Thiazolidinedione Use in Individuals With Type 2 Diabetes and Chronic Obstructive Pulmonary Disease

Fu-Shun Yen; James Cheng-Chung Wei; Yu-Cih Yang; Chih-Cheng Hsu; Chii-Min Hwu

doi:10.3389/fmed.2021.729518

Thiazolidinedione Use in Individuals With Type 2 Diabetes and Chronic Obstructive Pulmonary Disease

Front Med (Lausanne). 2021 Dec 9:8:729518. doi: 10.3389/fmed.2021.729518. eCollection 2021.

Authors

Fu-Shun Yen¹, James Cheng-Chung Wei^{2

3

4}, Yu-Cih Yang^{5

6}, Chih-Cheng Hsu^{7

8

9}, Chii-Min Hwu^{10

11}

Affiliations

¹ Dr. Yen's Clinic, Taoyuan, Taiwan.
² Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.
³ Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
⁴ Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
⁵ Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
⁶ College of Medicine, China Medical University, Taichung, Taiwan.
⁷ Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.
⁸ Department of Health Services Administration, China Medical University, Taichung, Taiwan.
⁹ Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan.
¹⁰ Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
¹¹ Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

Abstract

Few studies have investigated the effects of various antidiabetic agents on individuals with both type 2 diabetes mellitus (T2DM) and Chronic obstructive pulmonary disease (COPD). This study compared mortality, cardiovascular events and respiratory outcomes in individuals with both T2DM and COPD taking TZD vs. those not taking TZD. From Taiwan's National Health Insurance Research Database, 12 856 propensity-score-matched TZD users and non-users were selected between January 1, 2000, and December 31, 2012. Cox proportional hazards models were used to calculate the risks of investigated outcomes. Compared with non-use of TZD, the adjusted hazard ratios (95% CI) of TZD use were stroke 1.63 (1.21-2.18), coronary artery disease 1.55 (1.15-2.10), heart failure 1.61 (1.06-2.46), non-invasive positive pressure ventilation 1.82 (1.46-2.27), invasive mechanical ventilation 1.23 (1.09-1.37), bacterial pneumonia 1.55 (1.42-1.70), and lung cancer 1.71 (1.32-2.22), respectively. The stratified analysis disclosed that rosiglitazone, not pioglitazone, was associated with significantly higher risk of major cardiovascular events than TZD non-users. In patients with concomitant T2DM and COPD, TZD use was associated with higher risks of cardiovascular events, ventilation use, pneumonia, and lung cancer. Use of TZD in these patients should be supported by monitoring for cardiovascular and respiratory complications.

Keywords: bacterial pneumonia; coronary artery disease; heart failure; invasive mechanical ventilation; lung cancer; mortality; non-invasive positive pressure ventilation; stroke.