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

<b>OBJECTIVE:</b> Emerging data from animal and human pilot studies suggest potential benefits of glucagon-like peptide-1 receptor agonist (GLP-1RA) on lung function. We aimed to assess the association of GLP-1RAs and chronic lower respiratory disease exacerbations (CLRD) exacerbation in a population with comorbid type 2 diabetes (T2D) and CLRD. <p><b>RESEARCH DESIGN AND METHODS: </b>A new-user active-comparator analysis was conducted using a national claims database of beneficiaries with employer-sponsored health insurance spanning 2005 through 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 antidiabetic 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 in- or outpatient visits. Incidence rates were estimated using inverse probability of treatment weighting for each study group and compared via risk ratios.</p> <p><b>RESULTS: </b>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 1000 person-years for GLP-1RA and DPP-4I users, respectively, resulting in an adjusted hazard ratio (HR) 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).</p> <p><b>CONCLUSION: </b>GLP-1RA users had fewer CLRD exacerbations as compared to DPP-4I users. Considering both plausible mechanistic pathways and this real-world evidence, potential beneficial effects of GLP-1RA may be considered when selecting antidiabetic treatment regimen. Randomized clinical trials are warranted to confirm our findings.</p>