Decline of neuroadrenergic bronchial innervation and respiratory function in type 1 diabetes mellitus: a longitudinal study

Incalzi, Raffaele Antonelli; Fuso, Leonello; Pitocco, Dario; Basso, Salvatore; Trovè, Andrea; Longobardi, Anna; Calcagni, Maria Lucia; Giordano, Alessandro; Ghirlanda, Giovanni

doi:10.1002/dmrr.688

Cited by 24 publications

(11 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent study in lung function in a smaller group of type 1 diabetic patients followed up for a period of 5 years showed similar results regarding the time-related decline [98]. In these patients, a decline of 68 ml/year in FEV1 was observed, which was very similar to the results obtained in the previous study.…”

Section: Decline In Lung Function Over Time and Its Clinical Implicationsupporting

confidence: 86%

“…The FEV1 decline, unrelated to the quality of glycemic control, was almost equal in the subgroups of patients with or without autonomic neuropathy. Also, it affected other functional parameters, such as DLCO and neuroadrenergic bronchial innervation, measured by lung ventilation scintigraphy with MIBG [98]. Table 2 shows an overview of the major longitudinal studies which found an accelerated decline in lung function in diabetic patients.…”

Section: Decline In Lung Function Over Time and Its Clinical Implicationmentioning

confidence: 99%

See 1 more Smart Citation

The Diabetic Lung - A New Target Organ?

Pitocco

Fuso²,

Conte³

et al. 2012

Rev Diabet Stud

Self Cite

142

112

View full text Add to dashboard Cite

■ AbstractSeveral abnormalities of the respiratory function have been reported in patients with type 1 and type 2 diabetes. These abnormalities concern lung volume, pulmonary diffusing capacity, control of ventilation, bronchomotor tone, and neuroadrenergic bronchial innervation. Many hypotheses have emerged, and characteristic histological changes have been described in the "diabetic lung", which could explain this abnormal respiratory function. Given the specific abnormalities in diabetic patients, the lung could thus be considered as a target organ in diabetes. Although the practical implications of these functional changes are mild, the presence of an associated acute or chronic pulmonary and/or cardiac disease could determine severe respiratory derangements in diabetic patients. Another clinical consequence of the pulmonary involvement in diabetes is the accelerated decline in respiratory function. The rate of decline in respiratory function in diabetics has been found to be two-to-three times faster than in normal non-smoking subjects, as reported in longitudinal studies. This finding, together with the presence of anatomical and biological changes similar to those described in the aging lung, indicates that the "diabetic lung" could even be considered a model of accelerated aging. This review describes and analyses the current insight into the relationship of diabetes and lung disease, and suggests intensifying research into the lung as a possible target organ in diabetes.

show abstract

Section: Decline In Lung Function Over Time and Its Clinical Implicationsupporting

confidence: 86%

Section: Decline In Lung Function Over Time and Its Clinical Implicationmentioning

confidence: 99%

The Diabetic Lung - A New Target Organ?

Pitocco

Fuso²,

Conte³

et al. 2012

Rev Diabet Stud

Self Cite

142

112

View full text Add to dashboard Cite

show abstract

“…Some longitudinal studies suggested also that the decline of lung function in diabetes mellitus was faster than in normal subjects [79][80][81]. However, a 15-year observation study showed that FEV1 and forced vital capacity (FVC) declined at a comparable rate in diabetics and nondiabetic subjects [82].…”

Section: The Diabetic Lung: Potential Effects On Insulin Absorptionmentioning

confidence: 94%

“…While such a measure should be recommended when trying to define the effects of the drug in a framework free of confounding factors, it limits our knowledge of the usefulness and safety of inhaled insulin since it excludes not only patients with an obstructive respiratory disease, but also patients with a restrictive functional pattern. Indeed, diabetes mellitus is associated with accelerated decline of dynamic lung volumes, and FEV1 decreases in restrictive conditions [79][80][81]110]. Thus, longstanding diabetes likely becomes itself a criterion of exclusion from these studies.…”

Section: )mentioning

confidence: 99%

Inhaled Insulin and the Lung

Fuso¹,

Pitocco²,

Incalzi

2007

CMC

Self Cite

View full text Add to dashboard Cite

Pulmonary delivery of insulin is more than a promise in the treatment of diabetes mellitus. Inhaled insulin seems at least as efficacious as the conventional regimen of subcutaneous insulin and/or oral glucose-lowering agents in both type 1 and type 2 diabetes mellitus. Improved metabolic control and the use of a non-invasive route of administration represent the main benefits of this new treatment. Several physico-chemical factors could reduce the bioavailability of inhaled insulin. Indeed, both deep-lung deposition and adsorption of insulin variously depend on the type of propellants used, speed of air flow, particle size and velocity, drug deposition into the throat and larger bronchial tree. These factors, in turn, depend on the pulmonary delivery systems used and on respiratory mechanics and flows. Furthermore, the pharmacokinetics of inhaled insulin is affected by smoke, which increases its absorption, and by lung diseases, which decrease the available alveolar-capillary surface. Selected abnormalities of respiratory function complicate both type 1 and type 2 diabetes mellitus and a mild depression of carbon monoxide lung transfer after a 6-month period of treatment with inhaled insulin has been reported. Finally, results from some longitudinal studies suggest that diabetes might speed up the age-related decline of lung volumes and probably alter the pharmacokinetics of inhaled insulin, particularly in the elderly. Clarifying these issues is mandatory in order to define the indications and safety of inhaled insulin.

show abstract

“…Both peripheral and central chemosensitivity to hypoxia is altered, as is the bronchomotor tone in lung. The coexistence of this finding with other risk factors like lung microvascular complications, endocrine impairments, obesity, and hypertension, lead to a higher prevalence of sleep apnea syndrome (SAS) in diabetic patient ( 18 , 19 ). Clinical implications of SAS go from a decrease in quality of life due to sleepiness to an increased risk of sudden death ( 20 ).…”

Section: Definitionmentioning

confidence: 99%

Autonomic Neuropathy in Diabetes Mellitus

et al. 2014

View full text Add to dashboard Cite

Diabetic autonomic neuropathy (DAN) is a serious and common complication of diabetes, often overlooked and misdiagnosed. It is a systemic-wide disorder that may be asymptomatic in the early stages. The most studied and clinically important form of DAN is cardiovascular autonomic neuropathy defined as the impairment of autonomic control of the cardiovascular system in patients with diabetes after exclusion of other causes. The reported prevalence of DAN varies widely depending on inconsistent definition, different diagnostic method, different patient cohorts studied. The pathogenesis is still unclear and probably multifactorial. Once DAN becomes clinically evident, no form of therapy has been identified, which can effectively stop or reverse it. Prevention strategies are based on strict glycemic control with intensive insulin treatment, multifactorial intervention, and lifestyle modification including control of hypertension, dyslipidemia, stop smoking, weight loss, and adequate physical exercise. The present review summarizes the latest knowledge regarding clinical presentation, epidemiology, pathogenesis, and management of DAN, with some mention to childhood and adolescent population.

show abstract

Decline of neuroadrenergic bronchial innervation and respiratory function in type 1 diabetes mellitus: a longitudinal study

Abstract: Neuroadrenergic denervation of the lung parallels the decline of respiratory function indexes in diabetic patients both with and without AN and seems to be independent from the quality of glycemic control.

Cited by 24 publications

References 35 publications

The Diabetic Lung - A New Target Organ?

The Diabetic Lung - A New Target Organ?

Inhaled Insulin and the Lung

Autonomic Neuropathy in Diabetes Mellitus

Contact Info

Product

Resources

About