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Diabetes mellitus in patients with chronic obstructive pulmonary disease-The impact on mortality.

Diabetes mellitus in patients with chronic obstructive pulmonary disease-The impact on mortality.
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Ho TW, Huang CT, Ruan SY, Tsai YJ, Lai F, Yu CJ,


Ho TW, Huang CT, Ruan SY, Tsai YJ, Lai F, Yu CJ, (click to view)

Ho TW, Huang CT, Ruan SY, Tsai YJ, Lai F, Yu CJ,

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PloS one 2017 04 1412(4) e0175794 doi 10.1371/journal.pone.0175794
Abstract
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and mortality worldwide. There is evidence to support a connection between COPD and diabetes mellitus (DM), another common medical disorder. However, additional research is required to improve our knowledge of these relationships and their possible implications. In this study, we investigated the impact of DM on patient outcomes through the clinical course of COPD.

METHODS
We conducted a cohort study in patients from the Taiwan Longitudinal Health Insurance Database between 2000 and 2013. Patients with COPD were identified and assessed for pre-existing and incident DM. A Cox proportional hazards model was built to identify factors associated with incident DM and to explore the prognostic effects of DM on COPD patients. A propensity score method was used to match COPD patients with incident DM to controls without incident DM.

RESULTS
Pre-existing DM was present in 332 (16%) of 2015 COPD patients who had a significantly higher hazard ratio (HR) [1.244, 95% confidence interval (CI) 1.010-1.532] for mortality than that of the COPD patients without pre-existing DM. During the 10-year follow-up period, 304 (19%) of 1568 COPD patients developed incident DM; comorbid hypertension (HR, 1.810; 95% CI, 1.363-2.403), cerebrovascular disease (HR, 1.517; 95% CI, 1.146-2.008) and coronary artery disease (HR, 1.408; 95% CI 1.089-1.820) were significant factors associated with incident DM. Survival was worse for the COPD patients with incident DM than for the matched controls without incident DM (Log-rank, p = 0.027).

CONCLUSIONS
DM, either pre-existing or incident, was associated with worse outcomes in COPD patients. Targeted surveillance and management of DM may be important in clinical care of the COPD population.

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