Incident, pre-existing diabetes mellitus linked to poorer outcomes in COPD
Diabetes mellitus (DM), whether incident or pre-existing, is associated with worse clinical outcomes in patients with chronic obstructive pulmonary disease (COPD), a new study shows.
The study involved 2,015 patients (70 percent male; mean age 62.7±12.0 years) in Taiwan’s Longitudinal Health Insurance Database who had been diagnosed with COPD during at least two outpatient visits within 12 months; those who were hospitalized were also included. Exclusion criteria included having asthma or type 1 DM during the study the period and being younger than 40 at COPD diagnosis.
All-cause mortality was the primary endpoint for all COPD patients. For those without pre-existing DM, development of DM was also a primary endpoint. DM diagnoses after entry into the cohort were designated as incident DM.
In the COPD cohort, the most common comorbodities were hypertension (50 percent), coronary artery disease (23 percent) and cerebrovascular disease (18 percent). Furthermore, 16 percent (n=332) had pre-existing DM.
Those with pre-existing DM had a higher proportion of hypertension, coronary artery disease, heart failure, cerebrovascular disease, dyslipidaemia and other comorbidities compared with those without.
Of the 670 deaths (33 percent) in the COPD cohort, those with pre-existing DM had higher probabilities of mortality (hazard ratio [HR], 1.244; 95 percent CI, 1.010 to 1.532; p=0.04). There were no additive effects between DM and hypertension (p=0.72), dyslipidaemia (p=0.91), cerebrovascular disease (p=0.30), heart failure (p=0.70) and coronary artery disease (p=0.75) on mortality.
The effects of incident DM were evaluated in 304 matched COPD patients. These patients also had higher risks of mortality (HR, 1.810; 1.363 to 2.403; p<0.001). Survival was poorer for those with incident DM (p=0.027).