Prospective study of hyperglycemia and its impact on the causation of severe exacerbations in chronic obstructive pulmonary disease (COPD) patients attending a tertiary care hospital

Kakumanu Kalyani; Chappidi Rajesh Reddy; Muthineni Manoj Kumar

doi:10.18231/j.joapr.2023.11.5.9.14

Authors

Kakumanu Kalyani Department of Pulmonology, Narayana Medical College, Nellore, Andhra Pradesh
Chappidi Rajesh Reddy Department of Pulmonology, Narayana Medical College, Nellore, Andhra Pradesh
Muthineni Manoj Kumar Department of Pulmonology, Narayana Medical College, Nellore, Andhra Pradesh

DOI:

https://doi.org/10.18231/j.joapr.2023.11.5.9.14

Keywords:

Acute exacerbation, COPD, Gold staging, hyperglycemia, HbA1c

Abstract

Background: Hyperglycemic states are always associated with sudden onset of illnesses of both infectious and non-infectious nature. Chronic obstructive pulmonary disease is a chronic, lifelong suffering illness with sudden exacerbations. Objectives: To compare the affiliation of hyperglycemia with the chance of sudden exacerbations in sufferers with an established diagnosis of obstructive airway disease (COPD). Materials Methods: A total of 263 patients with an established diagnosis of COPD were taken into this observational study. The duration of the study extended between Jan. 2022 to July 2023. Sufferers were divided into 3 classes following the guidelines of the American Diabetes Association; those classes were: low HbA1c level class (n=102), moderate HbA1c level (n=83), and severe HbA1c level (n=74). Results: Among the 263 participants, 72 (27.4%) suffered severe exacerbation. The share of sufferers tormented by a minimum of one episode of intense and sudden exacerbation becomes extensively higher among participants with high (36.3%) and moderate HbA1c levels (24.7%) when compared with low HbA1c levels (22.6%). On the MCRA, high HbA1c levels (HR=2.65, 95% CI: 1.92–4.31; P<0.01) and moderate HbA1c levels (HR=2.06, 95% CI: 1.64–3.29; P<0.01). Participants with hyperglycemia were significantly associated with a higher risk of the next severe exacerbation compared with a euglycemic state. Conclusion: irrespective of current/previously established diagnosis of diabetes, hyperglycemic states are associated with a higher risk of severe exacerbation in patients with COPD.

Downloads

Download data is not yet available.

References

Wu L, Lan N, Yang X. Effects of Empirical Glucocorticoid Use on Severe Acute Exacerbation of COPD During Hospitalization. Int J Chron Obstruct Pulmon Dis 16, 2419-31 (2021)

Wedzicha JA, Seemungal TA. COPD exacerbations: defining their cause and prevention. Lancet 370, 786-96 (2007)

Jiménez D, Agustí A, Tabernero E, Jara-Palomares L, Hernando A, Ruiz-Artacho P et al. Effect of a Pulmonary Embolism Diagnostic Strategy on Clinical Outcomes in Patients Hospitalized for COPD Exacerbation: A Randomized Clinical Trial. JAMA 326, 1277-85 (2021)

Suissa S, Dell'Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax 67, 957-63 (2012)

Hogea SP, Tudorache E, Fildan AP, Fira-Mladinescu O, Marc M, Oancea C. Risk factors of chronic obstructive pulmonary disease exacerbations. Clin Respir J 14, 183-97 (2020)

Flattet Y, Garin N, Serratrice J, Perrier A, Stirnemann J, Carballo S. Determining prognosis in acute exacerbation of COPD. Int J Chron Obstruct Pulmon Dis 12, 467-75 (2017)

Rambaran K, Bhagan B, Ali A, Ali F, Toolsie S, Lobin R et al. High Prevalence of Diabetes Mellitus in a Cohort of Patients with Chronic Obstructive Pulmonary Disease in Trinidad, West Indies. Turk Thorac J 20, 12-7 (2019)

Castañ-Abad MT, Montserrat-Capdevila J, Godoy P, Marsal JR, Ortega M, Alsedà M, Barbé F. Diabetes as a risk factor for severe exacerbation and death in patients with COPD: a prospective cohort study. Eur J Public Health 30, 822-7 (2020)

Figueira Gonçalves JM, García Bello MÁ, Golpe R, Alonso Jerez JL, García-Talavera I. Impact of diabetes mellitus on the risk of severe exacerbation in patients with chronic obstructive pulmonary disease. Clin Respir J 14, 1208-11 (2020)

Zhu J, Fang Y, Chen X, Wang H, Teng Y, Yu D et al. The impacts of obstructive sleep apnea hypopnea syndrome severity and surgery intervention on psychological and behavioral abnormalities and postoperative recovery in pediatric patients. Med Sci Monit 20, 1474-80 (2014)

Standards of Medical Care in Diabetes-2018 Abridged for Primary Care Providers. Clin Diabetes 36, 14-37 (2018)

Yin HL, Yin SQ, Lin QY, Xu Y, Xu HW, Liu T. Prevalence of comorbidities in chronic obstructive pulmonary disease patients: A meta-analysis. Medicine (Baltimore) 96, e6836 (2017)

Baker EH, Janaway CH, Philips BJ, Brennan AL, Baines DL, Wood DM, Jones PW. Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease. Thorax 61, 284-9 (2006)

Marhoffer W, Stein M, Maeser E, Federlin K. Impairment of polymorphonuclear leukocyte function and metabolic control of diabetes. Diabetes Care 15, 256-60 (1992)

Papathanassiou E, Papaioannou AI, Papanikolaou I, Antonakis E, Makou I, Hillas G et al. Glycated Hemoglobin (HbA1c) as a Predictor of Outcomes during Acute Exacerbations of Chronic Obstructive Pulmonary Disease. COPD 18, 219-25 (2021)