OBJECTIVE -Alveolar microvascular function is moderately impaired in type 1 diabetes, as manifested by restriction of lung volume and diffusing capacity (DL CO ). We examined whether similar impairment develops in type 2 diabetes and defined the physiologic sources of impairment as well as the relationships to glycemia and systemic microangiopathy.
RESEARCH DESIGN AND METHODS-A cross-sectional study was conducted at a university-affiliated diabetes treatment center and outpatient diabetes clinic, involving 69 nonsmoking type 2 diabetic patients without overt cardiopulmonary disease. Lung volume, pulmonary blood flow (Q ), DL CO , membrane diffusing capacity (measured from nitric oxide uptake [DL NO ]), and pulmonary capillary blood volume (V C ) were determined at rest and exercise for comparison with those in 45 healthy nonsmokers as well as with normal reference values.RESULTS -In type 2 diabetic patients, peak levels of oxygen uptake, Q and DL CO , DL NO , and V C at exercise were 10 -25% lower compared with those in control subjects. In nonobese patients (BMI Ͻ30 kg/m 2 ), reductions in DL CO , DL NO , and V C were fully explained by the lower lung volume and peak Q , but these factors did not fully explain the impairment in obese patients (BMI Ͼ30 kg/m 2 ). The slope of the increase in V C with respect to Q was reduced ϳ20% in patients regardless of BMI, consistent with impaired alveolar-capillary recruitment. Functional impairment was directly related to A1C level, retinopathy, neuropathy, and microalbuminuria in a sex-specific manner.CONCLUSIONS -Alveolar microvascular reserves are reduced in type 2 diabetes, reflecting restriction of lung volume, alveolar perfusion, and capillary recruitment. This reduction correlates with glycemic control and extrapulmonary microangiopathy and is aggravated by obesity.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.