Glucose-Lowering Medications and Risk of Chronic Obstructive Pulmonary Disease Exacerbations in Patients With Type 2 Diabetes

JAMA Internal Medicine, Год журнала: 2025, Номер unknown

Опубликована: Фев. 10, 2025

Importance Recent studies have suggested that sodium-glucose cotransporter-2 inhibitors (SGLT-2is), glucagon-like peptide-1 receptor agonists (GLP-1RAs), and dipeptidyl peptidase 4 (DPP-4is) may benefit patients with chronic obstructive pulmonary disease (COPD). However, clinical evidence is lacking on their comparative association COPD exacerbations in US type 2 diabetes (T2D). Objective To compare the risk of moderate or severe among SGLT-2is, GLP-1RAs, DPP-4is. Design, Setting, Participants This effectiveness research study used data from three 1:1 propensity score–matched cohort emulated 3 target trials comparing 40 years older T2D active who initiated treatment SGLT-2is vs DPP-4is, GLP-1RAs GLP-1RAs. Data were insurance claims databases: Optum deidentified Clinformatics Mart Database (2013-2023), IBM Health MarketScan (2013-2021), Medicare fee for service (2013-2020). The analysis was conducted January to June 2024. Exposures Initiation SGLT-2i DPP-4i, GLP-1RA trials, respectively. Main Outcomes Measures First occurrence a exacerbation, defined as filled prescription oral glucocorticoids an outpatient visit hospitalization COPD. Incidence rates, incidence rate differences (IRDs), hazard ratios (HRs) 95% CIs calculated. Results There 27 991, 32 107, 36 218 pairs cohorts, respectively (mean [SD] age, 70.8 [8.6] 70.7 [8.8], 70.4 [8.5] [8.2], 69.8 [8.7] years, respectively; 13 767 [49.2%] 847 [49.5%], 17 622 [54.9%] 620 [54.9%], 18 807 [51.9%] 854 [52.1%] female individuals, respectively). During median follow-up 145 (IQR, 61-355) days treatment, exacerbation lower those treated DPP-4is (9.26 11.4 per 100 person-years [PYs]; HR, 0.81; CI, 0.76-0.86; IRD/100 PYs, −2.20; −2.83 −1.58) (9.89 11.49 PYs; 0.86; 0.81-0.91; −1.60; −2.18 −1.02), minimal (9.47 10.00 0.94; 0.89-1.00; −0.55; −1.09 −0.01). consistent across sensitivity subgroup analyses. Conclusions Relevance results this suggest associated reduced compared DPP-4i adults inform prescribing glucose-lowering medications

Язык: Английский

---

Long term survival with stereotactic ablative radiotherapy (SABR) versus thoracoscopic sublobar lung resection in elderly people: national population based study with propensity matched comparative analysis

BMJ, Год журнала: 2016, Номер unknown, С. i3570 - i3570

Опубликована: Июль 8, 2016

Objectives To compare cancer specific survival after thoracoscopic sublobar lung resection and stereotactic ablative radiotherapy (SABR) for tumors ≤2 cm in size (sublobar or lobectomy) SABR ≤5 size. Design National population based retrospective cohort study with propensity matched comparative analysis. Setting Surveillance, Epidemiology, End Results (SEER) registry linked Medicare database the United States. Participants Patients aged ≥66 undergoing lobectomy from 1 Oct 2007 to 31 June 2012 followed up December 2013. Main outcome measures Cancer surgery cancer. Results 690 (275 (39.9%) 415 (60.1%) resection) 2967 (714 (24.1%) 2253 (75.9%) patients were included primary secondary analyses. The average age of entire was 76. Follow-up ranged 0 6.25 years, an three years. In analysis sized cm, 37 (13.5%) 44 (10.6%) died cancer, respectively. diverged one year, but (201 each group) there no significant difference between groups (SABR v mortality: hazard ratio 1.32, 95% confidence interval 0.77 2.26; P=0.32). Estimated at years 82.6% 86.4%, (643 showed that associated improved over 2.10, 1.52 2.89; P<0.001). 80.0% 90.3%, Conclusions This suggests surgical resection, particularly larger tumors, might have compared SABR. Despite strategies used design matching analysis, are inherent limitations this observational related confounding, similar most studies healthcare non-surgical technologies surgery. As adoption treatment early stage operable would be a paradigm shift care, it warrants further thorough evaluation before widespread practice.

Язык: Английский

---

Deep learning on graphs for multi-omics classification of COPD

PLoS ONE, Год журнала: 2023, Номер 18(4), С. e0284563 - e0284563

Опубликована: Апрель 21, 2023

Network approaches have successfully been used to help reveal complex mechanisms of diseases including Chronic Obstructive Pulmonary Disease (COPD). However despite recent advances, we remain limited in our ability incorporate protein-protein interaction (PPI) network information with omics data for disease prediction. New deep learning methods convolution Graph Neural (ConvGNN) has shown great potential classification using transcriptomics and known PPI networks from existing databases. In this study, first reconstructed the COPD-associated through AhGlasso (Augmented High-Dimensional Graphical Lasso Method) algorithm based on one independent dataset COPD cases controls. Then extended ConvGNN integrate PPI, proteomics, developed a prediction model classification. This approach improves accuracy over several conventional neural that do not information. We also demonstrated updated further accuracy. Although often achieve superior statistical power compared other methods, it can be very difficult explain how model, especially graph network(s), makes decisions given features identifies contribute most generally individually. To better spectral-based model(s) works, applied unified explainable machine method, SHapley Additive exPlanations (SHAP), identified CXCL11, IL-2, CD48, KIR3DL2, TLR2, BMP10 relevant genes subnetworks Finally, Gene Ontology (GO) enrichment analysis glycosaminoglycan, heparin signaling, carbohydrate derivative signaling pathways significantly enriched top important gene/proteins classifications.

Язык: Английский

---

Algorithms to identify COPD in health systems with and without access to ICD coding: a systematic review

BMC Health Services Research, Год журнала: 2019, Номер 19(1)

Опубликована: Окт. 22, 2019

Chronic obstructive pulmonary disease (COPD) causes significant morbidity and mortality worldwide. Estimation of incidence, prevalence burden through routine insurance data is challenging because under-diagnosis under-treatment, particularly for early stage in health care systems where outpatient International Classification Diseases (ICD) diagnoses are not collected. This poses the question which criteria commonly applied to identify COPD patients claims datasets absence ICD diagnoses, information can be used as a substitute. The aim this systematic review summarize previously reported methodological approaches identification compile potential if codes available.A literature was performed Medline via PubMed Google Scholar from January 2000 October 2018, followed by manual included studies at least two independent raters. Study characteristics all identifying were systematically extracted publications, categorized, compiled evidence tables.In total, search yielded 151 publications. After title abstract screening, 38 publications into assessment. In these studies, most frequently (22/38) set codes, hospitalization, ambulatory visits. Only four out methods other than coding. proportion age range target population (33/38) hospitalization (30/38) provided. Ambulatory 24, physician 22, pharmaceutical 18 studies. five spirometry, surgery one oxygen therapy.A variety different data. promising environments diagnosis lacking consideration additional illness-related with special attention pharmacotherapy Further services research should focus on application more internal and/or external validation approaches.

Язык: Английский

---

Evaluation of exacerbations and blood eosinophils in UK and US COPD populations

Respiratory Research, Год журнала: 2019, Номер 20(1)

Опубликована: Авг. 7, 2019

Blood eosinophil counts and history of exacerbations have been proposed as predictors patients with chronic obstructive pulmonary disease (COPD) who may benefit from triple therapy (inhaled corticosteroid, long-acting β2-agonist muscarinic antagonist).In a retrospective cohort analysis we examined the profiles COPD UK Clinical Practice Research Datalink (CPRD) US Optum Clinformatics™ Data Mart (Optum) databases reference to exacerbation frequency blood distribution.Of 31,437 383,825 COPD, 15,364 139,465 met eligibility criteria were included. Among ≥2 available in baseline period (CPRD, n = 3089 Optum, 13414), 17.0 13.3% respectively had ≥400 cells/μL. Patients or count cells/μL during first year, exacerbated at least once 82.8% vs 80.6%) continued ≥300 (76.8% 76.5%), follow-up year. In both years, higher variability number was observed one between 300 400 cells/μL; < 150 lowest variability. Approximately 10% across databases.A high over two consecutive years should be considered while making treatment decisions. A small proportion frequent

Язык: Английский

---

Continuity of Care and Avoidable Hospitalizations for Chronic Obstructive Pulmonary Disease (COPD)

The Journal of the American Board of Family Medicine, Год журнала: 2015, Номер 28(2), С. 222 - 230

Опубликована: Март 1, 2015

Background:

Numerous studied suggest that better continuity of care could result in health outcomes. However, few studies have examined the relationship between and avoidable hospitalizations.

Methods:

A retrospective cohort study design was adopted. We used secondary data analysis based on claim regarding utilization under a universal coverage insurance scheme Taiwan. The population included 3,015 subjects who were newly diagnosed with chronic obstructive pulmonary disease (COPD) 2006. main outcome COPD-related hospitalization, index (COCI) to measure care. logistic regression model control for sex, age, low-income status, status.

Results:

With regard effects hospitalizations, dose–response trends observed. showed after controlling covariables, low COCI group 129% (adjusted odds ratio, 2.29; 95% confidence interval, 1.26–4.15) more likely undergo hospitalizations than those high group.

Conclusions:

Patients COPD higher had significantly lower likelihood hospitalization. To prevent future policy stakeholders should encourage physicians patients develop long-term relationships further improve their

Язык: Английский

---

Effects of long-term high continuity of care on avoidable hospitalizations of chronic obstructive pulmonary disease patients

Health Policy, Год журнала: 2017, Номер 121(9), С. 1001 - 1007

Опубликована: Июль 6, 2017

Язык: Английский

---

Effect of compliance with GOLD treatment recommendations on COPD health care resource utilization, cost, and exacerbations among patients with COPD on maintenance therapy

Journal of Managed Care & Specialty Pharmacy, Год журнала: 2021, Номер 27(5), С. 625 - 637

Опубликована: Апрель 28, 2021

BACKGROUND: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) report the management of chronic obstructive pulmonary disease (COPD) focuses on reducing existing symptoms, decreasing risk future exacerbations, and improving health status by recommending specific drug therapy based exacerbation symptoms. However, disparities exist between evidence-based recommendations clinical practice. Research that quantifies real-world effect COPD regimen alignment with GOLD economic outcomes is needed. OBJECTIVE: To compare COPD-related care resource utilization (HRU) costs, as well rates, among patients maintenance 2017 treatment recommendation compliance per ABCD group classification in a U.S. commercially insured/Medicare Advantage population. METHODS: This retrospective cohort study utilized administrative claims data HealthCore Integrated Database. population was identified using previously validated claims-based predictive model. Among this population, ≥ 1 claim medication (earliest fill-date = index date) January 1, 2014, March 31, 2017, were identified. Patients required to be aged 40 years, have 12 months pre-index 30 days post-index plan enrollment, no diagnosis asthma, cystic fibrosis, and/or lung cancer at any time from 2013, 2018. categorized into risk/symptomatology groups according assessment then classified treatment-compliance their therapy. Multivariable analyses conducted examine HRU, exacerbations status. RESULTS: primary analytical sample included 38,382 A/B 6,525 C/D group. further A (n 19,345), B 19,037), C 1,865), D 4,670). GOLD-compliant regimens observed 32.9% 58.9% Inhaled corticosteroid-containing most commonly noncompliant regimen. compliant had significantly fewer inpatient emergency department visits therefore lower medical costs both cohorts. Similar results individual cohorts B, C, D. These savings offset increased pharmacy expenditures. Being guideline-compliant reduced 8% (hazard ratio [HR] 0.92; P < 0.0001) 12% (HR 0.88; 0.0005) cohort, also associated rate (rate [RR] 0.93; (RR 0.0129) groups. CONCLUSIONS: suggests continuing trend high prevalence suboptimal prescriber recommendations. Treatment improvement cost offsets. DISCLOSURES: funded Boehringer Ingelheim Pharmaceuticals, Inc. (BIPI). BIPI given opportunity review manuscript scientific accuracy intellectual property considerations. Palli Shaikh are employees BIPI. Willey an employee HealthCore, which contracted conduct study. Zhou execution. Data presented part during AMCP webinar (recording not made public) held lieu Spring 2020 conference, canceled due COVID-19 pandemic.

Язык: Английский

---

Identifying individuals with physician-diagnosed chronic obstructive pulmonary disease in primary care electronic medical records: a retrospective chart abstraction study

npj Primary Care Respiratory Medicine, Год журнала: 2017, Номер 27(1)

Опубликована: Май 5, 2017

Little is known about using electronic medical records to identify patients with chronic obstructive pulmonary disease improve quality of care. Our objective was develop record algorithms that can accurately disease. A retrospective chart abstraction study conducted on data from the Electronic Medical Record Administrative Linked Database (EMRALD

Язык: Английский

---

End-of-Life Spending and Healthcare Utilization Among Older Adults with Chronic Obstructive Pulmonary Disease

The American Journal of Medicine, Год журнала: 2019, Номер 133(7), С. 817 - 824.e1

Опубликована: Дек. 27, 2019

Язык: Английский

---