Glucagon-Like Peptide 1 Receptor Agonists and Chronic Lower Respiratory Disease Exacerbations Among Patients With Type 2 Diabetes

• Published in: Diabetes care Vol. 44; no. 6; pp. 1344 - 1352
• Main Authors: Albogami, Yasser, Cusi, Kenneth, Daniels, Michael J, Wei, Yu-Jung J, Winterstein, Almut G
• Format: Journal Article
• Language: English
• Published: United States American Diabetes Association 01.06.2021
• Subjects: Agonists; Clinical trials; Comorbidity; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Emerging Therapies: Drugs and Regimens; Glucagon; Glucagon-like peptide 1; Health services; Peptidase; Peptidases; Peptides; Receptors; Research design; Respiratory diseases; Respiratory function
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/DC20-1794

Emerging data from animal and human pilot studies suggest potential benefits of glucagon-like peptide 1 receptor agonists (GLP-1RA) on lung function. We aimed to assess the association of GLP-1RA and chronic lower respiratory disease (CLRD) exacerbation in a population with comorbid type 2 diabetes (T2D) and CLRD. A new-user active-comparator analysis was conducted with use of a national claims database of beneficiaries with employer-sponsored health insurance spanning 2005-2017. We included adults with T2D and CLRD who initiated GLP-1RA or dipeptidyl peptidase 4 inhibitors (DPP-4I) as an add-on therapy to their antidiabetes regimen. The primary outcome was time to first hospital admission for CLRD. The secondary outcome was a count of any CLRD exacerbation associated with an inpatient or outpatient visit. We estimated incidence rates using inverse probability of treatment weighting for each study group and compared via risk ratios. The study sample consisted of 4,150 GLP-1RA and 12,540 DPP-4I new users with comorbid T2D and CLRD. The adjusted incidence rate of first CLRD admission during follow-up was 10.7 and 20.3 per 1,000 person-years for GLP-1RA and DPP-4I users, respectively, resulting in an adjusted hazard ratio of 0.52 (95 CI 0.32-0.85). For the secondary outcome, the adjusted incidence rate ratio was 0.70 (95% CI 0.57-0.87). GLP-1RA users had fewer CLRD exacerbations in comparison with DPP-4I users. Considering both plausible mechanistic pathways and this real-world evidence, potential beneficial effects of GLP-1RA may be considered in selection of an antidiabetes treatment regimen. Randomized clinical trials are warranted to confirm our findings.