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Peer-reviewedCC BY-NC 4.0Diabetes & Vascular Disease Research

Impact of antidiabetic agents on COPD exacerbations in patients with type 2 diabetes mellitus: A systematic review and network meta-analysis

  • Muhammed Shabil1
  • Asif Jan2,3,4
  • Muhammad Aaqib Shamim5
  • Hussein Aziz Naser6
  • Sourav Sudan7
  • Huma Sultana8
  • Muhammad Imran9
  • Farhad Ullah10
  • Daniel Dubwa11
  • Shubham Kumar12
12 affiliations
  1. 1Department of Pharmacy Practice, M. S. Ramaiah University of Applied Sciences, Bangalore, India
  2. 2Department of Pharmacy, University of Peshawar, Peshawar, KP, Pakistan
  3. 3Saidu Group of Teaching Hospitals, Saidu Sharif, KP, Pakistan
  4. 4District Headquarter Hospital Charsadda, Charsadda, KP, Pakistan
  5. 5Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
  6. 6Al-Zahraa University for women -Karabella City, lraq
  7. 7Saint Vincent Hospital, Worcester, MA, USA
  8. 8Department of pharmaceutical chemistry, M. S. Ramaiah University of Applied Sciences, Bangalore, India
  9. 9Diabetes and Endocrinology, Cork University Hospital, Ireland
  10. 10Department of Chemistry, Kohat University of Science & Technology (KUST), Kohat, Pakistan
  11. 11Department of Pharmacy, Makerere University, Kampala, Uganda
  12. 12Dental Research Cell, Dr. D. Y. Patil Dental College & Hospital, Dr. D. Y. Patil Vidyapeeth (Deemed to Be University), Pune, India
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Abstract

Background: The impact of Antidiabetic Agents on COPD Exacerbations remains uncertain. We conducted a comprehensive review to evaluate the impact Antidiabetic Agents on COPD Exacerbations in patients with T2DM.

Methods: We searched PubMed, Embase, and Web of Science from inception to January 15, 2026 for observational studies involving adults with T2DM and COPD. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models, treatments were ranked using the Surface Under the Cumulative Ranking Curve (SUCRA), and study quality was assessed using the Newcastle–Ottawa Scale.

Results: Thirteen studies comprising 755,206 participants were included. Compared with sulfonylureas, SGLT-2 inhibitors were associated with the lowest risk of overall COPD exacerbations (RR 0.71, 95% CI 0.66–0.77), followed by GLP-1 receptor agonists (RR 0.77, 95% CI 0.71–0.84). Metformin demonstrated a near-neutral association (RR 0.89, 95% CI 0.79–1.00), whereas DPP-4 inhibitors (RR 1.05, 95% CI 0.97–1.13) and meglitinides (RR 1.13, 95% CI 0.93–1.36) showed no evidence of benefit. Similar findings were observed for severe exacerbations, with SGLT-2 inhibitors and GLP-1 receptor agonists demonstrating the strongest associations.

Conclusions: SGLT-2 inhibitors and GLP-1 receptor agonists were associated with a lower risk of COPD exacerbations than sulfonylureas, whereas metformin showed a near-neutral association and DPP-4 inhibitors and meglitinides showed no clear benefit.

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Cite

BibTeXRIS
BibTeX
@article{shabil2026impact,
  title = {{Impact of antidiabetic agents on COPD exacerbations in patients with type 2 diabetes mellitus: A systematic review and network meta-analysis}},
  author = {Muhammed Shabil and Asif Jan and Muhammad Aaqib Shamim and Hussein Aziz Naser and Sourav Sudan and Huma Sultana and Muhammad Imran and Farhad Ullah and Daniel Dubwa and Shubham Kumar},
  journal = {Diabetes \& Vascular Disease Research},
  year = {2026},
  month = oct,
  doi = {10.1177/14791641261487590},
  url = {https://doi.org/10.1177/14791641261487590},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Impact of antidiabetic agents on COPD exacerbations in patients with type 2 diabetes mellitus: A systematic review and network meta-analysis
AU  - Muhammed Shabil
AU  - Asif Jan
AU  - Muhammad Aaqib Shamim
AU  - Hussein Aziz Naser
AU  - Sourav Sudan
AU  - Huma Sultana
AU  - Muhammad Imran
AU  - Farhad Ullah
AU  - Daniel Dubwa
AU  - Shubham Kumar
PY  - 2026
DA  - 2026/10/01
JO  - Diabetes & Vascular Disease Research
DO  - 10.1177/14791641261487590
UR  - https://doi.org/10.1177/14791641261487590
AB  - Background: The impact of Antidiabetic Agents on COPD Exacerbations remains uncertain. We conducted a comprehensive review to evaluate the impact Antidiabetic Agents on COPD Exacerbations in patients with T2DM.  Methods: We searched PubMed, Embase, and Web of Science from inception to January 15, 2026 for observational studies involving adults with T2DM and COPD. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models, treatments were ranked using the Surface Under the Cumulative Ranking Curve (SUCRA), and study quality was assessed using the Newcastle–Ottawa Scale.  Results: Thirteen studies comprising 755,206 participants were included. Compared with sulfonylureas, SGLT-2 inhibitors were associated with the lowest risk of overall COPD exacerbations (RR 0.71, 95% CI 0.66–0.77), followed by GLP-1 receptor agonists (RR 0.77, 95% CI 0.71–0.84). Metformin demonstrated a near-neutral association (RR 0.89, 95% CI 0.79–1.00), whereas DPP-4 inhibitors (RR 1.05, 95% CI 0.97–1.13) and meglitinides (RR 1.13, 95% CI 0.93–1.36) showed no evidence of benefit. Similar findings were observed for severe exacerbations, with SGLT-2 inhibitors and GLP-1 receptor agonists demonstrating the strongest associations.  Conclusions: SGLT-2 inhibitors and GLP-1 receptor agonists were associated with a lower risk of COPD exacerbations than sulfonylureas, whereas metformin showed a near-neutral association and DPP-4 inhibitors and meglitinides showed no clear benefit.
SN  - 1479-1641
SN  - 1752-8984
ER  -