Diabetes, Prediabetes, and Diabetes Duration Linked to Higher Risk of COPD, Death

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Patients with diabetes and prediabetes are at a higher risk of developing chronic obstructive pulmonary disease (COPD), according to new data from a prospective UK Biobank study.

Findings also showed that longer diabetes duration was associated with an increased risk of COPD. In addition, prediabetes, diabetes, and longer diabetes duration were associated with lower overall survival among participants with COPD.

“Further studies are warranted to clarify the underlying mechanisms and to determine the optimal diabetes control measures that might reduce the risk of COPD in the general population,” wrote researchers in Diabetes, Obesity and Metabolism.

Study authors note that an estimated 10% of individuals with diabetes also have COPD. While past research suggests worse prognosis among patients with COPD with comorbid diabetes, they observe there is little prospective epidemiologic evidence of the risk in the general population.

To address this gap in data, investigators conducted a prospective analysis of data from the UK Biobank, a database comprising detailed long-term health information from approximately half a million UK adults.

The primary outcome of the analysis was the incidence of COPD, and the secondary outcomes were all-cause mortality and COPD-related mortality among study participants with COPD, according to the study.

FINDINGS

The analysis included 452 680 (mean age, 56.5 years; 54.8% women) participants without COPD at baseline. During a median follow-up of 12.3 years, 12 595 cases of COPD were documented, according to the results.

Investigators observed that compared with the reference group (ie, adults without diabetes), those with prediabetes had an 18% (hazard ratio [HR] 1.18, 95% CI 1.13-1.24) higher risk of COPD and those with diabetes had a 35% (HR 1.35, 95% CI 1.24-1.47) higher risk of COPD.

“Furthermore, a higher COPD risk was associated with a longer diabetes duration,” added investigators. When compared with participants with a diabetes duration of <1 year, those with a diabetes duration of ≥7 years, 3 to <7 years, and 1 to <3 years had multivariable HRs of 1.23 (95% CI 1.05-1.44), 1.20 (95% CI 1.04-1.39), and 1.18 (95% CI 1.01-1.37), respectively.

In a separate survival analysis of the 12 595 patients with incident COPD, authors observed that those with prediabetes and diabetes had a 9% (HR 1.09, 95% CI 1.00-1.19) and 21% (HR 1.21, 95% CI 1.05-1.41) higher risk of overall death, respectively, than those in the reference group.

Additionally, compared with patients with COPD with a diabetes duration of <1 year, those with a diabetes duration of ≥7 years were had a 46% higher risk of overall mortality (HR 1.46, 95% CI 1.11-1.92), according to the results.

“No significant association was observed between prediabetes, diabetes or diabetes duration and the risk of COPD-specific survival,” wrote researchers.

Limitations of the current study include the fact that investigators did not measure 2-hour glucose levels, most of the participants in the UK Biobank were White, and researchers did not consider new diabetes diagnoses during the follow-up period.

Reference: Su J, Li M, Wan X, et al. Associations of diabetes, prediabetes and diabetes duration with the risk of chronic obstructive pulmonary disease: A prospective UK Biobank study. Diabetes Obes Metab. Published online May 29, 2023. doi:10.1111/dom.15142.