{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T23:12:39Z","timestamp":1775776359238,"version":"3.50.1"},"reference-count":43,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,4,24]],"date-time":"2023-04-24T00:00:00Z","timestamp":1682294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Health and Welfare Clinical Trial Center, Taiwan","award":["MOHW109-TDU-B-212-114004"],"award-info":[{"award-number":["MOHW109-TDU-B-212-114004"]}]},{"name":"Ministry of Health and Welfare Clinical Trial Center, Taiwan","award":["MOST 108-2321-B-039-003-"],"award-info":[{"award-number":["MOST 108-2321-B-039-003-"]}]},{"name":"MOST Clinical Trial Consortium for Stroke, Taiwan","award":["MOHW109-TDU-B-212-114004"],"award-info":[{"award-number":["MOHW109-TDU-B-212-114004"]}]},{"name":"MOST Clinical Trial Consortium for Stroke, Taiwan","award":["MOST 108-2321-B-039-003-"],"award-info":[{"award-number":["MOST 108-2321-B-039-003-"]}]},{"name":"Tseng-Lien Lin Foundation, Taichung, Taiwan","award":["MOHW109-TDU-B-212-114004"],"award-info":[{"award-number":["MOHW109-TDU-B-212-114004"]}]},{"name":"Tseng-Lien Lin Foundation, Taichung, Taiwan","award":["MOST 108-2321-B-039-003-"],"award-info":[{"award-number":["MOST 108-2321-B-039-003-"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Acute exacerbations of chronic obstructive pulmonary disease (COPD) with severe hyperglycemia may require insulin to lower glucose levels in people with coexisting type 2 diabetes (T2D) and COPD. We conducted this study to examine the risk of hospitalization for COPD, pneumonia, ventilator use, lung cancer, hypoglycemia, and mortality with and without insulin use in people with T2D and COPD. We adopted propensity-score-matching to identify 2370 paired insulin users and non-users from Taiwan\u2019s National Health Insurance Research Database between 1 January 2000 and 31 December 2018. Cox proportional hazards models and the Kaplan\u2013Meier method were utilized to compare the risk of outcomes between study and control groups. The mean follow-up for insulin users and non-users was 6.65 and 6.37 years. Compared with no insulin use, insulin use was associated with a significantly increased risk of hospitalization for COPD (aHR 1.7), bacterial pneumonia (aHR 2.42), non-invasive positive pressure ventilation (aHR 5.05), invasive mechanical ventilation (aHR 2.72), and severe hypoglycemia (aHR 4.71), but with no significant difference in the risk of death. This nationwide cohort study showed that patients with T2D and COPD requiring insulin therapy may have an increased risk of acute COPD exacerbations, pneumonia, ventilator use, and severe hypoglycemia without a significant increase in the risk of death.<\/jats:p>","DOI":"10.3390\/ph16050643","type":"journal-article","created":{"date-parts":[[2023,4,25]],"date-time":"2023-04-25T02:06:35Z","timestamp":1682388395000},"page":"643","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Respiratory Outcomes of Insulin Use in Patients with COPD: A Nationwide Population-Based Cohort Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4677-2415","authenticated-orcid":false,"given":"Fu-Shun","family":"Yen","sequence":"first","affiliation":[{"name":"Dr. Yen\u2019s Clinic, No. 15, Shanying Road, Gueishan District, Taoyuan 33354, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3427-6035","authenticated-orcid":false,"given":"Shu-Hao","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine, Department of Internal Medicine, Cheng Ching Hospital, No. 139, Pingdeng Street, Central District, Taichung 40045, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James Cheng-Chung","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, No. 110, Section 1, Jianguo N. Road, South District, Taichung 40201, Taiwan"},{"name":"Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan"},{"name":"Graduate Institute of Integrated Medicine, China Medical University, Taichung 40402, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3967-784X","authenticated-orcid":false,"given":"Ying-Hsiu","family":"Shih","sequence":"additional","affiliation":[{"name":"Management Office for Health Data, China Medical University Hospital, Taichung 40201, Taiwan"},{"name":"College of Medicine, China Medical University, Taichung 40402, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8209-9627","authenticated-orcid":false,"given":"Chii-Min","family":"Hwu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, National Yang-Ming Chiao Tung University School of Medicine, No. 155, Section 2, Linong Street, Taipei 11221, Taiwan"},{"name":"Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei 11217, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1016\/S0140-6736(22)01273-9","article-title":"Towards the elimination of chronic obstructive pulmonary disease: A Lancet commission","volume":"400","author":"Stolz","year":"2022","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2227","DOI":"10.1016\/S0140-6736(22)00470-6","article-title":"Chronic obstructive pulmonary disease","volume":"399","author":"Christenson","year":"2022","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1056\/NEJMra1900475","article-title":"Update on the pathogenesis of chronic obstructive pulmonary disease","volume":"381","author":"Hogg","year":"2019","journal-title":"N. 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