Generic placeholder image

Current Respiratory Medicine Reviews

Editor-in-Chief

ISSN (Print): 1573-398X
ISSN (Online): 1875-6387

Research Article

Effect of Type 2 Diabetes Mellitus and Diabetic Medication on Pulmonary Function

Author(s): Alaa M. Hammad*, Walid Al-Qerem, Ameen Alassi and Dana Hyassat

Volume 16, Issue 4, 2020

Page: [213 - 219] Pages: 7

DOI: 10.2174/1573398X17666210121141412

Price: $65

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a chronic condition with an impairing effect on multiple organs. Numerous respiratory disorders have been observed in patients with T2DM. However, the effect of T2DM on pulmonary function is inconclusive.

Aims: In this study, we investigated the effect of T2DM on respiratory function and the correlation of glycemic control, diabetes duration and insulin intake.

Methods: 1500 patients were recruited for this study; 560 having T2DM for at least a year were included in the final data, in addition to 540 healthy volunteers. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), forced expiratory flow at 25-75% (FEF 25-75%), as well as FEV1/FVC ratio values were measured.

Results: A two-sample t-test showed that z-scores produced by Al-Qerem et al.’s equations for FEV1, FVC, and FEF 25-75% were significantly lower for the T2DM group than the control group (p < 0.01). FEV1/FVC ratio in the T2DM group was significantly higher (p < 0.01). Multiple linear regression analysis found that glycemic control represented by HbA1c as well as disease duration were negatively associated with the pulmonary function (p < 0.01). However, insulin intake was found to have no significant correlation with pulmonary function.

Conclusion: T2DM was linked to reduced pulmonary function and was consistent with a restrictive ventilation pattern. HbA1c, as well as disease duration, were found to be independent risk factors for reduced pulmonary function.

Keywords: Diabetes, FVC, FEV1, HbA1c, T2DM, FEV1.

Graphical Abstract
[1]
[2]
Klein OL, Krishnan JA, Glick S, Smith LJ. Systematic review of the association between lung function and Type 2 diabetes mellitus. Diabet Med 2010; 27(9): 977-87.
[http://dx.doi.org/10.1111/j.1464-5491.2010.03073.x] [PMID: 20722670]
[3]
Chance WW, Rhee C, Yilmaz C, et al. Diminished alveolar microvascular reserves in type 2 diabetes reflect systemic microangiopathy. Diabetes Care 2008; 31(8): 1596-601.
[http://dx.doi.org/10.2337/dc07-2323] [PMID: 18492945]
[4]
Hsia CC, Raskin P. Lung involvement in diabetes: does it matter? Am Diabetes Assoc 2008.
[5]
Sandler M. Is the lung a ‘target organ’ in diabetes mellitus? Arch Intern Med 1990; 150(7): 1385-8.
[http://dx.doi.org/10.1001/archinte.1990.00390190051006] [PMID: 2196023]
[6]
Lim SY, Rhee E-J, Sung K-C. Metabolic syndrome, insulin resistance and systemic inflammation as risk factors for reduced lung function in Korean nonsmoking males. J Korean Med Sci 2010; 25(10): 1480-6.
[http://dx.doi.org/10.3346/jkms.2010.25.10.1480] [PMID: 20890430]
[7]
Sampol G, Lecube A. Type 2 diabetes and the lung: a bidirectional relationship. Endocrinol Nutr 2012; 59(2): 95-7.
[http://dx.doi.org/10.1016/j.endonu.2011.12.003] [PMID: 22265762]
[8]
Marvisi M, Bartolini L, del Borrello P, et al. Pulmonary function in non-insulin-dependent diabetes mellitus. Respiration 2001; 68(3): 268-72.
[http://dx.doi.org/10.1159/000050509] [PMID: 11416247]
[9]
Ford ES, Mannino DM. National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Prospective association between lung function and the incidence of diabetes: findings from the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Diabetes Care 2004; 27(12): 2966-70.
[http://dx.doi.org/10.2337/diacare.27.12.2966] [PMID: 15562215]
[10]
van den Borst B, Gosker HR, Zeegers MP, Schols AM. Pulmonary function in diabetes: a metaanalysis. Chest 2010; 138(2): 393-406.
[http://dx.doi.org/10.1378/chest.09-2622] [PMID: 20348195]
[11]
Anandhalakshmi S, Manikandan S, Ganeshkumar P, Ramachandran C. Alveolar gas exchange and pulmonary functions in patients with type II diabetes mellitus. J Clin Diagn Res 2013; 7(9): 1874-7.
[http://dx.doi.org/10.7860/JCDR/2013/6550.3339] [PMID: 24179886]
[12]
Mirrakhimov AE. Chronic obstructive pulmonary disease and glucose metabolism: a bitter sweet symphony. Cardiovasc Diabetol 2012; 11(1): 132.
[http://dx.doi.org/10.1186/1475-2840-11-132] [PMID: 23101436]
[13]
Engström G, Janzon L. Risk of developing diabetes is inversely related to lung function: a population-based cohort study. Diabet Med 2002; 19(2): 167-70.
[http://dx.doi.org/10.1046/j.1464-5491.2002.00652.x] [PMID: 11874435]
[14]
Barrett-Connor E, Frette C. NIDDM, impaired glucose tolerance, and pulmonary function in older adults. The Rancho Bernardo Study. Diabetes Care 1996; 19(12): 1441-4.
[http://dx.doi.org/10.2337/diacare.19.12.1441] [PMID: 8941481]
[15]
Davis TM, Knuiman M, Kendall P, Vu H, Davis WA. Reduced pulmonary function and its associations in type 2 diabetes: the Fremantle Diabetes Study. Diabetes Res Clin Pract 2000; 50(2): 153-9.
[http://dx.doi.org/10.1016/S0168-8227(00)00166-2] [PMID: 10960726]
[16]
Benbassat CA, Stern E, Kramer M, Lebzelter J, Blum I, Fink G. Pulmonary function in patients with diabetes mellitus. Am J Med Sci 2001; 322(3): 127-32.
[http://dx.doi.org/10.1097/00000441-200109000-00003] [PMID: 11570776]
[17]
Davis WA, Knuiman M, Kendall P, Grange V, Davis TM. Fremantle Diabetes Study. Glycemic exposure is associated with reduced pulmonary function in type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care 2004; 27(3): 752-7.
[http://dx.doi.org/10.2337/diacare.27.3.752] [PMID: 14988297]
[18]
Walter RE, Beiser A, Givelber RJ, O’Connor GT, Gottlieb DJ. Association between glycemic state and lung function: the Framingham Heart Study. Am J Respir Crit Care Med 2003; 167(6): 911-6.
[http://dx.doi.org/10.1164/rccm.2203022] [PMID: 12623860]
[19]
Yeh H-C, Punjabi NM, Wang NY, et al. Cross-sectional and prospective study of lung function in adults with type 2 diabetes: the Atherosclerosis Risk in Communities (ARIC) study. Diabetes Care 2008; 31(4): 741-6.
[http://dx.doi.org/10.2337/dc07-1464] [PMID: 18056886]
[20]
Yeh H-C, Punjabi NM, Wang NY, Pankow JS, Duncan BB, Brancati FL. Vital capacity as a predictor of incident type 2 diabetes: the Atherosclerosis Risk in Communities study. Diabetes Care 2005; 28(6): 1472-9.
[http://dx.doi.org/10.2337/diacare.28.6.1472] [PMID: 15920070]
[21]
McKeever TM, Weston PJ, Hubbard R, Fogarty A. Lung function and glucose metabolism: an analysis of data from the Third National Health and Nutrition Examination Survey. Am J Epidemiol 2005; 161(6): 546-56.
[http://dx.doi.org/10.1093/aje/kwi076] [PMID: 15746471]
[22]
Verma M, Paneri S, Badi P, Raman PG. Effect of increasing duration of diabetes mellitus type 2 on glycated hemoglobin and insulin sensitivity. Indian J Clin Biochem 2006; 21(1): 142-6.
[http://dx.doi.org/10.1007/BF02913083] [PMID: 23105586]
[23]
Shah SH, Sonawane P, Nahar P, Vaidya S, Salvi S. Pulmonary function tests in type 2 diabetes mellitus and their association with glycemic control and duration of the disease. Lung India 2013; 30(2): 108-12.
[http://dx.doi.org/10.4103/0970-2113.110417] [PMID: 23741090]
[24]
Miller MR, Hankinson J, Brusasco V, et al. ATS/ERS Task Force. Standardisation of spirometry. Eur Respir J 2005; 26(2): 319-38.
[http://dx.doi.org/10.1183/09031936.05.00034805] [PMID: 16055882]
[25]
Al-Qerem W, Hammad AM, Gassar ES, Al-Qirim RA, Ling J. Spirometry reference equations for an adult Middle Eastern population. Expert Rev Respir Med 2019; 13(5): 489-97.
[http://dx.doi.org/10.1080/17476348.2019.1601560] [PMID: 30942108]
[26]
Stanojevic S, Wade A, Stocks J, et al. Reference ranges for spirometry across all ages: a new approach. Am J Respir Crit Care Med 2008; 177(3): 253-60.
[http://dx.doi.org/10.1164/rccm.200708-1248OC] [PMID: 18006882]
[27]
Quanjer PH, Pretto JJ, Brazzale DJ, Boros PW. Grading the severity of airways obstruction: new wine in new bottles. Eur Respir J 2014; 43(2): 505-12.
[http://dx.doi.org/10.1183/09031936.00086313] [PMID: 23988764]
[28]
Stanojevic S, Wade A, Stocks J. Reference values for lung function: past, present and future. Eur Respir J 2010; 36(1): 12-9.
[http://dx.doi.org/10.1183/09031936.00143209] [PMID: 20595163]
[29]
Aaron SD, Dales RE, Cardinal P. How accurate is spirometry at predicting restrictive pulmonary impairment? Chest 1999; 115(3): 869-73.
[http://dx.doi.org/10.1378/chest.115.3.869] [PMID: 10084506]
[30]
Venkateshiah SB, Ioachimescu OC, McCarthy K, Stoller JK. The utility of spirometry in diagnosing pulmonary restriction. Lung 2008; 186(1): 19-25.
[http://dx.doi.org/10.1007/s00408-007-9052-8] [PMID: 17990034]
[31]
Huang H, Guo Q, Li L, et al. Effect of type 2 diabetes mellitus on pulmonary function. Exp Clin Endocrinol Diabetes 2014; 122(6): 322-6.
[http://dx.doi.org/10.1055/s-0034-1372579] [PMID: 24941430]
[32]
Lecube A, Sampol G, Muñoz X, Hernández C, Mesa J, Simó R. Type 2 diabetes impairs pulmonary function in morbidly obese women: a case-control study. Diabetologia 2010; 53(6): 1210-6.
[http://dx.doi.org/10.1007/s00125-010-1700-5] [PMID: 20217039]
[33]
Weynand B, Jonckheere A, Frans A, Rahier J. Diabetes mellitus induces a thickening of the pulmonary basal lamina. Respiration 1999; 66(1): 14-9.
[http://dx.doi.org/10.1159/000029331] [PMID: 9973685]
[34]
Sun Z, Liu L, Liu N, Liu Y. Muscular response and adaptation to diabetes mellitus. Front Biosci 2008; 13(4765): 4765-94.
[http://dx.doi.org/10.2741/3038] [PMID: 18508544]
[35]
Kabitz H-J, Sonntag F, Walker D, et al. Diabetic polyneuropathy is associated with respiratory muscle impairment in type 2 diabetes. Diabetologia 2008; 51(1): 191-7.
[http://dx.doi.org/10.1007/s00125-007-0856-0] [PMID: 18034226]
[36]
Kornum JB, Thomsen RW, Riis A, Lervang HH, Schønheyder HC, Sørensen HT. Diabetes, glycemic control, and risk of hospitalization with pneumonia: a population-based case-control study. Diabetes Care 2008; 31(8): 1541-5.
[http://dx.doi.org/10.2337/dc08-0138] [PMID: 18487479]
[37]
Knuiman MW, James AL, Divitini ML, Ryan G, Bartholomew HC, Musk AW. Lung function, respiratory symptoms, and mortality: results from the Busselton health study. Ann Epidemiol 1999; 9(5): 297-306.
[http://dx.doi.org/10.1016/S1047-2797(98)00066-0] [PMID: 10976856]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy