Abstract Rationale Individuals hospitalized for acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) have a high rate of 30-day readmission. Pulmonary issues account for some readmissions, but about half are due to other causes like cardiovascular events and heart failure. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA) are diabetes medications that have demonstrated cardiovascular benefits in randomized controlled trials and have been associated with reduced risk for respiratory events in observational studies. We hypothesized that diabetic patients hospitalized for AE-COPD who are prescribed SGLT2i or GLP1-RA would have a lower risk of 30-day readmission than those on other diabetes medications. Methods Data were obtained from the inpatient and outpatient medical records of 10 hospitals in a single health care system in Minnesota for this retrospective cohort. Data extraction utilized the Common Longitudinal ICU Data Format (CLIF). We identified AE-COPD admissions between 2011 and 2024 using a previously validated ICD-10 algorithm. We tested associations between the medications of interest and a composite outcome of 30-day readmission and death using multivariate logistic regression, Cox proportional hazards models, and Fine-Gray sub-distribution hazards models (which account for the competing risk of death for 30-day readmission). We also tested these outcomes separately. All models were adjusted for important covariates as indicated in the figure legend. Results We identified 11,610 AE-COPD admissions (35% ICU admissions) among diabetic individuals on diabetes medications; 514 were on SGLT2i and 587 were on GLP1-RA. The composite outcome occurred in 15.8% of individuals on SGLT2i, 15.7% on GLP1-RA, and 19.8% on other diabetes medications. SGLT2i use was associated with lower odds of the composite outcome adjusted odds ratio (aOR) 0.71, 95% CI 0.55 to 0.91 and 30-day readmission (aOR 0.74, 95% CI 0.57 to 0.95). SGLT2i use was also associated with a lower risk of adverse outcomes in time-to-event analyses (Figure, top). GLP1-RA analyses suggested similar potential benefits, but were not statistically significant (composite aOR 0.85, 95% CI 0.67 to 1.07 and 30-day readmission aOR 0.83, 95% CI 0.65 to 1.06). GLP1-RA time to event analyses also suggested a benefit, but were not statistically significant (Figure, bottom). Conclusions SGLT2i prescriptions are associated with a reduced 30-day readmission rate among diabetic individuals hospitalized for AE-COPD. These results should be confirmed through systematic study of SGLT2i implementation in individuals with COPD and diabetes who are at high risk of hospitalization. This abstract is funded by: NIH - NHLBI
Macdonald et al. (Fri,) studied this question.