COPD among diabetics associated with increased mortality from respiratory causes

Type 2 Diabetes (T2D) is a metabolic disorder over time leads to persistent hyperglycemia that can be attributed to either defective insulin secretion or insulin resistance. It is estimated that 10% of individuals with T2D also have Chronic Obstructive Pulmonary Disease (COPD). Studies have noticed an interplay between COPD and T2D individuals, with reports indicating that T2D can worsen progression and severity of COPD.

A recent study in International Journal of Chronic Obstructive Pulmonary Disease reports 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 and would be benefitted from intensive management of both conditions.

A three-year cohort study was conducted by Abdul Sattar Raslan and team 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.

The key findings of the study are

• 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.

Raslan and team concluded that “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.”

Reference: 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 DOI:https://doi.org/10.2147/COPD.S407085