Table 3.
Crude and adjusted ORs of severe COPD exacerbation associated with varying durations of current use of oral hypoglycemic agents
| Cases (n = 2700) | Controls (n = 9272) | OR (95% CI) | |||
|---|---|---|---|---|---|
| Crude OR | Model 1 Adjusted ORa |
Model 2 Adjusted ORb |
|||
| Current use, no (%)c | |||||
| Metformin | |||||
| ≤ 30 days | 222 (8.2) | 472 (5.1) | 1.51 (1.26–1.82)d | 1.55 (1.28–1.88)d | 1.61 (1.32–1.96)d |
| 31–90 days | 227 (8.4) | 709 (7.7) | 1.06 (0.89–1.26) | 1.09 (0.91–1.31) | 1.13 (0.94–1.37) |
| 91–180 days | 148 (5.5) | 736 (7.9) | 0.66 (0.54–0.80)d | 0.69 (0.56–0.85)d | 0.72 (0.58–0.89)d |
| 181–365 days | 167 (6.2) | 964 (10.4) | 0.54 (0.45–0.66)d | 0.60 (0.50–0.73)d | 0.63 (0.51–0.77)d |
| > 365 days | 341 (12.6) | 1773 (19.1) | 0.58 (0.50–0.67)d | 0.65 (0.56–0.76)d | 0.68 (0.57–0.79)d |
| Non-metformin | 741 (27.4) | 2348 (25.3) | Reference | Reference | Reference |
| p for trend | < 0.001 | < 0.001 | < 0.001 | ||
| Sulfonylureas | |||||
| ≤ 30 days | 220 (8.2) | 372 (4.0) | 2.02 (1.67–2.45)d | 2.24 (1.83–2.75)d | 2.35 (1.90–2.89)d |
| 31–90 days | 243 (9.0) | 642 (6.9) | 1.33 (1.11–1.59)d | 1.46 (1.21–1.75)d | 1.52 (1.26–1.85)d |
| 91–180 days | 137 (5.1) | 757 (8.2) | 0.63 (0.51–0.77)d | 0.68 (0.55–0.84)d | 0.72 (0.58–0.90)d |
| 181–365 days | 184 (6.8) | 1023 (11.0) | 0.60 (0.49–0.72)d | 0.67 (0.55–0.81)d | 0.70 (0.57–0.85)d |
| > 365 days | 397 (14.7) | 1978 (21.3) | 0.64 (0.55–0.74)d | 0.73 (0.63–0.85)d | 0.76 (0.65–0.90)d |
| Non-sulfonylureas | 665 (24.6) | 2230 (24.1) | Reference | Reference | Reference |
| p for trend | < 0.001 | < 0.001 | < 0.001 | ||
| Current use, no (%)c | |||||
| α-Glucosidase inhibitors | |||||
| ≤ 30 days | 42 (1.6) | 135 (1.5) | 1.14 (0.80–1.64) | 1.12 (0.77–1.62) | 1.12 (0.77–1.64) |
| 31–90 days | 48 (1.8) | 175 (1.9) | 1.04 (0.75–1.45) | 1.04 (0.74–1.46) | 1.05 (0.74–1.48) |
| 91–180 days | 26 (1.0) | 120 (1.3) | 0.80 (0.52–1.24) | 0.77 (0.49–1.22) | 0.78 (0.49–1.24) |
| 181–365 days | 30 (1.1) | 133 (1.4) | 0.85 (0.56–1.27) | 0.84 (0.55–1.29) | 0.85 (0.55–1.31) |
| > 365 days | 53 (2.0) | 211 (2.3) | 0.94 (0.68–1.28) | 1.02 (0.74–1.41) | 1.03 (0.74–1.43) |
| Non-α-glucosidase inhibitors | 1647 (61.0) | 228 (67.2) | Reference | Reference | Reference |
| p for trend | 0.525 | 0.810 | 0.835 | ||
| TZDs | |||||
| ≤ 30 days | 31 (1.2) | 74 (0.8) | 1.63 (1.06–2.50)d | 1.59 (1.02–2.49)d | 1.59 (1.01–2.50)d |
| 31–90 days | 26 (1.0) | 79 (0.9) | 1.26 (0.81–1.98) | 1.31 (0.82–2.09) | 1.33 (0.83–2.14) |
| 91–180 days | 23 (0.9) | 95 (1.0) | 0.88 (0.55–1.41) | 0.94 (0.58–1.54) | 0.94 (0.57–1.55) |
| 181–365 days | 16 (0.6) | 138 (1.5) | 0.44 (0.26–0.75)d | 0.52 (0.30–0.89)d | 0.52 (0.30–0.89)d |
| > 365 days | 27 (1.0) | 180 (1.9) | 0.53 (0.35–0.80)d | 0.58 (0.37–0.89)d | 0.57 (0.37–0.89)d |
| Non-TZDs | 1723 (63.8) | 6436 (69.4) | Reference | Reference | Reference |
| p for trend | 0.004 | 0.050 | 0.039 | ||
| Current use, no (%)c | |||||
| DPP-4 inhibitors | |||||
| ≤ 30 days | 32 (1.2) | 95 (1.0) | 1.31 (0.86–2.02) | 1.27 (0.81–1.99) | 1.31 (0.83–2.08) |
| 31–90 days | 44 (1.6) | 128 (1.4) | 1.29 (0.90–1.85) | 1.26 (0.86–1.84) | 1.30 (0.89–1.91) |
| 91–180 days | 36 (1.3) | 107 (1.2) | 1.33 (0.90–1.97) | 1.42 (0.95–2.12) | 1.47 (0.97–2.21) |
| 181–365 days | 28 (1.0) | 127 (1.4) | 0.83 (0.54–1.27) | 0.82 (0.52–1.28) | 0.85 (0.54–1.33) |
| > 365 days | 41 (1.5) | 188 (2.0) | 0.81 (0.57–1.16) | 0.89 (0.61–1.29) | 0.93 (0.64–1.35) |
| Non-DPP-4 inhibitors | 1665 (61.7) | 6357 (68.6) | Reference | Reference | Reference |
| p for trend | 0.586 | 0.787 | 0.860 | ||
| Meglitinides | |||||
| ≤ 30 days | 54 (2.0) | 86 (0.9) | 2.36 (1.66–3.37)d | 2.01 (1.39–2.92)d | 2.03 (1.40–2.95)d |
| 31–90 days | 55 (2.0) | 136 (1.5) | 1.60 (1.16–2.21) | 1.30 (0.92–1.83) | 1.32 (0.93–1.88) |
| 91–180 days | 37 (1.4) | 121 (1.3) | 1.18 (0.81–1.72) | 0.81 (0.54–1.21) | 0.81 (0.54–1.22) |
| 181–365 days | 39 (1.4) | 115 (1.2) | 1.33 (0.91–1.93) | 1.14 (0.77–1.70) | 1.14 (0.77–1.69) |
| > 365 days | 56 (2.1) | 193 (2.1) | 1.15 (0.85–1.57) | 1.01 (0.74–1.39) | 1.02 (0.74–1.40) |
| Non-meglitinides | 1605 (59.4) | 6351 (68.5) | Reference | Reference | Reference |
| p for trend | 0.015 | 0.615 | 0.588 | ||
OR, odds ratio; COPD, chronic obstructive pulmonary disease; CI confidence interval; No., Number; TZD, thiazolidinedione; DPP-4, dipeptidyl peptidase-4; DM, diabetic mellitus
a Adjusted for all covariates with standardized difference > 0.1 in Table 1
b Adjusted for all covariates with standardized difference > 0.1 in Table 1 and DM therapy regimen in the 180 days prior to the index date
c Current use was defined as the end date of the most recent prescription within the 30 days prior to the index date
d p < 0.05