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 Bac...

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Main Authors: Bishwakarma R, Zhang W, Lin YL, Kuo YF, Cardenas VJ, Sharma G
Format: Article
Language:English
Published: Dove Medical Press 2018-03-01
Series:International Journal of COPD
Subjects:
Online Access:https://www.dovepress.com/metformin-use-and-health-care-utilization-in-patients-with-coexisting--peer-reviewed-article-COPD
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author Bishwakarma R
Zhang W
Lin YL
Kuo YF
Cardenas VJ
Sharma G
author_facet Bishwakarma R
Zhang W
Lin YL
Kuo YF
Cardenas VJ
Sharma G
author_sort Bishwakarma R
collection DOAJ
description 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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spelling doaj.art-5bc0647cacab4112bd777f57e03aa2a12022-12-22T01:01:36ZengDove Medical PressInternational Journal of COPD1178-20052018-03-01Volume 1379380037052Metformin use and health care utilization in patients with coexisting chronic obstructive pulmonary disease and diabetes mellitusBishwakarma RZhang WLin YLKuo YFCardenas VJSharma GRaju 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, Medicarehttps://www.dovepress.com/metformin-use-and-health-care-utilization-in-patients-with-coexisting--peer-reviewed-article-COPDCOPDDiabetesMetforminER visitsHospitalizationMedicare
spellingShingle Bishwakarma R
Zhang W
Lin YL
Kuo YF
Cardenas VJ
Sharma G
Metformin use and health care utilization in patients with coexisting chronic obstructive pulmonary disease and diabetes mellitus
International Journal of COPD
COPD
Diabetes
Metformin
ER visits
Hospitalization
Medicare
title Metformin use and health care utilization in patients with coexisting chronic obstructive pulmonary disease and diabetes mellitus
title_full Metformin use and health care utilization in patients with coexisting chronic obstructive pulmonary disease and diabetes mellitus
title_fullStr Metformin use and health care utilization in patients with coexisting chronic obstructive pulmonary disease and diabetes mellitus
title_full_unstemmed Metformin use and health care utilization in patients with coexisting chronic obstructive pulmonary disease and diabetes mellitus
title_short Metformin use and health care utilization in patients with coexisting chronic obstructive pulmonary disease and diabetes mellitus
title_sort metformin use and health care utilization in patients with coexisting chronic obstructive pulmonary disease and diabetes mellitus
topic COPD
Diabetes
Metformin
ER visits
Hospitalization
Medicare
url https://www.dovepress.com/metformin-use-and-health-care-utilization-in-patients-with-coexisting--peer-reviewed-article-COPD
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