---
title: "Sepsis risk in COPD with type 2 diabetes: GLP-1RAs versus SGLT2is"
id: "pubmed-42543031"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42543031"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42543031/"
doi: "10.1080/17476348.2026.2713233"
published_at: "2026-08-02T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Sepsis risk in COPD with type 2 diabetes: GLP-1RAs versus SGLT2is
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42543031
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42543031/)
- **DOI:** [10.1080/17476348.2026.2713233](https://doi.org/10.1080%2F17476348.2026.2713233)
- **Published At:** 2026-08-02T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Patients with **COPD** and **type 2 diabetes mellitus (T2DM)** have an elevated risk of sepsis. The comparative infection-related outcomes of newer antihyperglycemic agents were evaluated because these agents are increasingly used in this population. - The study used a retrospective, new-user, active-comparator cohort design drawn from the TriNetX global federated database, selecting individuals aged 40–100 years with both COPD and T2DM who initiated either a **GLP-1 receptor agonist (GLP-1RA)** or a **SGLT2 inhibitor (SGLT2i)** between 2021 and 2024. - A 1:1 propensity score matching approach was applied to create comparable treatment groups and reduce confounding by measured covariates. - The primary outcome was **sepsis**. Secondary outcomes included **all-cause mortality** and components of the primary outcome, with time-to-event analysis performed using Cox proportional hazards models reporting hazard ratios (HRs) and 95% confidence intervals (CIs). - After propensity matching, the analysis included 45,491 matched pairs (GLP-1RA vs SGLT2i users). - Compared with SGLT2i initiators, GLP-1RA initiators had a lower risk of sepsis (adjusted HR 0.832; 95% CI 0.781–0.887). - GLP-1RA use was also associated with lower risk of all-cause mortality (adjusted HR 0.642; 95% CI 0.598–0.689) and lower risk of severe sepsis (adjusted HR 0.841; 95% CI 0.774–0.914) versus SGLT2i use. - The authors conclude that in patients with coexisting COPD and T2DM, **GLP-1RAs** were associated with significantly lower risks of sepsis and death compared with **SGLT2is**. - The abstract does not report certain methodological details (for example, specific covariates used for propensity matching, duration of follow-up, event rates, or sensitivity analyses); those details were not reported in the source abstract.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Sepsis risk in patients with COPD and type 2 diabetes mellitus: influence of emerging antihyperglycemic therapies [Kuan-Chih Kuo](https://pubmed.ncbi.nlm.nih.gov/?term=Kuo+KC&cauthor_id=42543031)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#full-view-affiliation-1 "Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, New Taipei City, Taiwan.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#full-view-affiliation-2 "Department of Medicine, MacKay Medical University, New Taipei City, Taiwan."), [Chao-Hsien Chen](https://pubmed.ncbi.nlm.nih.gov/?term=Chen+CH&cauthor_id=42543031)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#full-view-affiliation-2 "Department of Medicine, MacKay Medical University, New Taipei City, Taiwan.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#full-view-affiliation-3 "Division of Pulmonary andCritical Care Medicine, Department of Internal Medicine, Taitung MacKayMemorial Hospital, Taitung, Taiwan."), [Ting-Jia Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+TJ&cauthor_id=42543031)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#full-view-affiliation-4 "School of Medicine, Collegeof Medicine, Taipei Medical University, Taipei, Taiwan."), [Hsiu-Chin Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+HC&cauthor_id=42543031)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#full-view-affiliation-5 "Department of InternalMedicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan."), [Ya-Hui Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+YH&cauthor_id=42543031)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#full-view-affiliation-6 "Medical Research Center,Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu JenCatholic University, New Taipei, Taiwan."), [Cheng-Yi Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+CY&cauthor_id=42543031)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#full-view-affiliation-5 "Department of InternalMedicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan."), [Chih-Cheng Lai](https://pubmed.ncbi.nlm.nih.gov/?term=Lai+CC&cauthor_id=42543031)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#full-view-affiliation-7 "Division of HospitalMedicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.")[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#full-view-affiliation-8 "School of Medicine, Collegeof Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan."), [Vin-Cent Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+VC&cauthor_id=42543031)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#full-view-affiliation-9 "Division of Nephrology,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.")[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#full-view-affiliation-10 "PAC \(Primary AldosteronismCenter\), National Taiwan University Hospital, Taipei, Taiwan.")[ 11 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#full-view-affiliation-11 "NSARF \(National TaiwanUniversity Hospital Study Group of Acute Renal Failure\), Taipei, Taiwan.") Affiliations Expand ### Affiliations * 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, New Taipei City, Taiwan. * 2 Department of Medicine, MacKay Medical University, New Taipei City, Taiwan. * 3 Division of Pulmonary andCritical Care Medicine, Department of Internal Medicine, Taitung MacKayMemorial Hospital, Taitung, Taiwan. * 4 School of Medicine, Collegeof Medicine, Taipei Medical University, Taipei, Taiwan. * 5 Department of InternalMedicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan. * 6 Medical Research Center,Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu JenCatholic University, New Taipei, Taiwan. * 7 Division of HospitalMedicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan. * 8 School of Medicine, Collegeof Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan. * 9 Division of Nephrology,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. * 10 PAC (Primary AldosteronismCenter), National Taiwan University Hospital, Taipei, Taiwan. * 11 NSARF (National TaiwanUniversity Hospital Study Group of Acute Renal Failure), Taipei, Taiwan. * PMID: **42543031** * DOI: [ 10.1080/17476348.2026.2713233 ](https://doi.org/10.1080/17476348.2026.2713233) Item in Clipboard # Sepsis risk in patients with COPD and type 2 diabetes mellitus: influence of emerging antihyperglycemic therapies Kuan-Chih Kuo et al. Expert Rev Respir Med. 2026. Show details Display options Display options Format Abstract PubMed PMID Expert Rev Respir Med Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Expert+Rev+Respir+Med%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Expert+Rev+Respir+Med%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42543031/) . 2026 Aug 2. doi: 10.1080/17476348.2026.2713233. Online ahead of print. ### Authors [Kuan-Chih Kuo](https://pubmed.ncbi.nlm.nih.gov/?term=Kuo+KC&cauthor_id=42543031)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#short-view-affiliation-1 "Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, New Taipei City, Taiwan.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#short-view-affiliation-2 "Department of Medicine, MacKay Medical University, New Taipei City, Taiwan."), [Chao-Hsien Chen](https://pubmed.ncbi.nlm.nih.gov/?term=Chen+CH&cauthor_id=42543031)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#short-view-affiliation-2 "Department of Medicine, MacKay Medical University, New Taipei City, Taiwan.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#short-view-affiliation-3 "Division of Pulmonary andCritical Care Medicine, Department of Internal Medicine, Taitung MacKayMemorial Hospital, Taitung, Taiwan."), [Ting-Jia Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+TJ&cauthor_id=42543031)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#short-view-affiliation-4 "School of Medicine, Collegeof Medicine, Taipei Medical University, Taipei, Taiwan."), [Hsiu-Chin Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+HC&cauthor_id=42543031)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#short-view-affiliation-5 "Department of InternalMedicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan."), [Ya-Hui Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+YH&cauthor_id=42543031)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#short-view-affiliation-6 "Medical Research Center,Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu JenCatholic University, New Taipei, Taiwan."), [Cheng-Yi Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+CY&cauthor_id=42543031)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#short-view-affiliation-5 "Department of InternalMedicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan."), [Chih-Cheng Lai](https://pubmed.ncbi.nlm.nih.gov/?term=Lai+CC&cauthor_id=42543031)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#short-view-affiliation-7 "Division of HospitalMedicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.")[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#short-view-affiliation-8 "School of Medicine, Collegeof Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan."), [Vin-Cent Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+VC&cauthor_id=42543031)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#short-view-affiliation-9 "Division of Nephrology,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.")[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#short-view-affiliation-10 "PAC \(Primary AldosteronismCenter\), National Taiwan University Hospital, Taipei, Taiwan.")[ 11 ](https://pubmed.ncbi.nlm.nih.gov/42543031/#short-view-affiliation-11 "NSARF \(National TaiwanUniversity Hospital Study Group of Acute Renal Failure\), Taipei, Taiwan.") ### Affiliations * 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, New Taipei City, Taiwan. * 2 Department of Medicine, MacKay Medical University, New Taipei City, Taiwan. * 3 Division of Pulmonary andCritical Care Medicine, Department of Internal Medicine, Taitung MacKayMemorial Hospital, Taitung, Taiwan. * 4 School of Medicine, Collegeof Medicine, Taipei Medical University, Taipei, Taiwan. * 5 Department of InternalMedicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan. * 6 Medical Research Center,Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu JenCatholic University, New Taipei, Taiwan. * 7 Division of HospitalMedicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan. * 8 School of Medicine, Collegeof Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan. * 9 Division of Nephrology,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. * 10 PAC (Primary AldosteronismCenter), National Taiwan University Hospital, Taipei, Taiwan. * 11 NSARF (National TaiwanUniversity Hospital Study Group of Acute Renal Failure), Taipei, Taiwan. * PMID: **42543031** * DOI: [ 10.1080/17476348.2026.2713233 ](https://doi.org/10.1080/17476348.2026.2713233) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background and objective:** Patients with chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2DM) are at increased risk of sepsis, yet the comparative infection-related outcomes of newer antihyperglycemic agents remain unclear. We evaluated the associations of glucagon-like peptide-1 receptor agonists (GLP-1RAs) versus sodium-glucose cotransporter 2 inhibitors (SGLT2is) with infection outcomes in this population. **Methods:** In this retrospective cohort study using the TriNetX global federated database, individuals aged 40-100 years with coexisting COPD and T2DM who initiated a GLP-1RA or SGLT2i between 2021 and 2024 were identified. A new-user, active-comparator design with 1:1 propensity score matching was applied. Sepsis was the primary outcome; all-cause mortality and components of the primary outcome were secondary. Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs). **Results:** After matching, 45,491 pairs were included. Compared with SGLT2is, GLP-1RAs showed lower risks of sepsis (adjusted HR, 0.832; 95% CI, 0.781-0.887), all-cause mortality (0.642; 0.598-0.689), and severe sepsis (0.841; 0.774-0.914). **Conclusion:** In patients with COPD and T2DM, GLP-1RAs were associated with significantly lower risks of sepsis and all-cause mortality compared with SGLT2is. **Keywords:** COPD; GLP1-RA; SGLT2i; sepsis risk; type 2 diabetes mellitus. 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