Respiratory Outcomes of Insulin Use in Patients with COPD: A Nationwide Population-Based Cohort Study

Fu-Shun Yen; Shu-Hao Chang; James Cheng-Chung Wei; Ying-Hsiu Shih; Chii-Min Hwu

doi:10.3390/ph16050643

Respiratory Outcomes of Insulin Use in Patients with COPD: A Nationwide Population-Based Cohort Study

Pharmaceuticals (Basel). 2023 Apr 24;16(5):643. doi: 10.3390/ph16050643.

Authors

Fu-Shun Yen¹, Shu-Hao Chang², James Cheng-Chung Wei^{3

4

5}, Ying-Hsiu Shih^{6

7}, Chii-Min Hwu^{8

9}

Affiliations

¹ Dr. Yen's Clinic, No. 15, Shanying Road, Gueishan District, Taoyuan 33354, Taiwan.
² Division of Pulmonary Medicine, Department of Internal Medicine, Cheng Ching Hospital, No. 139, Pingdeng Street, Central District, Taichung 40045, Taiwan.
³ Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, No. 110, Section 1, Jianguo N. Road, South District, Taichung 40201, Taiwan.
⁴ Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan.
⁵ Graduate Institute of Integrated Medicine, China Medical University, Taichung 40402, Taiwan.
⁶ Management Office for Health Data, China Medical University Hospital, Taichung 40201, Taiwan.
⁷ College of Medicine, China Medical University, Taichung 40402, Taiwan.
⁸ Faculty of Medicine, National Yang-Ming Chiao Tung University School of Medicine, No. 155, Section 2, Linong Street, Taipei 11221, Taiwan.
⁹ Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei 11217, Taiwan.

Abstract

Acute exacerbations of chronic obstructive pulmonary disease (COPD) with severe hyperglycemia may require insulin to lower glucose levels in people with coexisting type 2 diabetes (T2D) and COPD. We conducted this study to examine the risk of hospitalization for COPD, pneumonia, ventilator use, lung cancer, hypoglycemia, and mortality with and without insulin use in people with T2D and COPD. We adopted propensity-score-matching to identify 2370 paired insulin users and non-users from Taiwan's National Health Insurance Research Database between 1 January 2000 and 31 December 2018. Cox proportional hazards models and the Kaplan-Meier method were utilized to compare the risk of outcomes between study and control groups. The mean follow-up for insulin users and non-users was 6.65 and 6.37 years. Compared with no insulin use, insulin use was associated with a significantly increased risk of hospitalization for COPD (aHR 1.7), bacterial pneumonia (aHR 2.42), non-invasive positive pressure ventilation (aHR 5.05), invasive mechanical ventilation (aHR 2.72), and severe hypoglycemia (aHR 4.71), but with no significant difference in the risk of death. This nationwide cohort study showed that patients with T2D and COPD requiring insulin therapy may have an increased risk of acute COPD exacerbations, pneumonia, ventilator use, and severe hypoglycemia without a significant increase in the risk of death.

Keywords: bacterial pneumonia; hypoglycemia; invasive mechanical ventilation; mortality; non-invasive positive pressure ventilation.

Grants and funding

This study was supported in part by the Ministry of Health and Welfare Clinical Trial Center, Taiwan (MOHW109-TDU-B-212-114004), MOST Clinical Trial Consortium for Stroke, Taiwan (MOST 108-2321-B-039-003-), and Tseng-Lien Lin Foundation, Taichung, Taiwan. These funding agencies did not influence the study design, data collection, and analysis; decision to publish; or preparation of the manuscript. The writing or preparation of this paper was not funded by any organization; the data analyses were not undertaken by individuals who are employees of funders, or any author who received funding from funders; and no writing support was provided by the funders. The corresponding authors had complete access to all data in the study and were responsible for the decision to submit this manuscript for publication.