Effects of Metformin Alone versus in Combination with Other Oral Anti-Diabetic Drugs on the Immuno-Inflammatory Status in Chronic Obstructive Pulmonary Disease Patients with Type Two Diabetes in Suez Canal University Hospitals, A Comparative Descriptive Cross-sectional Study

Background: Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory condition frequently complicated by type 2 diabetes mellitus (T2DM). Metformin, the first-line therapy for T2DM, possesses anti-inflammatory and antioxidant properties that may modulate systemic inflammation in COPD. However, the impact of metformin alone or combined with other oral antidiabetic drugs (OADs) on immuno-inflammatory markers in COPD patients remains underexplored.
Objective: To evaluate the effects of metformin, alone or in combination with other OADs, on clinical, biochemical, and inflammatory parameters in controlled COPD patients with coexisting T2DM.
Methods: This comparative descriptive cross-sectional study was conducted on 200 participants (40 per group) at Suez Canal University Hospital. Group A included COPD patients without T2DM; Group B, COPD + T2DM on metformin alone; Group C, COPD + T2DM on metformin plus other OADs; Group D, T2DM on metformin alone; Group E, T2DM on metformin plus other OADs. Clinical assessment included Modified Medical Research Council (mMRC) Dyspnea Scale, pulmonary artery pressure (PAP), and duration of disease. Laboratory evaluation comprised fasting blood glucose, serum insulin, total leukocyte count, neutrophil and lymphocyte counts, and serum interleukin-1β (IL-1β).
Results: No significant differences were found among COPD groups in age, gender distribution, residency, duration of COPD, mMRC grades, PAP, fasting glucose, insulin, or complete blood count parameters (p>0.05). IL-1β levels were significantly higher in COPD without T2DM (10.2 ± 2.1 ng/mL) compared to all other groups (p < 0.001), with no significant difference between metformin-alone and metformin-combination groups. Both metformin regimens were associated with lower IL-1β compared to COPD without diabetes.
Conclusion: Metformin, whether alone or combined with other OADs, is associated with reduced systemic inflammation—as indicated by lower IL-1β levels—in COPD patients with T2DM. These findings support the potential anti-inflammatory benefits of metformin in this population, although further longitudinal studies are warranted to confirm these effects and assess clinical outcomes.