Obstructive Lung Diseases: COPD Comorbidities |

Metformin and Health Care Utilization in Patients With Coexisting COPD and Diabetes FREE TO VIEW

Raju Bishwakarma, MBBS; Yu-li Lin, MS; Yong-Fang Kuo, PhD; Gulshan Sharma, MBBS
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Univesity of Texas Medical Branch, Galveston, TX

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):896A. doi:10.1016/j.chest.2016.08.996
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 24, 2016 at 04:30 PM - 05:30 PM

PURPOSE: Skeletal muscle dysfunction is well known in patients with chronic obstructive pulmonary disease (COPD). Mitochondrial dysfunction likely plays a role in skeletal muscle dysfunction. Metformin is known to enhance mitochondrial function. We aim to investigate the role of metformin in patient with coexisting chronic obstructive pulmonary disease and diabetes on health care utilization in terms of all cause and COPD related hospitalization.

METHODS: We study 5,614 Medicare beneficiaries with COPD and diabetes between 2008 and 2010. Subjects who initiated their antidiabetic medications (metformin, sulfonylurea, insulin and others) between 2008 and 2010 were included. Patients were followed for two years after the initial antidiabetic prescription for all-cause and COPD-related hospitalization. Patients who switched to another antidiabetic or were on multiple antidiabetics during follow-up were excluded. The association between antidiabetic medication use and the outcomes was examined by multivariable logistic regression model after adjusting for patient age, gender, race/ethnicity, dual eligibility, prior hospitalization, oxygen use, gastro-esophageal reflux disease, lung cancer, depression, cardiovascular disease such as ischemic heart disease, cerebrovascular disease, arrhythmia, heart failure, sarcopenia, osteoporosis and COPD medication use. All analyses were performed with SAS version 9.4 (SAS Inc., Cary, NC). ). All reported p-values were two-sided and p<0.05 was considered statistically significant.

RESULTS: Between 2008 and 2010; 5,614 patient with coexisting chronic obstructive pulmonary disease and diabetes were initiated on an antidiabetic medicine. Metformin, sulfonylurea, insulin and others were used in 3,110; 1,110; 936; and 435 patients with COPD, respectively. In comparison to oral hypoglycemic, patient on insulin group were sicker, more likely to be on oxygen, had more hospitalization in prior year, had more cardiovascular co-morbidities, sarcopenia, osteoporosis and were receiving hemodialysis. In a multivariate logistic regression model, after adjusting for baseline characteristics, patients with COPD on metformin had a lower odds of all cause hospitalization (0.50; 95 %CI 0.42-0.60) and COPD related hospitalization (0.74; 95 % CI 0.56-0.98) compared to those on insulin.

CONCLUSIONS: Our study showed that patient with coexisting chronic obstructive pulmonary disease and diabetes mellitus who received metformin were less likely to be admitted to the hospital for all cause and COPD related hospitalization as compared to those on insulin during the 2 year follow up period.

CLINICAL IMPLICATIONS: Patient with COPD who had coexisting diabetes mellitus may benefit from metformin use.

DISCLOSURE: Gulshan Sharma: Consultant fee, speaker bureau, advisory committee, etc.: The scientific advisory board of Theravance Biopharma, Mylan, and Sunovion pharmaceutical company The following authors have nothing to disclose: Raju Bishwakarma, Yu-li Lin, Yong-Fang Kuo

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