Lung function in children with diabetes mellitus

Abstract

A cross-sectional study design was undertaken to assess pulmonary function in children with insulin-dependent diabetes mellitus (IDDM), and to establish if there is any relationship with diabetic factors and complications. Thirty-eight children (10 +/- 1.8 years) with IDDM and without clinical or radiological evidence of lung involvement, and 41 healthy age-matched reference subjects, underwent a pulmonary function study. Thirteen (34%) of 38 subjects with IDDM were studied at the onset of their disease. Adjusted values expressed as SD score of forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV(1)), and the transfer factor for carbon monoxide (TLCO) were found to be significantly lower than in controls (-0.54 +/- 0.87 vs. 0.40 +/- 1.10, P = 0.0008; -0.11 +/- 0.96 vs. 0.52 +/- 1.07, P = 0.01; -1.60 +/- 1.07 vs. -0.57 +/- 1.28, P = 0.001, respectively). These differences also existed in the group investigated at onset of diabetes. Residual volume (RV) and RV/total lung capacity ratio (RV/TLC) were significantly higher in the whole group of patients with IDDM than in controls (-0.20 +/- 0.83 vs. -0.80 +/- 0.88, P = 0.003; and 26 +/- 6.2 vs. 21 +/- 5.0, P = 0.0002, respectively). Seventeen patients (45%) had abnormal pulmonary function (SD score, less than -1.64): 16 subjects had reduced TLCO, 4 had reduced FVC, and in 3 of the 17, both functional indices were abnormal. There was no significant relationship between pulmonary function indices and diabetic factors or complications. The only significant association was between abnormal TLCO and females (P = 0.03), suggesting that sex may be a predisposing factor for the development of pulmonary complications. This study supports the view that the lung is functionally involved in children with IDDM early on in the course of the disease.

Long-Term Effect of Insulin Treatment in Cystic Fibrosis-Related Diabetes

“…Although the cause of this decline in clinical status is unknown, insulin deficiency alters protein and fat metabolism, causing loss of weight and lean body mass [11]. There is also evidence that the lung is a target organ in diabetes, since lack of insulin has been shown to have a direct effect on lung function and structure in non-CF patients [12, 13], and a reduction in FEV 1 , FVC and TL CO has been demonstrated in non-CF children (mean age 10 years) at the onset of diabetes indicating that damage is done early in the course of the disease [14]. Recently, Brennan et al [15] have shown that airway glucose concentrations are elevated in CF patients when blood glucose exceeds >8 mmol/l.…”

Stress Hyperglycemia in Pediatric Critical Illness: The Intensive Care Unit Adds to the Stress!

“…59,60 Poor control of hyperglycemia in children with type 1 diabetes mellitus and cystic fibrosis is associated with worsening of pulmonary function. 61,62 It is conceivable that similar mechanisms may play a role during critical illness in children.…”

Gambaran Uji Fungsi Paru pada Diabetes Melitus Tipe 1 Usia 8-18 Tahun

“…20 Jumlah subjek yang mengalami gangguan fungsi paru 45,7% dan sesuai dengan penelitian sebelumnya. 12,21 Gangguan paru yang terjadi akibat hiperglikemia adalah gangguan restriktif, sedangkan gangguan obstruktif dapat disebabkan faktor lain seperti asma. 11,16 Pada 2 subjek dengan gangguan obstruktif, didapatkan riwayat penggunaan inhalasi sa at usia <5 tahun dan rerata FEV 1 74,9%.…”

“…Pasien yang mengalami gangguan fungsi paru 17 orang (45%). 12 Pieniewska dkk 13 melakukan uji fungsi paru dengan spirometri pada 35 pasien anak dengan DM tipe 1 rerata usia 13,45±3,58 tahun dibandingkan dengan 38 anak sehat. Hasil penelitian menunjukkan bahwa peak expiratory flow (PEF) lebih rendah pada kelompok studi (p=0,01091).…”