Combined GLP-1 Receptor Agonist and SGLT2 Inhibitor Therapy for Adults with Type 2 Diabetes and Chronic Obstructive Pulmonary Disease: A Large-Scale Target Trial Emulation
- Design
- Retrospective cohort
- Drugs
- Class unspecified
- Assessment
- Not yet reviewed by a person · added Oct 18, 2026
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Abstract
<title>Abstract</title> <p>Background Adults with type 2 diabetes mellitus (T2DM) and chronic obstructive pulmonary disease (COPD) experience substantial cardiometabolic and respiratory risk. Although glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) provide established metabolic, cardiovascular, and renal benefits, clinical outcomes associated with their combined use in this comorbid population remain uncertain. Methods We conducted a target trial emulation using the TriNetX US Collaborative Network (2018–2023). Adults with T2DM and COPD who initiated a GLP-1RA plus SGLT2i strategy were compared with those who initiated an SGLT2i-only strategy. Propensity score matching (1:1) balanced demographics, socioeconomic and lifestyle factors, comorbidities, medications, laboratory parameters, and available healthcare-utilization proxies. Follow-up began at a 90-day landmark and continued for up to 4 years. All-cause mortality was the primary outcome; COPD exacerbation and pneumonia were key secondary outcomes. Results After matching, 17,467 patients were included in each group. Compared with the SGLT2i-only strategy, the combination strategy was associated with lower risks of all-cause mortality (hazard ratio [HR] 0.86; 95% confidence interval [CI] 0.81–0.93), COPD exacerbation (HR 0.93; 95% CI 0.89–0.97), and pneumonia (HR 0.93; 95% CI 0.89–0.98). At 4 years, the corresponding absolute risk reductions were 2.27%, 2.07%, and 1.59%. No significant between-group differences were observed for dialysis initiation, major adverse cardiovascular events, emergency department visits, or hospitalization. Conclusions Among adults with T2DM and COPD who reached the 90-day landmark, initiation of GLP-1RA plus SGLT2i therapy was associated with modest but statistically significant reductions in all-cause mortality, COPD exacerbation, and pneumonia compared with SGLT2i initiation alone. These complementary relative and absolute associations support further evaluation of combination therapy as a potentially beneficial option for selected high-risk patients.</p>
Where this record came from
| Source | Retrieved | Identifier |
|---|---|---|
| europepmc | Sep 13, 2026 | PPR:PPR1308671 first ingestion |