To study the effect of glycemic control and duration of disease on pulmonary function tests and diffusion capacity in type 2 diabetes mellitus

Jitendra Singh, Kamlesh K. Gupta, D. Himanshu, Anju Dinkar, Virendra Atam, Surya Kant

Abstract


Background:Type 2 diabetes mellitus is known to cause serious progressive macro and micro vascular complications leading to end organ damage like retinopathy, nephropathy and neuropathy. Pulmonary complications due to collagen and elastin changes as well as microangiopathy has also been demonstrated in type 2 diabetes mellitus but prevalence in most of population is unknown and its possible correlation with duration of disease and degree of glycemic control is not studied more in our population. Aims and objectives: To compare Pulmonary Function Tests (PFT) in type 2 diabetes mellitus with control group and to evaluate possible correlation of PFT with status of sugar control and duration of disease.

Methods:Consecutively consenting 120 subjects who satisfied the inclusion criteria were recruited over one year duration. These 120 subjects are categorised into two i.e. healthy volunteers recruited as controls (n=60) and type 2 diabetic patients (n=60).  

Results:Both group compared and studied with each other. Diabetic patients showed a significant reduction in Forced Expiratory Volume in one second (FEV1), Forced Vital Capacity (FVC) and pulmonary diffusion capacity for carbon monoxide (DLCO) relative to their matched controls and these values were further reduced in diabetic patients with uncontrolled glycemic status.

Conclusion:Our study concluded that lung functions in type2 diabetes mellitus are impaired with restrictive pattern of respiratory abnormality. Duration of diabetes did not influence on pulmonary function and diffusion capacity.

 


Keywords


Diabetes mellitus, Pulmonary function test, Spirometry, Glycemic control, Glycosylated haemoglobin, Microvascular complications

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References


Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of type 2 diabetes: Indian scenario. Indian J Med Res. 2007 Mar;125(3):217-30.

Chance WW, Rhee C, Yilmaz C, Dane DM, Pruneda ML, Raskin P, et al. Diminished alveolar microvascular reserves in type 2 diabetes reflect systemic microangiopathy. Diabetes Care. 2008;31:1596-601.

Ferguson GT, Enright PL, Buist AS, Higgins MW. Office spirometry for lung health assessment in adults: a consensus statement from the National Lung Health Education Program. Chest. 2000;117:1146-61.

Davis WA, Knuiman M, Kendall P, Grange V, Davis TM. Glycemic exposure is associated with reduced pulmonary function in type 2 diabetes, the fremantle diabetes study. Diabetes Care. 2004;27:752-7.

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.

Lange P, Groth S, Kastrup J, Mortensen J, Appleyard M, Nyboe J, et al. Diabetes mellitus, plasma glucose and lung function in a cross sectional population study. Eur Respir J. 1989;2:14-9.

Barrett-Conor E, Frette C. NIDDM, impaired glucose tolerance, and pulmonary function in older adults. Diabetes Care. 1996;19:1441-4.

Davis TM, Knuiman M, Kendall P, Vu H, Davis WA. Reduced pulmonary function and its association in type 2 diabetes: the Fremantle diabetes study. Diabetes Res Clin Pract. 2000;50:153-9.

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 Sep;7(9):1874-7.

Engstrom GJ, Janzon L. Risk of developing diabetes is inversely related to lung function: a population based cohort study. Diabet Med. 2002;19:167-70.

Yeh HC, Punjabi NM, Wang NY, Pankow J, Duncan BB, Cox CE, et al. Cross sectional and prospective study of lung function in adults with diabetes mellitus. Diabetes. 2002;51:A242-3.

Borst BB, Gosker HR, Zeegers MP, Annemie MWJ. Pulmonary function in diabetes: a metaanalysis. Chest. 2010;138(2):393-406.

Mckeevear 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;161:546-56.

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;30:108-12.

Celik P, Özmen B, YorgancVoğlu A, Özmen D, Çok G. Pulmonary function parameters in patients with diabetes mellitus. Turk J Endocr Metab. 1999;1:5-10.

Marvisi M, Bartolini L, Del Borrello P, Brianti M, Marani G, Guariglia A, et al. Pulmonary function in non-insulin-pendent diabetes mellitus. Respiration. 2001;68:268-72.

Klein Oana L, Smith Lewis J, Matthew T, Jie P, Williams Mark V. Reduced diffusion lung capacity in patients with type 2 diabetes mellitus predicts hospitalization for pneumonia. Diabetes Res Clin Pract. 2011;92(1):12-5.

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

Celik P, Ozmen B, Arzu Y, Ozmen D, Gursel C. pulmonary function parameters in patients with diabetes mellitus. Turk J Endocrinol Metab. 1999;1:05-10.

Klein OL, Krishnan JA, Glick S, Smith LJ. Systematic review of the association between lung function and type 2 diabetes mellitus. Diabet Med. 2010;27:977-87.

Nandhini R, Sayed SS, Saikumar P. Respiratory myopathy in type II diabetes mellitus. J Clin Diagn Res. 2012;6(3):354-7.

Cooper BG, Taylor R, Alberti GMM. Lung functions in patients of diabetes mellitus. Respir Med. 1990;84:235-9.

Lipscomb DJ, Patel K, Hughes JMB. Interpretation of the increase in the transfer factor coefficient for carbon monoxide (DL/ VA or KCO). Thorax. 1978;135:223-8.

Ozoh OB, Okubabejo NU, Bandele EO, Chukwu CC. Ventilatory function in Nigerians with type 2 diabetes. Afr J Respir Med. 2010 Mar:18-22.

Nakagima K, Kubouchi Y, Muneyuki T, Ebata M, Eguchi S, Munakata H. A possible association between suspected restrictive pattern as assessed by ordinary pulmonary function test and the metabolic syndrome. Chest. 2008;134(4);712-8.

Matsurbara T, Hara F. The pulmonary function and histopathological studies of the lung in diabetes mellitus. Nihon Ika Daigaku Zasshi. 1991 Oct;58(5):528-36.

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

Benbassat CA, Stern E, Kramer M, Lebzelter J, Blum I, Fink G. Pulmonary function in patients with diabetes mellitus. Am J Med Sci. 2001;322:127-32.