Role of Diabetes in Exacerbation of Copd

Abstract

Diabetes is a complex, chronic systemic disease, with macroangiopathic and microangiopathic end-organ complications. There is emerging data that have identified high risk comorbidities for hospitalizations or readmissions, but association of diabetes with Chronic Obstructive Pulmonary Disease (COPD), their readmissions and pulmonary function changes is scarce. We sought to identify differences in rate of readmission/exacerbation, effects on lung function and differences in comorbidities in patients presenting with exacerbation of COPD among diabetics.METHODS: This is a retrospective study at Brooklyn Veterans hospital of patients admitted with the diagnosis of COPD exacerbation between 2015 and 2016. Patients were divided into two groups: Diabetes and No-Diabetes. Outcomes were total number of admissions prior to-, 1-year post-discharge and total number of readmission post-discharge for COPD Exacerbation after the index hospitalization. Data was collected on demographics, past medical history, length of stay, pulmonary function testing parameters, level of Hemoglobin A1C and smoking history. Patients with Interstitial lung disease, active cancer, ongoing lung infection and lung surgery were excluded. RESULTS:Of 152 patients identified, 76 (50%) were diabetic with predominantly male population in both groups. Patients with Diabetes had a significantly higher rate of comorbidities such as hypertension (p¼0.0023), hyperlipidemia (p¼0.0006), Atrial fibrillation/flutter (p¼0.0209) and sleep apnea (p¼0.0036). There was no difference in rate of coronary artery disease, heart failure, deep venous thrombosis/pulmonary embolism and home O2 requirement. Interestingly, rates of COPD exacerbation/ readmissions were significantly higher among patients with DM prior to-(p¼0.0002), 1-year after-(p¼0.0168) and total number post-(p¼0.0126) index admission. On multivariate analysis Diabetes stood out as predictor for readmissions for exacerbations (1year prior-, total number prior-and total number post-discharge) among other comorbidities.CONCLUSIONS: Diabetes in conjunction with COPD has detrimental clinical course, worst outcomes and increases rate of future exacerbation beyond 30-days. Higher hemoglobin A1C level creates systemic inflammation, lowers immunity and affect lung function in long term thus increasing the risk of exacerbation and clinical decline. Aggressive management of diabetes should be strategized early in its course however larger prospective studies are required to explore this observation.CLINICAL IMPLICATIONS: Early and aggressive strategies should be implemented to control Diabetes in patients with Chronic Obstructive Pulmonary Disease.