Impact of antidiabetic agents on COPD exacerbations in patients with type 2 diabetes mellitus: A systematic review and network meta-analysis.

BackgroundThe impact of Antidiabetic Agents on COPD Exacerbations remains uncertain. We conducted a comprehensive review to evaluate the impact Antidiabetic Agents on COPD Exacerbations in patients with T2DM.MethodsWe searched PubMed, Embase, and Web of Science from inception to January 15, 2026 for observational studies involving adults with T2DM and COPD. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models, treatments were ranked using the Surface Under the Cumulative Ranking Curve (SUCRA), and study quality was assessed using the Newcastle-Ottawa Scale.ResultsThirteen studies comprising 755,206 participants were included. Compared with sulfonylureas, SGLT-2 inhibitors were associated with the lowest risk of overall COPD exacerbations (RR 0.71, 95% CI 0.66-0.77), followed by GLP-1 receptor agonists (RR 0.77, 95% CI 0.71-0.84). Metformin demonstrated a near-neutral association (RR 0.89, 95% CI 0.79-1.00), whereas DPP-4 inhibitors (RR 1.05, 95% CI 0.97-1.13) and meglitinides (RR 1.13, 95% CI 0.93-1.36) showed no evidence of benefit. Similar findings were observed for severe exacerbations, with SGLT-2 inhibitors and GLP-1 receptor agonists demonstrating the strongest associations.ConclusionsSGLT-2 inhibitors and GLP-1 receptor agonists were associated with a lower risk of COPD exacerbations than sulfonylureas, whereas metformin showed a near-neutral association and DPP-4 inhibitors and meglitinides showed no clear benefit.