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.
Respir Res. 2019 Apr 5;20(1):69. doi: 10.1186/s12931-019-1035-9.
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.
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.
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.
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.
在慢性阻塞性肺疾病（COPD）患者中，糖尿病（DM）是一种常见的合并症，可能与全身炎症增加和预后恶化有关。二甲双胍具有多种抗炎和抗氧化作用，可能为合并 DM 的 COPD 患者带来理论上的益处。因此，本研究旨在探讨 DM 和二甲双胍的使用对 COPD 临床病程中死亡率的影响。
这是一项回顾性队列研究，纳入了 2008 年至 2014 年间经肺功能检查确诊的 COPD 患者，年龄≥40 岁。主要研究终点为全因死亡率。我们通过 COPD 的临床病程评估 DM 对死亡率的影响，还评估了二甲双胍的使用对 COPD 人群生存的影响。
在 4231 例 COPD 患者中，556 例（13%）患有 DM，与无 DM 患者相比，这些患者在调整年龄、性别、COPD 分期、合并症和既往 COPD 住院治疗后，2 年死亡率的危险比（HR）增加 1.62 倍（95%可信区间[CI]，1.15-2.28）。在 2 年期间，与非二甲双胍使用者相比，合并 COPD 和 DM 的患者中，二甲双胍使用者的死亡风险显著降低（HR，0.46；95%CI，0.23-0.92）。此外，二甲双胍使用者的生存情况与无 DM 的 COPD 患者相似。
本研究表明，DM 与 COPD 患者的死亡风险增加相关，而二甲双胍的使用似乎可以降低这种风险。我们的研究结果提示二甲双胍在 COPD 合并 DM 患者的管理中可能具有潜在作用。
