Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA.
Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA.
Respir Med. 2024 Nov-Dec;234:107819. doi: 10.1016/j.rmed.2024.107819. Epub 2024 Sep 24.
The Sodium-Glucose Cotransporter 2 inhibitors (SGLT2i) are a class of anti-diabetic medications that confer cardio-renal-metabolic (CRM) benefits. Emerging evidence also suggests that these agents provide better benefits for chronic pulmonary conditions, especially chronic obstructive pulmonary disease (COPD).
We aimed to assess the association between SGLT2i use and outcomes in patients with COPD and concomitant Type 2 Diabetes Mellitus (T2DM).
We conducted a retrospective cohort study on adults with T2DM and COPD in a primary care clinic from January 01, 2019 to 01/01//2023. Patients were categorized into two groups based on SGLT2i use. We collected demographic information and outcomes such as emergency room (ER) visits, hospitalizations secondary to COPD exacerbation over the period of four years and time to hospitalization and ER visits. Chi-square analysis was used for categorical variables, whereas an unpaired t-test was used for continuous variables. Cox regression was performed to identify significant prognostic factors of hospitalization and ER visits. A Kaplan-Meir analysis was used to visualize the probability of non-hospitalization and the probability of not visiting the ER. Statistical significance was set at p-value <0.05.
Of the 220 patients screened, 94 met the inclusion criteria, of which 20 patients (21.3 %) had SGLT2i use at admission, and 74 (78.7 %) did not. Baseline demographic information were well-matched between the two groups. SGLT2i use was associated with a significant reduction in ER visits (70 % vs. 97.3 %, p-0.001) and the number of hospitalizations (55 % vs 87.8 %, p-0.001). Further multivariate analysis showed lower hazards of hospitalization (adjusted HR-0.156; CI:0.073 to 0.331) and ER visits (HR)-0.232; CI:0.118 to 0.453) in patients on SGLT2i.
In patients with T2DM with COPD, SGLT2i use was associated with reduced ER visits and hospitalizations related to COPD. This protective effect of SGLT2i could be explained by reduced systemic proinflammatory markers and increased anti-inflammatory markers via inhibition of Node like receptor protein 3(NLRP3) inflammasome activation in multiple tissues, including the lungs.
钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）是一类具有心脏-肾脏-代谢（CRM）益处的抗糖尿病药物。新出现的证据还表明，这些药物对慢性肺部疾病，特别是慢性阻塞性肺疾病（COPD）有更好的益处。
我们旨在评估 SGLT2i 治疗对伴有 2 型糖尿病（T2DM）的 COPD 患者的影响。
我们对 2019 年 1 月 1 日至 2023 年 1 月 1 日在一家初级保健诊所的 T2DM 和 COPD 成年患者进行了回顾性队列研究。根据 SGLT2i 的使用情况，患者分为两组。我们收集了人口统计学信息和结果，如四年内因 COPD 加重而急诊就诊、住院的次数，以及住院和急诊就诊的时间。卡方分析用于分类变量，而配对 t 检验用于连续变量。Cox 回归用于确定住院和急诊就诊的显著预后因素。 Kaplan-Meier 分析用于可视化非住院和不就诊急诊的概率。统计显著性设定为 p 值<0.05。
在筛选的 220 名患者中，94 名符合纳入标准，其中 20 名患者（21.3%）入院时使用了 SGLT2i，74 名患者（78.7%）未使用。两组间的基线人口统计学信息匹配良好。SGLT2i 的使用与急诊就诊次数显著减少（70%比 97.3%，p=0.001）和住院次数减少相关（55%比 87.8%，p=0.001）。进一步的多变量分析显示，使用 SGLT2i 的患者住院（调整后的 HR-0.156；95%CI：0.073 至 0.331）和急诊就诊（HR-0.232；95%CI：0.118 至 0.453）的风险降低。
在伴有 COPD 的 T2DM 患者中，SGLT2i 的使用与减少与 COPD 相关的急诊就诊和住院有关。SGLT2i 的这种保护作用可能是通过抑制 NLRP3 炎症小体在包括肺部在内的多种组织中的激活，减少全身促炎标志物和增加抗炎标志物来解释的。
