Thiazolidinediones lower the risk of pneumonia in patients with type 2 diabetes

Fu-Shun Yen; James Cheng-Chung Wei; Yu-Tung Hung; Chung Y Hsu; Chii-Min Hwu; Chih-Cheng Hsu

doi:10.3389/fmicb.2023.1118000

Thiazolidinediones lower the risk of pneumonia in patients with type 2 diabetes

Front Microbiol. 2023 Feb 17:14:1118000. doi: 10.3389/fmicb.2023.1118000. eCollection 2023.

Authors

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

3

4}, Yu-Tung Hung^{5

6}, Chung Y Hsu⁷, Chii-Min Hwu^{8

9}, Chih-Cheng Hsu^{10

11

12

13}

Affiliations

¹ Dr. Yen's Clinic, Taoyuan, Taiwan.
² Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
³ Department of Medicine, Chung Shan Medical University Hospital, 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 Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.
⁸ Faculty of Medicine, National Yang-Ming Chiao Tung University School of Medicine, Taipei, Taiwan.
⁹ Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
¹⁰ Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
¹¹ Department of Health Services Administration, China Medical University, Taichung, Taiwan.
¹² Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan.
¹³ National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan.

Abstract

Introduction: We conducted this study to compare the risk of pneumonia between thiazolidinedione (TZD) use and nonuse in persons with type 2 diabetes (T2D).

Methods: We identified 46,763 propensity-score matched TZD users and nonusers from Taiwan's National Health Insurance Research Database between January 1, 2000, and December 31, 2017. The Cox proportional hazards models were used for comparing the risk of morbidity and mortality associated with pneumonias.

Results: Compared with the nonuse of TZDs, the adjusted hazard ratios (95% CI) for TZD use in hospitalization for all-cause pneumonia, bacterial pneumonia, invasive mechanical ventilation, and death due to pneumonia were 0.92 (0.88-0.95), 0.95 (0.91-0.99), 0.80 (0.77-0.83), and 0.73 (0.64-0.82), respectively. The subgroup analysis revealed that pioglitazone, not rosiglitazone, was associated with a significantly lower risk of hospitalization for all-cause pneumonia [0.85 (0.82-0.89)]. Longer cumulative duration and higher cumulative dose of pioglitazone were associated with further lower adjusted hazard ratios in these outcomes compared to no-use of TZDs.

Discussion: This cohort study demonstrated that TZD use was associated with significantly lower risks of hospitalization for pneumonia, invasive mechanical ventilation, and death due to pneumonia in patients with T2D. Higher cumulative duration and dose of pioglitazone were associated with a further lower risk of outcomes.

Keywords: all-cause pneumonia; bacterial pneumonia; death; invasive mechanical ventilation; pioglitazone.