As of 2021, 537 million adults are living with diabetes, globally. This is expected to reach 800 million in 20 years.1 Patients with diabetes live with a significantly heightened risk of morbidity and mortality from various causes.2 Among such causes are infections. Diabetes is associated with a significantly increased risk of infections like pneumonia and sepsis, due to immune system impairments from hyperglycaemia and metabolic disturbances.3 Pneumonia remains a leading cause of hospitalisation and death in this population, and sepsis is a severe, life-threatening complication.4 Understanding how antidiabetic treatments influence the risk of these infections is crucial for optimising patient outcomes.

In recent years, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) have revolutionised type 2 diabetes management by not only improving glycaemic control but also providing cardiovascular and renal benefits.5 However, their impact on infection risk remains less clear. While randomised controlled trials have provided valuable insights, they often lack the generalisability to real-world settings and may lack enough power to capture differences in the risk of rare adverse events.6 7 Therefore, investigating these associations using real-world data is imperative.

In this issue of Thorax, Henney et al explore the risk of incident pneumonia and severe sepsis associated with the use of GLP-1 RAs and SGLT2is in patients with diabetes. The authors use data from TriNetX,8 a ‘real-world’ international data set used extensively in research of this nature.9 In a quasi-experimental design, they applied pharmaco-epidemiological methods to compare …