New population-based study suggests SGLT2 inhibitors and GLP-1 receptor agonists may reduce COPD exacerbations in patients with type 2 diabetes.

In this episode of What's It Worth?, we examine a large real-world study assessing whether glucose-lowering medications influence the risk of COPD exacerbations in patients with type 2 diabetes and chronic obstructive pulmonary disease. We focus on SGLT2 inhibitors and GLP-1 receptor agonists and discuss whether potential pulmonary benefits should influence drug selection in patients with both conditions.

Guest: Ashley Wilke, PharmD — PGY2 Critical Care Pharmacy Resident at M Health Fairview East Bank Hospital.

Study at a Glance

• Design: Retrospective cohort study using nationwide claims and registry data
• Population: Adults with type 2 diabetes and COPD initiating glucose-lowering therapy
• Exposures: SGLT2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors
• Primary outcome: COPD exacerbations requiring hospitalization or systemic steroids
• Key Finding: SGLT2 inhibitors and GLP-1 receptor agonists were associated with a lower risk of COPD exacerbations compared with DPP-4's
• KEY Caveats: Results are observational and this study cannot prove causality - only association. 
• Tune in for our conclusions when we ask, "What's it Worth?"!

Key teaching points

1. SGLT2 inhibitors and GLP-1 RAs may reduce pulmonary inflammation and fluid overload, potentially contributing to fewer exacerbations.

2. In a patient with both COPD and type 2 diabetes, these agents may offer meaningful extra-glycemic benefits.

3. This evidence supports shared decision-making, not mandatory therapy selection

4. Pharmacists can identify dual-benefit opportunities and tailor therapy based on comorbidities, cardiovascular risk, and exacerbation history.

Citation:  
Patorno E, Feldman HA, Bykov K, et al. Glucose-lowering medications and risk of chronic obstructive pulmonary disease exacerbations in type 2 diabetes. JAMA Intern Med. 2025;185(4):405-414. doi:10.1001/jamainternmed.2024.7811

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