The study is a systematic review and meta-analysis of 27 randomized controlled trials with 202,727 participants that evaluated the effect of new antidiabetic drugs (SGLT2 inhibitors, GLP-1 receptor agonists, and DPP-4 inhibitors) on the risk of respiratory disease in patients with type 2 diabetes. SGLT2 inhibitors significantly reduced the risk of pneumonia (OR 0.84, 95% CI 0.77–0.92), bronchitis (OR 0.79, 95% CI 0.64–0.90), pulmonary edema (OR 0.51, 95% CI 0.39–0.67), respiratory failure (OR 0.77, 95% CI 0.64–0.91) and asthma (OR 0.55, 95% CI 0.35–0.85) compared with placebo. These benefits were consistent in patients with and without type 2 diabetes. GLP-1 receptor agonists were neutral in patients with type 2 diabetes, but reduced the risk of pneumonia, respiratory failure, and asthma in obese subjects. DPP-4 inhibitors were mostly neutral, but increased the risk of asthma (OR 1.70, 95% CI 1.03–2.82). The study is registered in PROSPERO under the identifier CRD420251158592. The findings serve to create hypotheses for further research.