Assessment of pulmonary function in patients with type 2 diabetes mellitus: a case-control study

Dhiraj Kapoor, Pankaj Kumar, Asha Ranjan, Kailash Nath Sharma, Varun Deep Dogra, Rekha Bansal, K. K. Sharma, Dinesh Kumar

Abstract


Background:As other microvascular complications, respiratory involvement is far less studied among patients with type-2 Diabetes Mellitus (DM). Objective: to study the extent of pulmonary function limitation among patients with type-2 DM.  

Methods:Hospital based matched case-control study.

Results:Total of 90 cases and 90 controls matched for age, sex, height and weight were recruited. Patients with DM had neuropathy [63.3% (57; male=27: Female: 30)], retinopathy [44.4% (40; male=22: Female: 18)], nephropathy [41.1% (37; male=17: Female: 20)] and microalbuminuria [14.4% (13; male=5: Female: 8)]. All cases and 88 controls observed with FEV1:FVC ratio of >70.0%, further assessment for delineation of normal and restrictive pattern patients with high level of predicted values of FEV1 as compare to FVC showed that significantly (P = 0.00) more (Cases: 76.6%; Controls: 42.2%) cases had FEV1 >FVC predicted levels as compare to controls, means among diabetics odds of restrictive pattern of lung abnormality is four times (OR: 4.4; CI: 2.3-8.5) more as compare to non-diabetics. In addition a long duration of DM was significantly (r: 0.39; P = 0.00) positively correlated with lung dysfunction.  

Conclusion: Patients with type 2 DM patients as compare to its controls observed with restrictive pattern of lung dysfunction.

 


Keywords


Pulmonary function test, Diabetes mellitus

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References


Sicree R, Shaw J, Baker PZ. The global burden: diabetes and impaired glucose tolerance. In: Sicree R, Shaw J, Baker PZ, eds. IDF Diabetes Atlas. 4th ed. Belgium: IDF; 2012.

World Health Organization. Media centre-Fact sheet N°312: Diabetes, 2011. Available at: http://www.who.int/mediacenter/factsheets/fs312/en/index.html. Accessed November 2014.

Kumar V, Abbas AK, Fausto N. Diabetes. In: Kumar V, Abbas AK, Fausto N, eds. Robbins and Cotron: Pathological Basis of Disease. 7th ed. Pennsylvania: Saunders; 2004.

Klein OL, Krishnan JA, Glick S, Smith LJ. Systematic review of the association between lung function and type 2 diabetes mellitus. Diabet Med. 2010;111:977-87.

Kida K, Utsuyama M, Takizawa T, Thurlbeck WM. Changes in lung morphologic features and elasticity caused by streptozotocin -induced diabetes mellitus in growing rats. Am Rev Respir Dis. 1983;128:125-31.

Weynand B, Jonckheere A, Frans A, Rahiera J. Diabetes mellitus induces a thickening of the pulmonary basal lamina. Respiration. 1999;66:14-9.

Goldman MD. Lung dysfunction in diabetes. Diabetes Care. 2003;26:1915-7.

Kuziemski K, Specjalski K, Jassem E. Diabetic pulmonary microangiopathy: fact or fiction? Polish J Endocrinol. 2011;62:171-5.

Thyagarajan B, Jacobs DR, Apostol GG, Smith LJ, Lewis CE, Williams OD. Plasma fibrinogen and lung function: the CARDIA Study. Int J Epidemiol. 2006;35:1001-8.

Hancox RJ, Poulton R, Greene JM, Filsell S, McLachlan CR, Rasmussen F, et al. Systemic inflammation and lung function in young adults. Thorax. 2007;62:1064-8.

Williams JG, Morris AI, Hayter RC, Ogilvie CM. Respiratory responses of diabetics to hypoxia, hypercapnea and exercise. Thorax. 1984;39:529-34.

Hamlin CR, Kohn RR, Luschin JH. Apparent accelerated aging of human collagen in diabetes mellitus. Diabetes. 1975;24:902-4.

Cheng N, Cai W, Jiang M. Effect of hypoxia on blood glucose, hormones, and insulin receptor functions in new-born calves. Pediatr Res. 1997;41:852-6.

Philips DI, Barker DJ, Hales CN, Hirst S, Osmond C. Thinness at birth and insulin resistance in adult life. Diabetologia. 1994;37:150-4.

Sinha S, Guleria R, Misra A, Pandey RM, Yadav R, Tiwari S. Pulmonary functions in patients with type 2 diabetes mellitus & correlation with anthropometry & microvascular complications. Indian J Med Res. 2004;119:66-71.

Asanuma Y, Fujiya S, Ide H, Agishi Y. Characteristics of pulmonary function in patients with diabetes mellitus. Diabetes Res Clin Pract. 1985;1:95-101.

Mohammad I, Abdul J, Ahmad SH, Safia A, Hussain FH. Pulmonary function in patients with diabetes mellitus. Lung India. 2011;28:89-92.

Verma S, Goni M, Kudyar RP. Assessment of pulmonary functions in patients with diabetes mellitus. JK Sci. 2009;11:71-4.

Ramchandran A, Snehalatha C, Satyavani K, Latha E, Sasikala R, Vijay V. Prevalence of vascular complications and their risk factors in type 2 diabetes. J Assoc Physicians India. 1999;47:1152-6.

Vaz NC, Kulkarni MS, Vaz FS, Pinto NS. Prevalence of diabetic complications in rural Goa, India. Indian J Community Med. 2011;36:283-6.

Agrawal RP, Ranka M, Beniwal R, Sharma S, Purohit VP, Kochar DK, et al. Prevalence of micro and macro vascular complications in type 2 diabetes and their risk factors. Int J Diabet Dev Countr. 2004;24:11-6.

Roaeid RB, Kadiki OA. Prevalence of long-term complications among type 2 diabetic patients in Benghazi, Libya. J Diabetol. 2011;3:324-31.

Yadav R, Tiwari P, Dhanaraj E. Risk factors and complications of type 2 diabetes in Asians. CRIPS. 2008;9:8-12.

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;167:911-6.

Dharwadkar AR, Dharwadkar GB, Bagali S. Reduction in lung functions in type 2 diabetes in Indian population ; correlation with glycemic status. Indian J Physiol Pharmacol. 2011;55:170-5.

Celik P, Ozmen B, Yorganacioglu A, Ozmen D, Cok G. Pulmonary function parameters in patients with diabetes mellitus. Turkish J Endocrinol Metab. 1999;1:5-10.

Mori H, Okubo M, Okamura M, Yamane K, Kado S, Egusa G, et al. Abnormalities of pulmonary functions in patients with non-insulin dependent diabetes mellitus. Intern Med. 1992;31:189-93.

Davis WA, 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;50:153-9.

Yeh HC, Punjabi NM, Wang NY, Pankow JS, Duncan BB, Cox CE, 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;31:741-6.

Agrawal RP, Ranka M, Beniwal R, Sharma S, Purohit VP, Kochar DK, et al. Prevalence of micro and macro vascular complications in type 2 diabetes and their risk factors. Int J Diabet Dev Countr. 2004;24:11-6.

Boulbou MS, Gourgoulianis KI, Klisiaris VK, Tsikrikas TS, Stathakis NE, et al. Diabetes mellitus and lung function. Med Princ Pract. 2003;12:87-91.

Makkar P, Gandhi M, Agrawal, RP, Sabir M, Kothari RP. Ventilatory pulmonary function tests in type 1 diabetes mellitus. J Assoc Physicians India. 2000;48:962-6.

Hu Y, Ma Z, Guo Z, Zhao F, Wang Y, Cai L, et al. Type 1 diabetes mellitus is an independent risk factor for pulmonary fibrosis. Cell Biochem Biophys. 2014 Nov;70(2):1385-91.

Yang J, Xue Q, Miao L, Cai L. Pulmonary fibrosis: a possible diabetic complication. Diabetes Metab Res Rev. 2011;27(4):311-7.

Yang J, Tan Y, Zhao F, Ma Z, Wang Y, Zheng S, et al. Angiotensin II plays a critical role in diabetic pulmonary fibrosis most likely via activation of NADPH oxidase-mediated nitrosative damage. Am J Physiol Endocrinol Metab. 2011;301(1):E132-44.

Campbell DJ, Somaratne JB, Jenkins AJ, Prior DL, Yii M, Kenny JF et al. Impact of type 2 diabetes and the metabolic syndrome on myocardial structure and microvasculature of men with coronary artery disease. Cardiovasc Diabetol. 2011;10:80.