CHINA: Chronic Obstructive Pulmonary Disease (COPD) Study

Chronic obstructive pulmonary disease (COPD) characterized by progressive partially reversible airflow obstruction and airways inflammation is a leading cause of mortality globally. Further acute exacerbation of COPD is a leading cause of hospitalization and mortality among COPD patients. Researchers wanted to explore the effect of high blood sugar with or without diabetes mellitus on the risk of severe exacerbations in patients with COPD.

According to a prospective cohort study that was published in the International Journal of Chronic Obstructive Pulmonary Disease, elevated blood sugar is linked to a severe exacerbation of COPD regardless of whether a person has diabetes.

By 2030, chronic obstructive pulmonary disease (COPD), which affects 65 million people, is expected to overtake heart disease as the third biggest cause of mortality globally. Furthermore, type-2 diabetic mellitus (T2DM), hypertension, cardiovascular disease, obstructive sleep apnea, and other significant chronic concomitant disorders are recognized to be connected with COPD. These conditions are already indirectly related. Recent research has demonstrated that T2DM can worsen the course and prognosis of COPD, raising the risk of death from COPD.

"The most common reason for hospitalization and mortality in people with COPD is severe exacerbation. Even worse, severe COPD exacerbations are linked to a meager 3.6-year median survival. Research suggests that strict blood sugar control is necessary regardless of diabetes status to improve the prognosis of COPD," Researchers from the Department of Pulmonary and Critical Care Medicine at the Affiliated Hospital of Putian University in China, led by Guohuan Chen, reported their findings.

"Although the link between diabetes and severe COPD exacerbations has been well documented, there is ongoing debate over the link between hyperglycemia and unfavorable outcomes after COPD," they continued.

The researchers sought to determine if individuals with chronic obstructive lung disease are at increased risk for acute exacerbations when their blood sugar levels are raised.

526 consecutive COPD patients who were recruited between January 2018 and July 2019 were included in the study for this purpose. These patients were split into three groups based on their HbA1c levels and the American Diabetes Association's Standards of Care:

• Low HbA1c level (HbA1c 5.7%, n=204)
• Moderate HbA1c level (HbA1c 5.7–6.4%, n=165)
• High HbA1c level (HbA1c 6.5%, n=157)

For 18 months, all participants were followed up with. The predictive value of HbA1c for the next severe exacerbation of COPD was assessed using multivariate Cox regression analysis.

Major Findings of the Research:

• Over the course of the 18-month follow-up, at least 1 severe exacerbation occurred in 26.8% of the 526 patients.
• After adjusting for a variety of possible confounders, those with high (36.3%) and moderate (25.5%) HbA1c had a higher likelihood of experiencing 1 severe exacerbation (P<.01) compared to those with low HbA1c (20.6%).
• High HbA1c individuals had a 2.74 times higher chance of experiencing a severe COPD exacerbation than those with low HbA1c, according to multivariate Cox regression (HR, 2.74; 95% CI, 1.70-4.41).
• A severe COPD exacerbation was 2.19 times more likely in people with moderate HbA1c (HR, 2.19; 95% CI, 1.39-3.46).
• With rising HbA1c, subgroup analysis revealed that both diabetics and nondiabetics had a higher chance of severe aggravation.

The authors concluded that patients with COPD who had excessive blood glucose at admission—whether they had diabetes or not—have a higher probability of having their subsequent severe exacerbation. To support the conclusion, additional research that takes into account blood sugar variation and incorporates other confounders are needed, they added.

Reference

Chen G, Lin Q, Zhuo D, Cui J. Elevated Blood Glucose is Associated with Severe Exacerbation of Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis. 2022;17:2453-2459

https://doi.org/10.2147/COPD.S378259