0.96), with a confirmed safety profile. CONCLUSIONS In patients with T2DM and CVD, COPD increased the risk of mortality and cardiorenal outcomes, including HF. Empagliflozin consistently reduced these outcomes versus placebo regardless of COPD, suggesting that empagliflozin's benefits in patients with T2DM and CVD are not mitigated by the presence of COPD.
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Affiliation(s)
- Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site, Berlin, Germany, Charité Universitätsmedizin Berlin, Berlin, Germany; Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
| | - Leif-Erik Sander
- Department of Infectious Diseases and Respiratory Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - David H Fitchett
- St Michael's Hospital, Division of Cardiology, University of Toronto, Toronto, ON, Canada
| | - Bernard Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | | | | | - Ola Vedin
- Boehringer Ingelheim AB, Stockholm, Sweden
| | - Sabine Lauer
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - Subodh Verma
- St Michael's Hospital, Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Henry K Yaggi
- Section of Pulmonary, Critical Care & Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
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Chen YY, Li TC, Li CI, Lin SP, Fu PK. Statins Associated with Better Long-Term Outcomes in Aged Hospitalized Patients with COPD: A Real-World Experience from Pay-for-Performance Program. J Pers Med 2022; 12:jpm12020299. [PMID: 35207787 PMCID: PMC8877141 DOI: 10.3390/jpm12020299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally. Previous studies have addressed the impact of comorbidity on short-term mortality in patients with COPD. However, the prevalence of cardiovascular disease (CVD) and the association of statins prescription with mortality for aged COPD patients remains unclear. We enrolled 296 aged, hospitalized patients who were monitored in the pay-for-performance (P-4-P) program of COPD. Factors associated with long-term mortality were identified by Cox regression analysis. The median age of the study cohort was 80 years old, and the prevalence of coronary artery disease (CAD) and statins prescriptions were 16.6% and 31.4%, respectively. The mortality rate of the median 3-year follow-up was 51.4%. Through multivariate analysis, body mass index (BMI), statin prescription, and events of respiratory failure were associated with long-term mortality. A Cox analysis showed that statins prescription was associated with lower mortality (hazard ratio (HR): 0.5, 95% Confident interval, 95% CI: 0.34–0.73, p = 0.0004) and subgroup analysis showed that rosuvastatin prescription had protective effect on long-term mortality (HR: 0.44; 95% CI: 0.20–0.97; p < 0.05). Statin prescriptions might be associated with better long-term survival in aged COPD patients, especially those who experienced an acute exacerbation of COPD (AECOPD) who require hospitalization.
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Affiliation(s)
- Ying-Yi Chen
- Department of Public Health, China Medical University, Taichung 406040, Taiwan; (Y.-Y.C.); (T.-C.L.)
| | - Tsai-Chung Li
- Department of Public Health, China Medical University, Taichung 406040, Taiwan; (Y.-Y.C.); (T.-C.L.)
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 413305, Taiwan
| | - Chia-Ing Li
- Department of Medical Research, China Medical University Hospital, Taichung 404332, Taiwan;
| | - Shih-Pin Lin
- Department of Information Engineering and Computer Science, Feng Chia University, Taichung 407802, Taiwan;
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Pin-Kuei Fu
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 402010, Taiwan
- College of Human Science and Social Innovation, Hungkuang University, Taichung 433304, Taiwan
- Correspondence: ; Tel.: +886-937-701-592
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Subclinical Diabetic Peripheral Vascular Disease and Epidemiology Using Logistic Regression Mathematical Model and Medical Image Registration Algorithm. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:2116224. [PMID: 35083022 PMCID: PMC8786497 DOI: 10.1155/2022/2116224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/11/2021] [Accepted: 12/14/2021] [Indexed: 11/18/2022]
Abstract
The study aims to explore the effect of subclinical diabetic peripheral vascular disease and an epidemiological investigation of colour Doppler ultrasound images based on a logistic regression mathematical model and a medical image registration algorithm. Subclinical diabetes patients were selected as subjects, and after ultrasound colour Doppler ultrasonography of peripheral blood vessels, ultrasound images were taken. The experimental results show that the area under the curve (AUC) predicted by the model was 0.748, the sensitivity was 94.12%, and the specificity was 67.93%. All Δ were smaller than a single pixel. The detection rate of colour Doppler ultrasonography was 82.6%, which was significantly better than that of clinical examination (
). The age, course of disease, SBP, low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and triglyceride (TG) of the peripheral vascular disease group were significantly different from those of the no peripheral vascular disease group (
). The incidence of peripheral vascular diseases and nonperipheral vascular diseases in male patients was remarkably higher than that in female patients (
). Moreover, with the increase of age, the incidence of peripheral vascular disease and nonperipheral vascular disease in diabetic patients showed a trend of gradual increase (
). In summary, the mathematical model and registration method have high accuracy for medical image registration of patients with the diabetes epidemic. In addition, the age, course of disease, SBP, LDL-C, TG, and TC of diabetic patients were significantly different from those of normal people, which can provide a reference for the development of later diabetes epidemiology.
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20
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Chen KY, Wu SM, Tseng CH, Lee KY, Lin YH, Liu HY, Chien LN. Combination therapies with thiazolidinediones are associated with a lower risk of acute exacerbations in new-onset COPD patients with advanced diabetic mellitus: a cohort-based case-control study. BMC Pulm Med 2021; 21:141. [PMID: 33926423 PMCID: PMC8086317 DOI: 10.1186/s12890-021-01505-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 04/19/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The effects of oral antihyperglycaemic drugs (OADs) for type 2 diabetes mellitus (T2DM) on the outcomes of co-existing chronic obstructive pulmonary disease (COPD) patients are not well studied. We examined the association of combinational OADs and the risk of acute exacerbations of COPD (AECOPD) in T2DM patients with co-existing COPD. METHODS A cohort-based case-control study was conducted using data from the National Health Insurance Research Database of Taiwan. Among new-onset COPD-T2DM patients, 65,370 were prescribed metformin and 2nd-line OADs before the date of COPD onset. Each AECOPD case was matched to 4 randomly selected controls according to the propensity score estimated by the patient's baseline characteristics. Conditional logistic regression analysis was performed to estimate the association between AECOPD risk and OAD use. RESULTS Among COPD-T2DM patients, 3355 AECOPD cases and 13,420 matched controls were selected. Of the patients treated with a double combination of oral OADs (n = 12,916), those treated with sulfonylurea (SU) and thiazolidinediones (TZD) had a lower AECOPD risk than the patients who received metformin (MET) and SU, with an adjusted odds ratio (OR) of 0.69 (95% confidence interval [CI] 0.51-0.94, P = 0.02). Of the patients with a triple combination of oral OADs (n = 3859), we found that those treated with MET, SU and TZD had a lower risk of AECOPD (adjusted OR 0.81 (0.68-0.96, P = 0.01) than a combination of MET, SU and α-glucosidase inhibitors (AGIs) regardless of the level of COPD complexity. CONCLUSION Combination therapies with TZD were associated with a reduced risk of AECOPD in advanced T2DM patients with co-existing COPD.
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Affiliation(s)
- Kuan-Yuan Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Sheng-Ming Wu
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Hua Tseng
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kang-Yun Lee
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Huei Lin
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Hung-Yi Liu
- Office of Data, Taipei Medical University, No. 250 Wuxing St., Taipei, 11031, Taiwan
| | - Li-Nien Chien
- Office of Data, Taipei Medical University, No. 250 Wuxing St., Taipei, 11031, Taiwan.
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.
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21
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Papathanassiou E, Papaioannou AI, Papanikolaou I, Antonakis E, Makou I, Hillas G, Mizi E, Bakakos P, Apollonatou V, Verykokou G, Roussakis N, Tsilogianni Z, Papiris S, Loukides S. Glycated Hemoglobin (HbA1c) as a Predictor of Outcomes during Acute Exacerbations of Chronic Obstructive Pulmonary Disease. COPD 2021; 18:219-225. [PMID: 33759663 DOI: 10.1080/15412555.2021.1902491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Systemic inflammation may be the common denominator between COPD and type 2 diabetes and may explain the correlation in both diseases' development and progress. The aim of this prospective observational study is to examine the prognostic value of glycated hemoglobin levels (HbA1c) and HbA1c-adjusted glycemic variables (glycemic gap, stress hyperglycemia ratio και modified stress hyperglycemia ratio) in an acute exacerbation of COPD (AECOPD) as well as in COPD disease's morbidity and mortality during the following year. We evaluated patients hospitalized only for COPD exacerbations. Levels of HbA1c and HbA1c-adjusted glycemic variables were recorded upon admission. The study outcomes included duration of hospital stay, need for mechanical ventilation and exacerbation outcome. All subjects were followed up for one year. A total of 156 patients were included in the study (74.4% men, age [mean ± SD] 72 ± 7 years). Patients (21.8%) had type 2 diabetes and 67.9% of patients were receiving ICS treatment. The median value of HbA1c was 5.9 (IQR: 5.4, 6.5). Necessity for mechanical ventilation was significantly higher for patients with lower values of HbA1c [median: 5.3 (IQR 5.02, 6.3) vs. 5.9 (IQR 5.5, 6.5), p = .038]. However, duration of hospitalization, death during hospitalization as well as the number of new exacerbation events, time to next exacerbation and mortality during the following year did not differ significantly. Moreover, none of the HbA1c-adjusted glycemic variables examined, demonstrated any statistical significance. In conclusion neither the preceding nor the present glycemic state exhibit a predictive value regarding short- or long-term outcomes of an AECOPD.
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Affiliation(s)
- Evgenia Papathanassiou
- Second Respiratory Medicine Department, University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Andriana I Papaioannou
- Second Respiratory Medicine Department, University of Athens, "Attikon" University Hospital, Athens, Greece
| | | | | | - Ioanna Makou
- Respiratory Medicine Department, Corfu General Hospital, Corfu, Greece
| | - Georgios Hillas
- Department of Critical Care and Pulmonary Services, University of Athens, Evangelismos Hospital, Athens, Greece
| | - Eleutheria Mizi
- Department of Critical Care and Pulmonary Services, University of Athens, Evangelismos Hospital, Athens, Greece
| | - Petros Bakakos
- First Respiratory Medicine Department, University of Athens, "Sotiria" Chest Hospital, Athens, Greece
| | - Vasiliki Apollonatou
- Second Respiratory Medicine Department, University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Galateia Verykokou
- Second Respiratory Medicine Department, University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Nikolaos Roussakis
- Second Respiratory Medicine Department, University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Zoe Tsilogianni
- Second Respiratory Medicine Department, University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Spyros Papiris
- Second Respiratory Medicine Department, University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Stelios Loukides
- Second Respiratory Medicine Department, University of Athens, "Attikon" University Hospital, Athens, Greece
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22
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Tinsley IC, Borner T, Swanson ML, Chepurny OG, Doebley SA, Kamat V, Sweet IR, Holz GG, Hayes MR, De Jonghe BC, Doyle RP. Synthesis, Optimization, and Biological Evaluation of Corrinated Conjugates of the GLP-1R Agonist Exendin-4. J Med Chem 2021; 64:3479-3492. [PMID: 33677970 PMCID: PMC8279408 DOI: 10.1021/acs.jmedchem.1c00185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
![]()
Corrination
is the conjugation of a corrin ring containing molecule,
such as vitamin B12 (B12) or B12 biosynthetic precursor
dicyanocobinamide (Cbi), to small molecules, peptides, or proteins
with the goal of modifying pharmacology. Recently, a corrinated GLP-1R
agonist (GLP-1RA) exendin-4 (Ex4) has been shown in vivo to have reduced penetration into the central nervous system relative
to Ex4 alone, producing a glucoregulatory GLP-1RA devoid of anorexia
and emesis. The study herein was designed to optimize the lead conjugate
for GLP-1R agonism and binding. Two specific conjugation sites were
introduced in Ex4, while also utilizing various linkers, so that it
was possible to identify Cbi conjugates of Ex4 that exhibit improved
binding and agonist activity at the GLP-1R. An optimized conjugate
(22), comparable with Ex4, was successfully screened
and subsequently assayed for insulin secretion in rat islets and in vivo in shrews for glucoregulatory and emetic behavior,
relative to Ex4.
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Affiliation(s)
- Ian C Tinsley
- Department of Chemistry, Syracuse University, 111 College Place, Syracuse, New York 13244, United States
| | - Tito Borner
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania 19104, United States
| | - MacKenzie L Swanson
- Department of Chemistry, Syracuse University, 111 College Place, Syracuse, New York 13244, United States
| | - Oleg G Chepurny
- Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York 13210, United States
| | - Sarah A Doebley
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania 19104, United States
| | - Varun Kamat
- Department of Medicine, University of Washington, Medicine Diabetes Institute, Seattle, Washington 98109, United States
| | - Ian R Sweet
- Department of Medicine, University of Washington, Medicine Diabetes Institute, Seattle, Washington 98109, United States
| | - George G Holz
- Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York 13210, United States
| | - Matthew R Hayes
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania 19104, United States
| | - Bart C De Jonghe
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania 19104, United States
| | - Robert P Doyle
- Department of Chemistry, Syracuse University, 111 College Place, Syracuse, New York 13244, United States.,Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York 13210, United States
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23
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Wu TD, Fawzy A, Kinney GL, Bon J, Neupane M, Tejwani V, Hansel NN, Wise RA, Putcha N, McCormack MC. Metformin use and respiratory outcomes in asthma-COPD overlap. Respir Res 2021; 22:70. [PMID: 33637087 PMCID: PMC7908718 DOI: 10.1186/s12931-021-01658-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/08/2021] [Indexed: 01/09/2023] Open
Abstract
Background Metformin is associated with improved respiratory outcomes in asthma; however, metformin in COPD and asthma-COPD overlap (ACO) remains unexplored. Objective To determine the association between metformin use and respiratory outcomes in COPD and ACO. Study design and methods Participants with COPD (FEV1/FVC < 0.70) in the Genetic Epidemiology of COPD study (COPDGene®) were categorized as ACO (n = 510), defined as concurrent physician-diagnosed asthma before age 40 years, or COPD alone (n = 3459). We estimated the association of baseline metformin use with (1) rate of total and severe respiratory exacerbations during follow-up, (2) cross-sectional St. George’s Respiratory Questionnaire (SGRQ) score, six-minute walk distance (6MWD), and post-bronchodilator FEV1 percent predicted (FEV1pp), and (3) 5-year change in SGRQ, 6MWD, and FEV1pp. We also examined change in SGRQ, 6MWD and FEV1pp among participants who initiated metformin during follow-up (n = 108) compared to persistent metformin non-users (n = 2080). Analyses were adjusted for sociodemographic factors, medications, and comorbidities. Results Among participants with ACO, metformin use was associated with lower rate of total (adjusted incidence rate ratio [aIRR] 0.3; 95% confidence interval [95%CI] 0.11, 0.77) and severe exacerbations (aIRR 0.29; 95%CI 0.10, 0.89). Among participants with COPD alone, there was no association between metformin use with total (aIRR 0.98; 95%CI 0.62, 1.5) or severe exacerbations (aIRR 1.3; 95% CI 0.68, 2.4) (p-interaction < 0.05). Metformin use was associated with lower baseline SGRQ score (adjusted mean difference [aMD] − 2.7; 95%CI − 5.3, − 0.2) overall. Metformin initiation was associated with improved SGRQ score (aMD –10.0; 95% CI − 18.7, − 1.2) among participants with ACO but not COPD alone (p-interaction < 0.05). There was no association between metformin use and 6MWD or FEV1pp in any comparison. Conclusions Metformin use was associated with fewer respiratory exacerbations and improved quality of life among individuals with ACO but not COPD alone. Results suggest a potential role for metformin in ACO which requires further prospective study. Trial Registry: NCT00608764
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Affiliation(s)
- Tianshi David Wu
- Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA.,Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St. 5th Floor, Baltimore, MD, 21205, USA
| | - Ashraf Fawzy
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St. 5th Floor, Baltimore, MD, 21205, USA
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Jessica Bon
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Maniraj Neupane
- Department of Critical Care Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Vickram Tejwani
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St. 5th Floor, Baltimore, MD, 21205, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St. 5th Floor, Baltimore, MD, 21205, USA
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St. 5th Floor, Baltimore, MD, 21205, USA
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St. 5th Floor, Baltimore, MD, 21205, USA
| | - Meredith C McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St. 5th Floor, Baltimore, MD, 21205, USA.
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24
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Kobylyansky VI. [The role of counterinsular hormones in the regulation of glucose homeostasis and the pathogenesis of type 2 diabetes mellitus in COPD]. ACTA ACUST UNITED AC 2021; 67:93-101. [PMID: 34004106 PMCID: PMC8926108 DOI: 10.14341/probl12566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 02/03/2021] [Accepted: 02/17/2021] [Indexed: 11/06/2022]
Abstract
The frequent combination of type 2 diabetes mellitus (T2DM) and chronic obstructive pulmonary disease (COPD) is an important socially significant and far from being studied problem. However, only a few works are devoted to it. To solve this problem, we analyzed the possible pathogenetic mechanisms from the standpoint of the impact on glucose homeostasis of the main hormones - insular and contrainsular.The analysis was carried out using various literature databases, including Index Medicus, Scopus, Pub Med, Embase, Cochrane and others for the period, with rare exceptions, for 2000-2020, of which the works devoted directly to the aspect considered in this work were published in the last 5 years.The analysis revealed a mutual aggravating effect of COPD and T2DM, in which COPD plays an initiating role. It also revealed a significant role of counterinsular hormones, which largely determines the nature of the pathogenesis of T2DM in COPD.In addition, the article draws attention to the possible role of genetic factors that can be common for COPD and T2DM and have a significant role in the comorbidity of COPD and T2DM. The data obtained can be used for both diagnostic and therapeutic purposes in the correction of disorders of carbohydrate metabolism in COPD, which is the lot of further research.
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25
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The Impact of Diabetes Mellitus in Patients with Chronic Obstructive Pulmonary Disease (COPD) Hospitalization. J Clin Med 2021; 10:jcm10020235. [PMID: 33440707 PMCID: PMC7827207 DOI: 10.3390/jcm10020235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 01/04/2023] Open
Abstract
(1) Background: Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and mortality worldwide. Diabetes mellitus (DM) has been shown to have adverse inflammatory effects on lung anatomy and physiology. We investigated the impact of DM on COPD patient outcomes during inpatient hospitalization. (2) Methods: We conducted a retrospective analysis using the Nationwide Inpatient Sample (NIS) over the years 2002–2014. Three groups, COPD without diabetes, COPD with diabetes but no complication, and COPD with DM and complication, were analyzed. (3) Results: A total of 7,498,577 were COPD hospitalization; of those, 1,799,637 had DM without complications, and 483,467 had DM with complications. After adjusting for clinical, demographic, and comorbidities, the odds of increased LOS in the COPD/DM with complication were 1.37 (confidence interval (CI): 1.326–1.368), and those of DM without complication were 1.061 (1.052–1.070) when compared with COPD alone. The odds of pneumonia, respiratory failure, stroke, and acute kidney injury were also higher in COPD hospitalizations with DM. Both DM with complication (odds ratio (OR): 0.751 (CI 0.727–0.777)) and DM without complication (OR: 0.635 (CI: 0.596–0.675)) have lesser odds of mortality during hospitalization than with COPD alone. (4) Conclusions: There is a considerable inpatient burden among COPD patients with DM in the United States.
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26
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Lin L, Shi J, Kang J, Wang Q. Analysis of prevalence and prognosis of type 2 diabetes mellitus in patients with acute exacerbation of COPD. BMC Pulm Med 2021; 21:7. [PMID: 33407328 PMCID: PMC7788870 DOI: 10.1186/s12890-020-01371-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/11/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND For patients with acute exacerbation of COPD (AECOPD), type 2 diabetes mellitus (T2DM) as comorbidity have poor outcomes. However, data on the impact of previously diagnosed and new- diagnosed T2DM in such a patient population is lacking. METHODS Inpatients diagnosed with AECOPD in the department of Pulmonary and Critical Care Medicine of The First Hospital of China Medical University during 2011-2017 were enrolled. Data on demography, prevalence of type 2 DM, other comorbidities, hospital stays and laboratory tests (including arterial partial pressure of oxygen [PaO2]) results were recorded. Results were compared with AECOPD patients having previously diagnosed and new-diagnosed type 2 diabetes. Markers associated with development of type 2 DM and the prognosis of AECOPD patients were identified. RESULTS Of the 196 patients enrolled in this study, the overall prevalence of T2DM was 26%. The PaO2 in the newly diagnosed T2DM group was considerably lower versus non-diabetic group. The T2DM group had a longer hospital stay and higher troponin level versus the non-diabetic group. AECOPD patients with T2DM were found to be correlated with hypertension. Age, need for assisted ventilation, increased troponin, and elevated fasting blood glucose on admission were risk factors for death in hospitalized AECOPD patients. CONCLUSIONS AECOPD patients had a higher prevalence of T2DM than the general population; T2DM comorbidity caused lower PaO2, longer hospital stays, and increased troponin. Poor blood glucose control may increase the risk of death in AECOPD patients.
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Affiliation(s)
- Li Lin
- Department of Pulmonary and Critical Care Medicine, Institute of Respiratory Disease, The First Hospital of China Medical University, No. 155 Nanjing Street, North, Shenyang, 110001, China
| | - Jianxin Shi
- Department of Pulmonary and Critical Care Medicine, Institute of Respiratory Disease, The First Hospital of China Medical University, No. 155 Nanjing Street, North, Shenyang, 110001, China
| | - Jian Kang
- Department of Pulmonary and Critical Care Medicine, Institute of Respiratory Disease, The First Hospital of China Medical University, No. 155 Nanjing Street, North, Shenyang, 110001, China
| | - Qiuyue Wang
- Department of Pulmonary and Critical Care Medicine, Institute of Respiratory Disease, The First Hospital of China Medical University, No. 155 Nanjing Street, North, Shenyang, 110001, China.
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27
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Mao X, Liang C, Niu H, Dong F, Huang K, Chen Y, Huang K, Zhan Q, Zhang Y, Huang Y, Yang T, Wang C. Outcomes associated with comorbid diabetes among patients with COPD exacerbation: findings from the ACURE registry. Respir Res 2021; 22:7. [PMID: 33407433 PMCID: PMC7789818 DOI: 10.1186/s12931-020-01607-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/17/2020] [Indexed: 01/01/2023] Open
Abstract
Background Diabetes is a common comorbidity among patients with exacerbation of chronic obstructive pulmonary disease (AECOPD). Diabetes has been reported to be associated with length of stay (LOS), death, and cost among AECOPD patients. However, most studies are retrospective or have small sample sizes. The association for cost has not been researched using diabetes as a main analytic factor. This study aimed to fill gaps mentioned above, to compare basic characteristics between the diabetic and non-diabetic group, and to detect associations between diabetes and clinical outcomes among patients hospitalized with AECOPD. Methods A total of 5334 AECOPD patients, classified into diabetic and non-diabetic group, were included from a prospective multicenter patient registry study. Generalized linear regression and logistic regression were separately used for the association between diabetes and direct hospitalization cost and the association between diabetes and LOS. Results Generally, diabetic patients had a more severe profile, including being older, more overweight or obese, having more former smokers, more emergency room visits in the past 12 months, and more comorbidities occurrence. Diabetic patients also had worse clinical outcomes, including higher cost and longer LOS. Additionally, the generalized linear regression indicated that the marginal mean cost difference between diabetic and non-diabetic patients was RMB (¥) 775.7. Conclusions AECOPD patients with comorbid diabetes had a more severe profile and higher direct hospitalization cost. Diabetes screening and integrated care programs might help reduce the heavy comorbidity and economic burden. Moreover, corticosteroids and metformin could be considered in the treatment of these patients. Trial registration Clinicaltrials.gov with the identifier NCT0265752.
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Affiliation(s)
- Xihua Mao
- Chinese Alliance for Respiratory Diseases in Primary Care, Beijing, China
| | - Chen Liang
- Chinese Alliance for Respiratory Diseases in Primary Care, Beijing, China
| | - Hongtao Niu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Fen Dong
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China.,Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Ke Huang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Yahong Chen
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Kewu Huang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing, China.,Department of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Qingyuan Zhan
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Yaowen Zhang
- Chinese Alliance for Respiratory Diseases in Primary Care, Beijing, China
| | - Yin Huang
- Chinese Alliance for Respiratory Diseases in Primary Care, Beijing, China
| | - Ting Yang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China. .,National Clinical Research Center for Respiratory Diseases, Beijing, China. .,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China.
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China. .,National Clinical Research Center for Respiratory Diseases, Beijing, China. .,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China. .,Chinese Academy of Medical Sciences and Peking Union Medical College, 9 Dongdan 3rd Alley, Dong Dan, Dongcheng, Beijing, 100730, China.
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28
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Wu SW, Ho YC, Luo CW, Chen HY, Su CH, Kuan YH. Oral treatment for diabetes using α-glucosidase inhibitors was a risk factor for chronic obstructive pulmonary disease: a cohort study. Int J Med Sci 2021; 18:778-784. [PMID: 33437213 PMCID: PMC7797545 DOI: 10.7150/ijms.55361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/17/2020] [Indexed: 12/26/2022] Open
Abstract
Objectives: Currently, diabetes mellitus (DM) and chronic obstructive pulmonary disease (COPD) have proven to be risk factors for each other. This study aimed to determine the risk relationship between COPD and five common oral medications for DM among patients with DM. Methods: This population-based cohort study was conducted from 2008 to 2013. Patient data were retrieved from the Longitudinal Health Insurance Database (LHID) of the National Health Insurance Research Database (NHIRD). After pairing by gender, age, and index date, time-to-event analysis and multiple regression analysis were performed to determine the factors associated with COPD in patients taking oral medication for DM, including age, gender, income, and comorbidities. We identified 1,028 patients who took oral medication for DM and 1,028 controls who did not take oral medication for DM. Results: We observed that the use of α-glucosidase inhibitors was associated with a higher risk of COPD (hazard ratio [HR]: 1.964, 95% confidence interval [CI]: 1.207-2.380). Furthermore, compared with the control group, α-glucosidase inhibitor users had a higher risk of COPD (HR: 2.295, 95% CI: 1.304-4.038), and no significant difference was observed in other oral medications for DM. Conclusions: Based on present results, we could suggest that patients with DM who used α-glucosidase inhibitors are probably a higher risk of COPD. We recommend that in the future, treatment with α-glucosidase inhibitors upregulate the occurrence of COPD might through gastrointestinal side effects and malnutrition.
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Affiliation(s)
- Sheng-Wen Wu
- Division of Nephrology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- The School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yung-Chyuan Ho
- School of Medical Applied Chemistry, Chung Shan Medical University, Taichung, Taiwan
| | - Ci-Wen Luo
- Department of Pharmacology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Hung-Yi Chen
- School of Pharmacy, China Medical University, Taichung, Taiwan
| | - Chun-Hung Su
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Internal Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Hsiang Kuan
- Department of Pharmacology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
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Easter M, Bollenbecker S, Barnes JW, Krick S. Targeting Aging Pathways in Chronic Obstructive Pulmonary Disease. Int J Mol Sci 2020; 21:E6924. [PMID: 32967225 PMCID: PMC7555616 DOI: 10.3390/ijms21186924] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/05/2020] [Accepted: 09/15/2020] [Indexed: 12/17/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) has become a global epidemic and is the third leading cause of death worldwide. COPD is characterized by chronic airway inflammation, loss of alveolar-capillary units, and progressive decline in lung function. Major risk factors for COPD are cigarette smoking and aging. COPD-associated pathomechanisms include multiple aging pathways such as telomere attrition, epigenetic alterations, altered nutrient sensing, mitochondrial dysfunction, cell senescence, stem cell exhaustion and chronic inflammation. In this review, we will highlight the current literature that focuses on the role of age and aging-associated signaling pathways as well as their impact on current treatment strategies in the pathogenesis of COPD. Furthermore, we will discuss established and experimental COPD treatments including senolytic and anti-aging therapies and their potential use as novel treatment strategies in COPD.
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Affiliation(s)
- Molly Easter
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA; (M.E.); (S.B.); (J.W.B.)
| | - Seth Bollenbecker
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA; (M.E.); (S.B.); (J.W.B.)
| | - Jarrod W. Barnes
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA; (M.E.); (S.B.); (J.W.B.)
- Gregory Fleming James Cystic Fibrosis Center, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Stefanie Krick
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA; (M.E.); (S.B.); (J.W.B.)
- Gregory Fleming James Cystic Fibrosis Center, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Moll M, Qiao D, Regan EA, Hunninghake GM, Make BJ, Tal-Singer R, McGeachie MJ, Castaldi PJ, San Jose Estepar R, Washko GR, Wells JM, LaFon D, Strand M, Bowler RP, Han MK, Vestbo J, Celli B, Calverley P, Crapo J, Silverman EK, Hobbs BD, Cho MH. Machine Learning and Prediction of All-Cause Mortality in COPD. Chest 2020; 158:952-964. [PMID: 32353417 PMCID: PMC7478228 DOI: 10.1016/j.chest.2020.02.079] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND COPD is a leading cause of mortality. RESEARCH QUESTION We hypothesized that applying machine learning to clinical and quantitative CT imaging features would improve mortality prediction in COPD. STUDY DESIGN AND METHODS We selected 30 clinical, spirometric, and imaging features as inputs for a random survival forest. We used top features in a Cox regression to create a machine learning mortality prediction (MLMP) in COPD model and also assessed the performance of other statistical and machine learning models. We trained the models in subjects with moderate to severe COPD from a subset of subjects in Genetic Epidemiology of COPD (COPDGene) and tested prediction performance in the remainder of individuals with moderate to severe COPD in COPDGene and Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE). We compared our model with the BMI, airflow obstruction, dyspnea, exercise capacity (BODE) index; BODE modifications; and the age, dyspnea, and airflow obstruction index. RESULTS We included 2,632 participants from COPDGene and 1,268 participants from ECLIPSE. The top predictors of mortality were 6-min walk distance, FEV1 % predicted, and age. The top imaging predictor was pulmonary artery-to-aorta ratio. The MLMP-COPD model resulted in a C index ≥ 0.7 in both COPDGene and ECLIPSE (6.4- and 7.2-year median follow-ups, respectively), significantly better than all tested mortality indexes (P < .05). The MLMP-COPD model had fewer predictors but similar performance to that of other models. The group with the highest BODE scores (7-10) had 64% mortality, whereas the highest mortality group defined by the MLMP-COPD model had 77% mortality (P = .012). INTERPRETATION An MLMP-COPD model outperformed four existing models for predicting all-cause mortality across two COPD cohorts. Performance of machine learning was similar to that of traditional statistical methods. The model is available online at: https://cdnm.shinyapps.io/cgmortalityapp/.
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Affiliation(s)
- Matthew Moll
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Dandi Qiao
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | - Elizabeth A Regan
- Division of Pulmonary and Critical Care Medicine, University of Colorado, Denver, CO
| | - Gary M Hunninghake
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Barry J Make
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO
| | | | - Michael J McGeachie
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | - Peter J Castaldi
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | - Raul San Jose Estepar
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - James M Wells
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - David LaFon
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Matthew Strand
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO
| | - Russell P Bowler
- Division of Pulmonary and Critical Care Medicine, University of Colorado, Denver, CO; Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI
| | - Jorgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre, The University of Manchester and the Manchester University NHS Foundation Trust, Manchester, England
| | - Bartolome Celli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Peter Calverley
- Department of Medicine, University of Liverpool, Liverpool, England
| | - James Crapo
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Brian D Hobbs
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA.
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Vakharia RM, Adams CT, Anoushiravani AA, Ehiorobo JO, Mont MA, Roche MW. Chronic Obstructive Pulmonary Disease Is Associated With Higher Rates of Venous Thromboemboli Following Primary Total Knee Arthroplasty. J Arthroplasty 2020; 35:2066-2071.e9. [PMID: 32349891 DOI: 10.1016/j.arth.2020.03.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/24/2020] [Accepted: 03/31/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is discordance in the literature regarding the presence of chronic obstructive pulmonary disease (COPD) and the development of venous thromboemboli (VTEs). Therefore, the purpose of this study is to determine whether COPD patients undergoing primary total knee arthroplasty (TKA) have higher rates of (1) in-hospital lengths of stay (LOS); (2) readmissions; (3) VTEs; and (4) costs of care. METHODS COPD patients undergoing primary TKA were identified and matched to controls in a 1:5 ratio by age, gender, and medical comorbidities. Patients with a history of VTEs or hypercoagulable states were excluded. The query yielded 211,378 patients in the study (n = 35,230) and control (n = 176,148) cohorts. Outcomes analyzed included in-hospital LOS, readmission rates, VTEs, and costs of care. A P-value less than .01 was considered statistically significant. RESULTS COPD patients were found to have significantly longer in-hospital LOS (4 vs 3 days, P < .0001). Study group patients were also found to have significantly higher incidence and odds ratio (OR) of readmission rates (20.9% vs 16.3%; OR 1.36, P < .0001) and VTEs (1.75 vs .93; OR 1.18, P < .0001). Additionally, the study demonstrated that COPD patients incurred higher 90-day episode-of-care costs ($15,626.85 vs $14,471.29, P < .0001). CONCLUSION After adjusting for confounding variables, our study found an association between COPD and higher rates of developing VTEs following primary TKA. The study can be used by orthopedic surgeons to adequately counsel and educate these patients of the potential complications which may arise following their TKA.
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Affiliation(s)
- Rushabh M Vakharia
- Department of Orthopaedic Surgery, Holy Cross Hospital, Orthopaedic Research Institute, Fort Lauderdale, FL
| | - Curtis T Adams
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY
| | | | - Joseph O Ehiorobo
- Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY
| | - Michael A Mont
- Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY; Department of Orthopaedic Surgery, Cleveland Clinic Hospital, Cleveland, OH
| | - Martin W Roche
- Department of Orthopaedic Surgery, Holy Cross Hospital, Orthopaedic Research Institute, Fort Lauderdale, FL
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Soh JGS, Wong WP, Mukhopadhyay A, Quek SC, Tai BC. Predictors of 30-day unplanned hospital readmission among adult patients with diabetes mellitus: a systematic review with meta-analysis. BMJ Open Diabetes Res Care 2020; 8:8/1/e001227. [PMID: 32784248 PMCID: PMC7418689 DOI: 10.1136/bmjdrc-2020-001227] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 02/06/2023] Open
Abstract
Adult patients with diabetes mellitus (DM) represent one-fifth of all 30-day unplanned hospital readmissions but some may be preventable through continuity of care with better DM self-management. We aim to synthesize evidence concerning the association between 30-day unplanned hospital readmission and patient-related factors, insurance status, treatment and comorbidities in adult patients with DM. We searched full-text English language articles in three electronic databases (MEDLINE, Embase and CINAHL) without confining to a particular publication period or geographical area. Prospective and retrospective cohort and case-control studies which identified significant risk factors of 30-day unplanned hospital readmission were included, while interventional studies were excluded. The study participants were aged ≥18 years with either type 1 or 2 DM. The random effects model was used to quantify the overall effect of each factor. Twenty-three studies published between 1998 and 2018 met the selection criteria and 18 provided information for the meta-analysis. The data were collected within a period ranging from 1 to 15 years. Although patient-related factors such as age, gender and race were identified, comorbidities such as heart failure (OR=1.81, 95% CI 1.67 to 1.96) and renal disease (OR=1.69, 95% CI 1.34 to 2.12), as well as insulin therapy (OR=1.45, 95% CI 1.24 to 1.71) and insurance status (OR=1.41, 95% CI 1.22 to 1.63) were stronger predictors of 30-day unplanned hospital readmission. The findings may be used to target DM self-management education at vulnerable groups based on comorbidities, insurance type, and insulin therapy.
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Affiliation(s)
- Jade Gek Sang Soh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Health and Social Sciences, Singapore Institute of Technology, Singapore
| | - Wai Pong Wong
- Health and Social Sciences, Singapore Institute of Technology, Singapore
| | - Amartya Mukhopadhyay
- Respiratory and Critical Care Medicine, National University Hospital, Singapore
- National University Singapore, Yong Loo Lin School of Medicine, Singapore
| | - Swee Chye Quek
- Department of Paediatrics, National University Hospital, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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CAUSES, mortality rates and risk factors of death in community-dwelling Europeans aged 50 years and over: Results from the Survey of Health, Ageing and Retirement in Europe 2013-2015. Arch Gerontol Geriatr 2020; 89:104035. [PMID: 32325305 DOI: 10.1016/j.archger.2020.104035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/11/2019] [Accepted: 02/18/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine mortality rates and to rank the causes and predictors of mortality using a wide range of sociodemographic and clinical variables. MATERIALS AND METHODS It is a prospective population-based cohort study of adults living in the community, 2013-15 N = 48,691, age ≥50; deceased = 1,944. Clinical and sociodemographic data were obtained from the Survey of Health, Ageing and Retirement in Europe SHARE: Age, Gender, Marital Status, Years of Schooling, Income, Loneliness, Cognition, Self-Rated Health, Diseases, Activities of daily living ADL, and Frailty. Mortality rates were calculated. A Cox proportional hazards model were used to determine risk-adjusted mortality ratios. RESULTS The crude mortality rate was 18.39 (1000 person-years at risk), (99 % CI, 18.37-18.42). The factors most associated with an increased mortality risk were older age, lower self-rated health, lower cognition, male gender, ADL deficits, higher comorbidity, frailty and loneliness. The diseases with a higher mortality risk were: cancer (Hazard ratio, HR = 2.67), dementia (HR = 2.19), depressive symptoms (HR = 2.10), fractures (hip, femur) (HR = 1.57), stroke (HR = 1.55), chronic lung disease (HR = 1.52), diabetes (HR = 1.36) and heart attack (HR = 1.21). CONCLUSIONS The main mortality risk factors, associated independently in the eight diseases were: older age, poor self-rated health, ADL deficits, male gender, lower cognition, comorbidity and the presence of depressive symptoms, with a different influence in the European regions. The need to evaluate and treat the depressive symptoms that accompanies diseases with higher risk of mortality is stressed.
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Metoprolol Versus Carvedilol in Patients With Heart Failure, Chronic Obstructive Pulmonary Disease, Diabetes Mellitus, and Renal Failure. Am J Cardiol 2020; 125:1069-1076. [PMID: 32000982 DOI: 10.1016/j.amjcard.2019.12.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/18/2019] [Accepted: 12/23/2019] [Indexed: 12/11/2022]
Abstract
This study compared the survival and the risk of heart failure (HF), chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), hypoglycemia, and renal failure (RF) hospitalizations in geriatric patients exposed to carvedilol or metoprolol. Data sources were Danish administrative registers. Patients aged ≥65 and having HF, COPD, and DM were followed for 1 year from the first β-blocker prescription redemption. Patients' characteristics were used to 1:1 propensity score match carvedilol and metoprolol users. A Cox regression model was used to compute the hazard ratio (HR) of study outcomes. For statistically significant associations, a conditional inference tree was used to assess predictors most associated with the outcome. In total, 1,424 patients were included. No statistically significant differences were observed for survival (HR 0.86; 95% confidence interval [CI] 0.67 to 1.11, p = 0.240) between carvedilol/metoprolol users. The same applied to COPD (HR 0.88; 95% CI 0.75 to 1.05, p = 0.177), DM (HR 0.95; 95% CI 0.82 to 1.10, p = 0.485), hypoglycemia (HR 0.88; 95% CI 0.47 to 1.67, p = 0.707), and RF (HR 1.25; 95% CI 0.93 to 1.69, p = 0.142) hospitalizations. Carvedilol users had a 38% higher hazard then metoprolol users of HF hospitalization during the follow-up period (HR 1.38; 95% CI 1.19 to 1.60, p <0.001). Artificial intelligence identified carvedilol exposure as the most important predictor for HF hospitalization. In conclusion, we found an increased risk of HF hospitalization for carvedilol users with this triad of diseases but no statistically significant differences in survival or risk of COPD, DM, hypoglycemia, and RF hospitalizations.
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Blagev DP, Collingridge DS, Rea S, Carey KA, Mularski RA, Zeng S, Arjomandi M, Press VG. Laboratory-based Intermountain Validated Exacerbation (LIVE) Score stability in patients with chronic obstructive pulmonary disease. BMJ Open Respir Res 2020; 7:e000450. [PMID: 32060034 PMCID: PMC7047500 DOI: 10.1136/bmjresp-2019-000450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 11/12/2019] [Accepted: 12/10/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Laboratory-based Intermountain Validated Exacerbation (LIVE) Score is associated with mortality and chronic obstructive pulmonary disease (COPD) exacerbation risk across multiple health systems. However, whether the LIVE Score and its associated risk is a stable patient characteristic is unknown. METHODS We validated the LIVE Score in a fourth health system. Then we determined the LIVE Score stability in a retrospective cohort of 98 766 patients with COPD in four health systems where it was previously validated. We assessed whether LIVE Scores changed or remained the same over time. Stability was defined as a majority of surviving patients having the same LIVE Score 4 years later. RESULTS The LIVE Score separated patients into three LIVE Score risk groups of low, medium, and high mortality and LIVE Score stability. Mortality ranged from 6.2% for low-risk LIVE to 45.8% for high-risk LIVE (p<0.001). We found that low-risk LIVE groups were stable and high-risk LIVE groups were unstable. Low-risk LIVE group patients remained low risk, but few high-risk LIVE group patients remained high risk (79.0% high vs 48.1% medium vs 8.8% low, p<0.001 for all pairwise comparisons). CONCLUSION The LIVE Score identifies three major clinically actionable cohorts: a stable low-risk LIVE group, an unstable high-risk LIVE group with high mortality rates, and a medium-risk LIVE group. These observations further our understanding of how existing data used to calculate the LIVE Score may target interventions across risk cohorts of patients with COPD in a health system.
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Affiliation(s)
- Denitza P Blagev
- Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah, USA
- Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Dave S Collingridge
- Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah, USA
| | - Susan Rea
- Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah, USA
| | - Kyle A Carey
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Richard A Mularski
- Department of Medicine, Kaiser Permanente Center for Health Research Northwest Region, Portland, Oregon, USA
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Siyang Zeng
- Medicine, University of California San Francisco, San Francisco, California, USA
- Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Mehrdad Arjomandi
- Medicine, University of California San Francisco, San Francisco, California, USA
- Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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Zhou S, Dai YM, Zeng XF, Chen HZ. Circadian Clock and Sirtuins in Diabetic Lung: A Mechanistic Perspective. Front Endocrinol (Lausanne) 2020; 11:173. [PMID: 32308644 PMCID: PMC7145977 DOI: 10.3389/fendo.2020.00173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 03/10/2020] [Indexed: 12/16/2022] Open
Abstract
Diabetes-induced tissue injuries in target organs such as the kidney, heart, eye, liver, skin, and nervous system contribute significantly to the morbidity and mortality of diabetes. However, whether the lung should be considered a diabetic target organ has been discussed for decades. Accumulating evidence shows that both pulmonary histological changes and functional abnormalities have been observed in diabetic patients, suggesting that the lung is a diabetic target organ. Mechanisms underlying diabetic lung are unclear, however, oxidative stress, systemic inflammation, and premature aging convincingly contribute to them. Circadian system and Sirtuins have been well-documented to play important roles in above mechanisms. Circadian rhythms are intrinsic mammalian biological oscillations with a period of near 24 h driven by the circadian clock system. This system plays an important role in the regulation of energy metabolism, oxidative stress, inflammation, cellular proliferation and senescence, thus impacting metabolism-related diseases, chronic airway diseases and cancers. Sirtuins, a family of adenine dinucleotide (NAD+)-dependent histone deacetylases, have been demonstrated to regulate a series of physiological processes and affect diseases such as obesity, insulin resistance, type 2 diabetes (T2DM), heart disease, cancer, and aging. In this review, we summarize recent advances in the understanding of the roles of the circadian clock and Sirtuins in regulating cellular processes and highlight the potential interactions of the circadian clock and Sirtuins in the context of diabetic lung.
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Affiliation(s)
- Shuang Zhou
- Department of Rheumatology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Shuang Zhou
| | - Yi-Min Dai
- State Key Laboratory of Medical Molecular Biology, Department of Biochemistry and Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Feng Zeng
- Department of Rheumatology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hou-Zao Chen
- State Key Laboratory of Medical Molecular Biology, Department of Biochemistry and Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Hou-Zao Chen ;
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Sawalha S, Hedman L, Backman H, Stenfors N, Rönmark E, Lundbäck B, Lindberg A. The impact of comorbidities on mortality among men and women with COPD: report from the OLIN COPD study. Ther Adv Respir Dis 2019; 13:1753466619860058. [PMID: 31291820 PMCID: PMC6624914 DOI: 10.1177/1753466619860058] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Comorbidities probably contribute to the increased mortality observed among subjects with chronic obstructive pulmonary disease (COPD), but sex differences in the prognostic impact of comorbidities have rarely been evaluated in population-based studies. The aim of this study was to evaluate the impact of common comorbidities, cardiovascular disease (CVD), diabetes mellitus (DM), and anxiety/depression (A/D), on mortality among men and women with and without airway obstruction in a population-based study. METHODS All subjects with airway obstruction [forced expiratory volume in 1 second (FEV1)/(forced) vital capacity ((F)VC) <0.70, n = 993] were, together with age- and sex-matched referents, identified after examinations of population-based cohorts in 2002-2004. Spirometric groups: normal lung function (NLF) and COPD (post-bronchodilator FEV1/(F)VC <0.70) and additionally, LLN-COPD (FEV1/(F)VC <lower limit of normal). Mortality data was collected until December 2015. RESULTS In COPD, the prevalence of CVD and DM was higher in men, whereas the prevalence of A/D was higher in women. The cumulative mortality was significantly higher in COPD than NLF, and higher in men than women in both groups. Among women with COPD, CVD and A/D but not DM increased the risk of death independent of age, body mass index, smoking habits, and disease severity, whereas among men DM and A/D but not CVD increased the risk for death. When the LLN criterion was applied, the pattern was similar. CONCLUSION There were sex-dependent differences regarding the impact of comorbidities on prognosis in COPD. Even though the prevalence of CVD was higher in men, the impact of CVD on mortality was higher in women, and despite higher prevalence of A/D in women, the impact on mortality was similar in both sexes. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Sami Sawalha
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.,Division of Respiratory Medicine, Sunderby Hospital, 971 80 Luleå, Sweden
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, The OLIN unit, Section of Sustainable Health, Umeå University, Umeå, Sweden.,Department of Health Science, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| | - Helena Backman
- Department of Public Health and Clinical Medicine, The OLIN unit, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Nikolai Stenfors
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University. Umeå, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, The OLIN unit, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Bo Lundbäck
- Krefting Research center, Institution of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University. Umeå, Sweden
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Incidence of type II diabetes in chronic obstructive pulmonary disease: a nested case-control study. NPJ Prim Care Respir Med 2019; 29:28. [PMID: 31308364 PMCID: PMC6629671 DOI: 10.1038/s41533-019-0138-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 06/17/2019] [Indexed: 12/20/2022] Open
Abstract
We investigated the incidence of type II diabetes mellitus (T2DM) among people with COPD and whether exposure to inhaled corticosteroid (ICS) and exacerbation status was associated with T2DM. This descriptive cohort study used primary care data from the Clinical Practice Research Datalink (CPRD). The patient cohort included people with a diagnosis of COPD and previous smoking history registered at a CPRD practice between January 2010 and December 2016. We determined incidence rates by age, gender and deprivation. Using a nested case-control design-where cases and controls are drawn from the cohort population-we matched 1:5 with patients by age, gender and GP practice and estimated odds of T2DM using logistic regression (adjusting for smoking status, deprivation, BMI, hypertension, coronary heart disease and heart failure). We identified 220,971 COPD patients; mean age at COPD diagnosis was 66 years (SD 12) and 54% were male. The incidence rate of T2DM in COPD patients was 1.26 per 100 patient years (95% CI: 1.24-1.28) and was higher among men (1.32 vs 1.18 among women). The adjusted odds ratio for T2DM was 1.47 (95% CI: 1.36-1.60) among frequent exacerbators (≥2 treated exacerbations per year) compared to infrequent exacerbators and the odds ratio for patients receiving high-dose ICS (>800 mcg budesonide equivalent dose) was 1.73 (95% CI 1.65-1.82) compared to patients receiving no ICS therapy. Incidence of T2DM among COPD patients is high and exposure to ICS and frequent exacerbations are associated with a higher risk of T2DM among patients with COPD.
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Ho TW, Huang CT, Tsai YJ, Lien ASY, Lai F, Yu CJ. Metformin use mitigates the adverse prognostic effect of diabetes mellitus in chronic obstructive pulmonary disease. Respir Res 2019; 20:69. [PMID: 30953517 PMCID: PMC6451256 DOI: 10.1186/s12931-019-1035-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/26/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Among patients with chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM) is a common comorbidity and is probably associated with increased systemic inflammation and worse prognosis. Metformin, with its pleiotropic anti-inflammatory and antioxidant actions, may offer theoretical benefits in COPD patients with DM. Thus, this study aimed to investigate the effects of DM and metformin use on mortality in the clinical trajectory of COPD. METHODS This was a retrospective cohort study comprising patients with spirometry-confirmed COPD and an age of ≥40 years from 2008 to 2014. The primary outcome of interest was all-cause mortality. We evaluated the effects of DM on mortality through the clinical course of COPD and we also assessed the impact of metformin use on survival of the COPD population. RESULTS Among 4231 COPD patients, 556 (13%) had DM, and these patients had 1.62 times higher hazards of 2-year mortality than those without DM (95% confidence interval [CI], 1.15-2.28) after adjusting for age, gender, COPD stage, comorbidities and prior COPD hospitalization. Over a 2-year period, metformin users had a significantly lower risk of death (hazard ratio, 0.46; 95% CI, 0.23-0.92) compared with non-metformin users in patients with coexistent COPD and DM. Moreover, metformin users had similar survival to COPD patients without DM. CONCLUSIONS This study shows that DM is associated with an increased risk of death in COPD patients and metformin use seems to mitigate the hazard. Our findings suggest a potential role of metformin in the management of DM in COPD.
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Affiliation(s)
- Te-Wei Ho
- Graduate Institute of Biomedical Electronics and Bioinformatics, College of Electrical Engineering and Computer Science, National Taiwan University, Taipei, Taiwan
- Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Ta Huang
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100 Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ju Tsai
- Graduate Institute of Biomedical and Pharmaceutical Science, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Angela Shin-Yu Lien
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital Linkou Branch, Taoyuan City, Taiwan
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and Bioinformatics, College of Electrical Engineering and Computer Science, National Taiwan University, Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100 Taiwan
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Pérez-Bautista O, Montaño M, Pérez-Padilla R, Zúñiga-Ramos J, Camacho-Priego M, Barrientos-Gutiérrez T, Buendía-Roldan I, Velasco-Torres Y, Ramos C. Women with COPD by biomass show different serum profile of adipokines, incretins, and peptide hormones than smokers. Respir Res 2018; 19:239. [PMID: 30514305 PMCID: PMC6280373 DOI: 10.1186/s12931-018-0943-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/19/2018] [Indexed: 01/27/2023] Open
Abstract
Background The main causes of COPD are tobacco smoking (COPD-TS) and biomass smoke exposure (COPD-BS). COPD-TS is known to induce changes in adipokines, incretins, and peptide hormones, frequent biomarkers of inflammation; however, it is unknown if similar changes occur in COPD-BS. Methods Clinical and physiological characteristics, and serum concentration of C-peptide, ghrelin, GIP, GLP-1, glucagon, insulin, leptin, PAI-1, resistin, and visfatin were measured in women with COPD-BS, COPD-TS, and healthy controls. Data were compared with one-way ANOVA and Tukey’s post hoc test; nonparametric were expressed as median (interquartile ranges), with Kruskal-Wallis and Dunn’s post-hoc test. Multivariate analysis, age, BMI, MS, and FEV1% pred with levels of inflammatory mediators in COPD women. Results FEV1% pred, FVC% pred, and FEV1/FVC ratio were decremented in COPD. In COPD-TS increased C-peptide, ghrelin, GIP, GLP-1, and leptin, and reduced glucagon, PAI-1, resistin, and visfatin. In COPD-BS enlarged ghrelin, insulin, leptin, and PAI-1 comparatively with COPD-TS and control, while C-peptide and GLP-1 relatively with controls; conversely, glucagon, and resistin were reduced. Multivariate analysis showed association of ghrelin, insulin, PAI-1, and visfatin with BS exposure. Conclusions women with COPD-BS have a distinct profile of adipokines, incretins, and peptide hormones, and specifically with ghrelin, insulin, PAI-1, and visfatin related to BS exposure.
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Affiliation(s)
- Oliver Pérez-Bautista
- Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INERICV), Ciudad de México, Mexico
| | - Martha Montaño
- Departamento de Investigación en Fibrosis Pulmonar, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INERICV), Talpan 4502, C.P. 14080, Ciudad de México, Mexico
| | - Rogelio Pérez-Padilla
- Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INERICV), Ciudad de México, Mexico
| | - Joaquín Zúñiga-Ramos
- Laboratorio de Inmunobiología y Genética, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INERICV), Ciudad de México, Mexico
| | - Mariana Camacho-Priego
- Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INERICV), Ciudad de México, Mexico
| | - Tonatiuh Barrientos-Gutiérrez
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Morelos, Mexico
| | - Ivette Buendía-Roldan
- Departamento de Investigación en Fibrosis Pulmonar, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INERICV), Talpan 4502, C.P. 14080, Ciudad de México, Mexico
| | - Yadira Velasco-Torres
- Doctorado en Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana-Xochimilco (UAMX), Ciudad de México, Mexico
| | - Carlos Ramos
- Departamento de Investigación en Fibrosis Pulmonar, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INERICV), Talpan 4502, C.P. 14080, Ciudad de México, Mexico.
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Viglino D, Plazanet A, Bailly S, Benmerad M, Jullian-Desayes I, Tamisier R, Leroy V, Zarski JP, Maignan M, Joyeux-Faure M, Pépin JL. Impact of Non-alcoholic Fatty Liver Disease on long-term cardiovascular events and death in Chronic Obstructive Pulmonary Disease. Sci Rep 2018; 8:16559. [PMID: 30410123 PMCID: PMC6224555 DOI: 10.1038/s41598-018-34988-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/18/2018] [Indexed: 12/17/2022] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) and Non-Alcoholic Fatty Liver Disease (NAFLD) both independently increase cardiovascular risk. We hypothesized that NAFLD might increase the incidence of cardiovascular disease and death in COPD patients. The relationship between NAFLD, incident cardiovascular events, and death was assessed in a prospective cohort of COPD patients with 5-year follow-up. Noninvasive algorithms combining biological parameters (FibroMax®) were used to evaluate steatosis, non-alcoholic steatohepatitis (NASH) and liver fibrosis. Univariate and multivariate Cox regression models were used to assess the hazard for composite outcome at the endpoint (death or cardiovascular event) for each liver pathology. In 111 COPD patients, 75% exhibited liver damage with a prevalence of steatosis, NASH and fibrosis of 41%, 37% and 61%, respectively. During 5-year follow-up, 31 experienced at least one cardiovascular event and 7 died. In univariate analysis, patients with liver fibrosis had more cardiovascular events and higher mortality (Hazard ratio [95% CI]: 2.75 [1.26; 6.03]) than those with no fibrosis; this remained significant in multivariate analysis (Hazard ratio [95% CI]: 2.94 [1.18; 7.33]). We also found that steatosis and NASH were not associated with increased cardiovascular events or mortality. To conclude, early assessment of liver damage might participate to improve cardiovascular outcomes in COPD patients.
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Affiliation(s)
- Damien Viglino
- Emergency Department, Grenoble Alpes University Hospital, Grenoble, France
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
| | - Anais Plazanet
- Emergency Department, Grenoble Alpes University Hospital, Grenoble, France
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
| | - Sebastien Bailly
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Meriem Benmerad
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Ingrid Jullian-Desayes
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Renaud Tamisier
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Vincent Leroy
- Hepatogastroenterology Department, Grenoble Alpes University Hospital, Grenoble, France
- INSERM U823, IAPC Institute for Advanced Biosciences, University Grenoble Alpes, Grenoble, France
| | - Jean-Pierre Zarski
- Hepatogastroenterology Department, Grenoble Alpes University Hospital, Grenoble, France
- INSERM U823, IAPC Institute for Advanced Biosciences, University Grenoble Alpes, Grenoble, France
| | - Maxime Maignan
- Emergency Department, Grenoble Alpes University Hospital, Grenoble, France
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
| | - Marie Joyeux-Faure
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Pépin
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France.
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Takahashi T, Yoshihisa A, Sugimoto K, Yokokawa T, Misaka T, Kaneshiro T, Oikawa M, Kobayashi A, Nakazato K, Ishida T, Takeishi Y. Associations between diabetes mellitus and pulmonary hypertension in chronic respiratory disease patients. PLoS One 2018; 13:e0205008. [PMID: 30300400 PMCID: PMC6177140 DOI: 10.1371/journal.pone.0205008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/18/2018] [Indexed: 12/13/2022] Open
Abstract
Background Pulmonary hypertension (PH) is a common complication of chronic respiratory disease. Recent studies have reported diabetes mellitus (DM) to be a poor prognostic factor in patients with chronic respiratory disease, including chronic obstructive pulmonary disease or interstitial pneumoniae. However, the association between DM and PH in chronic respiratory disease remains unclear. In this study, we aimed to investigate whether DM is a predictor of PH in patients with chronic respiratory disease. Methods We prospectively analyzed 386 patients in our hospital with chronic respiratory disease. An echocardiographic pressure gradient between the right atrium and the right ventricle of ≥ 40 mmHg was defined as PH. We compared the clinical characteristics and impact of DM between chronic respiratory disease patients with and those without PH. Results Of the 386 patients, 42 (10.9%) were diagnosed as having PH. The PH group had higher modified medical research council (mMRC) grade and complication rate of DM, but not hypertension and hyperlipidemia, when compared to the non-PH group. Multivariable logistic regression analysis revealed that mMRC scale (odds ratio 1.702, 95% confidence interval, 1.297 to 2.232, P < 0.001) and presence of DM (odd ratio 2.935, 95% confidence interval, 1.505 to 5.725, P = 0.002) were associated with PH in chronic respiratory disease patients. Conclusion DM is potentially associated with PH and is an independent factor for prediction of PH in patients with chronic respiratory disease.
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Affiliation(s)
- Tomoko Takahashi
- Clinical Research Center, Fukushima Medical University Hospital, Fukushima, Japan
| | - Akiomi Yoshihisa
- Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Fukushima, Japan
| | - Koichi Sugimoto
- Department of Pulmonary Hypertension, Fukushima Medical University, Fukushima, Japan
- * E-mail:
| | - Tetsuro Yokokawa
- Department of Pulmonary Hypertension, Fukushima Medical University, Fukushima, Japan
| | - Tomofumi Misaka
- Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Fukushima, Japan
| | - Takashi Kaneshiro
- Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, Fukushima, Japan
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Atsushi Kobayashi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kazuhiko Nakazato
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takafumi Ishida
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
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Ho TW, Ruan SY, Huang CT, Tsai YJ, Lai F, Yu CJ. Validity of ICD9-CM codes to diagnose chronic obstructive pulmonary disease from National Health Insurance claim data in Taiwan. Int J Chron Obstruct Pulmon Dis 2018; 13:3055-3063. [PMID: 30323577 PMCID: PMC6174682 DOI: 10.2147/copd.s174265] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose Claim data from Taiwan’s National Health Insurance (NHI) database have previously been utilized in the study of COPD. However, there are limited data on the positive predictive value of claim data for COPD diagnosis. Therefore, this study aimed to characterize and validate the COPD cohort identified from the NHI research database. Methods This cross-sectional study compared records from claim data with those from a medical center. From 2007 to 2014, a COPD cohort was constructed from claim data using ICD9-CM codes for COPD. The diagnostic positive predictive value of these data was assessed with reference to physician-verified COPD. In addition, a multivariate logistic regression model was built to identify independent factors associated with the positive predictive value of COPD diagnosis by claim data. Results During the 8-year study period, a total of 12,127 subjects met the criterion of having two or more outpatient codes in 1 year or one or more inpatient COPD codes in their claim data. Of this total, the diagnosis of COPD was verified by physicians in 7,701 (63.5%) subjects. Applying a more stringent criterion – three or more outpatient codes or two or more inpatient codes – improved the diagnostic positive predictive value to 72.2%. Age ≥65 years and a claim for spirometry were the two most important factors associated with the positive predictive value of claim-data-defined COPD. Adding spirometry testing to diagnostic ICD9-CM codes for COPD increased the positive predictive value to 84.6%. Conclusion This study emphasizes the importance of validation of disease-specific diagnosis prior to applying an administrative database in clinical studies. It also indicates the limitation of ICD9-CM codes alone in recognizing COPD patients within the NHI research database.
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Affiliation(s)
- Te-Wei Ho
- Graduate Institute of Biomedical Electronics and Bioinformatics, College of Electrical Engineering and Computer Science, National Taiwan University, Taipei, Taiwan.,Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Sheng-Yuan Ruan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan,
| | - Chun-Ta Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, .,Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan,
| | - Yi-Ju Tsai
- Graduate Institute of Biomedical and Pharmaceutical Science, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and Bioinformatics, College of Electrical Engineering and Computer Science, National Taiwan University, Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan,
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