[Incidence of severe exacerbation in patients diagnosed with diabetes and chronic obstructive pulmonary disease: Cohort study]

Therapeutic Management in Patients with Chronic Obstructive Pulmonary Disease Who Are Overweight or Obese: A Systematic Review and Meta-Analysis

Introduction/Objective: The relationship between chronic obstructive pulmonary disease (COPD) and overweight is complex and multifaceted, as these conditions can interact in terms of symptoms, severity and clinical management. To analyse the clinical and therapeutic management of patients suffering from COPD and overweight. Methods: This systematic review was carried out, in accordance with the PRISMA statement, during November 2024, following a search of the Medline/PubMed databases. The search equation used, with MESH descriptors, was: "(Pulmonary Disease, Chronic Obstructive OR COPD) AND (obesity OR overweight)". Both inclusion and exclusion criteria were applied, focusing on the selection of clinical trials. The studies were classified into two main groups: by their focus on the relationship between overweight/obesity and COPD; and by the benefits provided by physical exercise to patients with these conditions. A random-effects meta-analysis was performed on the data obtained. The protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD42024576389). Results: The search produced nine relevant clinical trials with a total of 1345 COPD patients. Four of the trials incorporated obesity (BMI ≥ 30) as an inclusion criterion, while the other five had mixed samples, with patients presenting either overweight or obesity (four patients with BMI ≥ 25 and one with BMI ≥ 27). The risk of bias tool for randomised trials showed that all nine studies had a low risk of bias. Overall, these studies highlight the importance of overweight management and reject the use of extreme measures. Furthermore, they confirm the association between overweight/obesity and COPD, for which this condition is a risk factor, to a degree depending on the BMI. Four studies reported significant improvements in the clinical management of COPD patients following appropriate physical exercise. Specifically, one study observed that supervised exercise improved cardio-vascular performance; another, that observed that aquatic exercise increased maximal capacity, endurance and quality of life; another, that found cycling improved ventilatory performance; and the fourth, that observed exercise complementary to standard therapy in hospitalised obese COPD patients improved strength, exercise capacity and other perceived variables such as anxiety, mobility and dyspnoea. Conclusions: The therapeutic management of overweight COPD patients should include weight control, physical exercise and appropriate pharmacological treatment. Physical exercise is associated with improvements in endurance, exercise capacity, cardio-vascular performance, ventilatory performance and strength. In addition, the participants in these studies self-perceived clinical improvement. These findings justify the performance of further RCTs examining the role of physical exercise in patients with COPD and overweight/obesity, in order to improve their clinical outcomes and quality of life.

Significance of plasma TGF-β1 level detection in patients with T2DM with heart failure

Background

The aim of the study was to examine the significance of plasma Transforming Growth Factor-1/TGF-β1 (TGF-β1) level testing in patients with Type 2 Diabetes Mellitus (T2DM) and heart failure.

Methods

A sample of T2DM patients who were hospitalised for dyspnea was chosen between June 2021 and June 2023. Based on the convenience sample approach, 150 cases were screened for the study, and 50 healthy non-diabetic people without cardiac problems who completed physical examinations over the same period were included as a control group. All study participants had their serum NT-proBNP and plasma TGF-I levels checked, and the values between the two groups were compared. Then, the patients with T2DM with heart failure were grouped according to whether they were accompanied by heart failure or not and the grading of cardiac function, and then the serum NT-proBNP and plasma TGF-β1 levels were compared between the different groups of patients. The diagnostic value of plasma TGF-β1 in the occurrence of heart failure in patients with T2DM was analysed.

Results

There were 54 patients without heart failure and 96 people with heart failure among the 150 T2DM patients. The cut-off point was 44.50 g/L. At this time, the sensitivity and specificity for diagnosing concomitant heart failure in T2DM were 79.63% and 52.51%, respectively. 96 individuals with T2DM and heart failure showed greater serum and plasma levels of NT-proBNP and TGF-β1 compared to the other two groups (P=0.05). ProBNP and plasma TGF-β1 levels had a positive and significant relationship (P=0.05).

Conclusions

Plasma TGF-β1 levels were much higher in T2DM patients than in the general population, and the increase in this index was more pronounced in patients who also had heart failure, a diagnostic indicator for T2DM and heart failure.

The Role of Glucagon-Like Peptide-1 Receptor Agonists in Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is one of the common diseases of the respiratory system. As the disease recurs, damage to the airways and lung tissue gradually worsens, leading to a progressive decline in lung function, affecting the patient's workforce and quality of life, and causing a huge social and economic burden. Diabetes is a common comorbidity of COPD and patients with COPD are at increased risk of developing diabetes, while hyperglycemia can also reduce lung function and contribute to the progression and poor prognosis of COPD. Glucagon-like peptide-1 receptor agonist (GLP-1RA) is a new type of hypoglycemic agent that has been shown to regulate blood glucose levels, reduce inflammatory responses and oxidative stress, and regulate lipid metabolism, among other effects. GLP-1RAs may benefit COPD patients by acting directly on the lung from mechanisms such as reducing the inflammatory response, improving oxidative stress, regulating protease/anti-protease imbalance, improving airway mucus homeostasis, and reducing airway remodeling. This study provides a review of the potential role of GLP-1RAs in COPD and offers new ideas for the prevention and treatment of COPD.