Researchers had found in a new study that sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) associated with reduced risks of chronic obstructive pulmonary disease (COPD) exacerbations for patients with type 2 diabetes (T2D) and active COPD. This study was conducted by Avik Ray and fellow researchers published in JAMA Internal Medicine.The authors used data from three large US insurance claims databases: Optum de identified Clinformatics Data Mart Database (2013-2023), IBM Health MarketScan (2013-2021), and Medicare fee-for-service (2013-2020). It was conducted as a comparative effectiveness research study with the help of three 1:1 propensity scores–matched cohort studies, simulating target trials comparing different glucose-lowering medications. The patients included were aged 40 years or more with a diagnosis of T2D and active COPD. Analysis was performed between January and June 2024.Study Groups and ExposuresPatients were grouped into three groups for treatment comparison:SGLT-2i vs DPP-4i: 27,991 matched pairsGLP-1RA vs DPP-4i: 32,107 matched pairsSGLT-2i vs GLP-1RA: 36,218 matched pairsThe first moderate or severe COPD exacerbation was the primary outcome, an outpatient visit for COPD with an oral glucocorticoid prescription or a hospitalization for COPD.Key ResultsOver a median follow-up of 145 days (IQR, 61-355), the study determined:SGLT-2is vs DPP-4is:COPD exacerbation rate: 9.26 vs 11.4 per 100 person-years (PYs)Hazard ratio (HR): 0.81 (95% CI, 0.76-0.86)Incidence rate difference (IRD): -2.20 per 100 PYs (95% CI, -2.83 to -1.58)GLP-1RAs vs DPP-4is:COPD exacerbation rate: 9.89 vs 11.49 per 100 PYsHR: 0.86 (95% CI, 0.81-0.91)IRD: -1.60 per 100 PYs (95% CI, -2.18 to -1.02)SGLT-2is vs GLP-1RAs:COPD exacerbation rate: 9.47 vs 10.00 per 100 PYsHR: 0.94 (95% CI, 0.89-1.00)IRD: -0.55 per 100 PYs (95% CI, -1.09 to -0.01)The results of this comparative effectiveness research study suggest that SGLT-2is and GLP-1RAs were associated with a reduced risk of moderate or severe COPD exacerbations compared with dipeptidyl peptidase 4 inhibitors in adults with type 2 diabetes and active COPD. This may inform prescribing of glucose-lowering medications among patients with type 2 diabetes and active COPD.Reference:Ray A, Paik JM, Wexler DJ, et al. Glucose-Lowering Medications and Risk of Chronic Obstructive Pulmonary Disease Exacerbations in Patients With Type 2 Diabetes. JAMA Intern Med. Published online February 10, 2025. doi:10.1001/jamainternmed.2024.7811