Metformin use and health care utilization in patients with coexisting chronic obstructive pulmonary disease and diabetes mellitus

International Journal of Chronic Obstructive Pulmonary Disease, Mar 2018

Metformin use and health care utilization in patients with coexisting chronic obstructive pulmonary disease and diabetes mellitus Raju Bishwakarma,1 Wei Zhang,1 Yu-Li Lin,2 Yong-Fang Kuo,2,3 Victor J Cardenas,1 Gulshan Sharma1,3 1Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, 2Office of Biostatistics, 3Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA Background: Chronic obstructive pulmonary disease (COPD) is associated with persistent systemic inflammation. Anti-inflammatory therapies have been shown to decrease acute exacerbations of COPD. The antidiabetic medication metformin decreases oxidative stress and inflammation and may benefit patients with COPD. We aimed at investigating the effect of metformin on health care utilizations in patients with coexisting COPD and diabetes mellitus (DM). Methods: We studied 5% Medicare beneficiaries with coexisting COPD and DM prescribed metformin or other antidiabetics during the period 2007–2010. The primary outcome was COPD-specific emergency room (ER) visits and hospitalizations; the secondary outcome was all-cause ER visits and hospitalizations over the 2-year follow-up after the index antidiabetic prescription. The effects of metformin were examined by COPD complexity and compared with the effects of other antidiabetic medications. Results: Among 11,260 patients, 3,193 were metformin users and 8,067 were nonusers. Metformin users were younger, were less sick, were less likely to be on oxygen, and had fewer hospitalizations in the prior year compared with the nonusers. Over a 2-year period, metformin users had lower COPD-specific and all-cause ER visits and hospitalizations (7.11% vs 9.61%, p<0.0001; and 61.63% vs 71.27%, p<0.0001, respectively). In a stratified multivariable analysis, the odds of COPD-specific ER visits and hospitalizations were lower in patients with low-complexity COPD (adjusted odds ratio =0.66, 95% confidence interval =0.52–0.85). However, patients with all COPD complexities get benefits of metformin on all-cause ER visits and hospitalizations. Conclusion: The use of metformin in patients with coexisting COPD and DM was associated with fewer COPD-specific ER visits and hospitalizations, especially in low-complexity COPD. Keywords: COPD, diabetes, metformin, ER visits, hospitalization, Medicare

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Metformin use and health care utilization in patients with coexisting chronic obstructive pulmonary disease and diabetes mellitus

International Journal of COPD Metformin use and health care utilization in patients with coexisting chronic obstructive pulmonary disease and diabetes mellitus raju Bishwakarma 2 Wei Zhang 2 Yu-li lin 1 Yong-Fang Kuo 0 1 Victor J Cardenas 2 gulshan sharma 0 2 0 sealy Center on aging, University of Texas Medical Branch , galveston, TX, Usa , USA 1 Office of Biostatistics 2 Division of Pulmonary, Critical Care and s leep Medicine, Department of Internal Medicine froedm lsonue lnodow rsnope PowerdbyTCPDF(ww.tcpdf.org) Background: Chronic obstructive pulmonary disease (COPD) is associated with persistent systemic inflammation. Anti-inflammatory therapies have been shown to decrease acute exacerbations of COPD. The antidiabetic medication metformin decreases oxidative stress and inflammation and may benefit patients with COPD. We aimed at investigating the effect of metformin on health care utilizations in patients with coexisting COPD and diabetes mellitus (DM). Methods: We studied 5% Medicare beneficiaries with coexisting COPD and DM prescribed metformin or other antidiabetics during the period 2007-2010. The primary outcome was COPD-specific emergency room (ER) visits and hospitalizations; the secondary outcome was all-cause ER visits and hospitalizations over the 2-year follow-up after the index antidiabetic prescription. The effects of metformin were examined by COPD complexity and compared with the effects of other antidiabetic medications. Results: Among 11,260 patients, 3,193 were metformin users and 8,067 were nonusers. Metformin users were younger, were less sick, were less likely to be on oxygen, and had fewer hospitalizations in the prior year compared with the nonusers. Over a 2-year period, metformin users had lower COPD-specific and all-cause ER visits and hospitalizations (7.11% vs 9.61%, p,0.0001; and 61.63% vs 71.27%, p,0.0001, respectively). In a stratified multivariable analysis, the odds of COPD-specific ER visits and hospitalizations were lower in patients with low-complexity COPD (adjusted odds ratio =0.66, 95% confidence interval =0.52-0.85). However, patients with all COPD complexities get benefits of metformin on all-cause ER visits and hospitalizations. Conclusion: The use of metformin in patients with coexisting COPD and DM was associated with fewer COPD-specific ER visits and hospitalizations, especially in low-complexity COPD. - sae roF e s i D y r a n o m l u P e v it c u tr s b O c i n o r h C f o l a n r u o J l a n o it a n tr e n I 8 1 0 2 l u J 3 1 n o 3 7 . 7 1 1 . 7 3 . 4 5 y b / m o c . s s e r p e v o d . w w w / / : s p t th .y stress and chronic inflammation.9,10 Animal and clinical studies have suggested other beneficial effects of metformin besides diabetes control. Metformin decreases inflammatory cytokines, such as tumor necrosis factor-α, interleukin (IL)-6, and IL-1, and the inflammatory response of macrophages and induces the production of anti-inflammatory cytokines such as IL-4 and IL-10.11,12 In the animal model, metformin has been shown to decrease eosinophilic inflammation, airway remodeling, and peribronchial and parenchymal fibrosis.13–15 In clinical studies, metformin use in patients with COPD and DM is associated with improvement in respiratory symptoms, St George Respiratory Questionnaire (SGRQ) and transitional dyspnea index scores, respiratory muscle function,16 and overall survival among long-term users.17 It is plausible that metformin use in patients with COPD decreases both local and systemic inflammation and oxidative damage. Our hypothesis was that patients with coexisting COPD and DM on metformin have lower health care utilizafroedm lsonue triooonmas(EmRea)svuisreitds bayndpehrocsepnittaagliezoatfipoantsiednutrsinwgitah2a-nyeemareprgereinocdy. Methods Data source This is a retrospective study using 5% Medicare beneficiaries’ data from the year 2006 to 2012. Over 98% of adults in the USA aged $65 years were enrolled in Medicare, which serves .45 million beneficiaries. The Centers for Medicare and Medicaid Services selected a random sample of 5% Medicare beneficiaries based on the eighth and ninth digits (05, 20, 45, 70, and 95) of their health insurance claim number. This population is the standard available for research purposes and has been shown to be representative of the whole cohort. Medicare Beneficiary Summary Files, Medicare Provider Analysis and Review (MedPAR) Files, Outpatient Standard Analytical Files (OutSAFs), Medicare Carrier Files, Durable Medical Equipment (DME) Files, and Prescription Drug Event (PDE) records18 were used for the study. We also used the Chronic Condition Data Warehouse (CCW) to identify patients with coexisting COPD and DM.19 The CCW data were linked by a unique, unidentifiable beneficiary key, which allows researchers to analyze information across the continuum of care. The 27 CCW chronic condition categories include COPD and DM, available from 1999.19 The Research Data Assistance Center provided deide (...truncated)


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Raju Bishwakarma, Wei Zhang, Yu-Li Lin, Yong-Fang Kuo, Victor J Cardenas, Gulshan Sharma. Metformin use and health care utilization in patients with coexisting chronic obstructive pulmonary disease and diabetes mellitus, International Journal of Chronic Obstructive Pulmonary Disease, 2018, pp. 793-800, DOI: 10.2147/COPD.S150047