Pulmonary Complications in Diabetes Mellitus: The Role of Glycemic Control

Abstract

Insulin deficiency induces an increase in blood glucose levels that, in long run, becomes toxic for many organs and systems. Microangiopathy and derangements in the immune function are known consequences of hyperglycemia, but the way in which these systemic alterations may affect pulmonary function has been scarcely investigated. Although confirmation from large clinical trials is still to come, the diabetic disease seems to hit the pulmonary microcirculation as any other organ by increasing vessel wall thickness and impairing gas exchange, which leads to a measurable loss of function and respiratory efficiency. In addition, a diabetic lung is more susceptible to low respiratory tract infections by atypical microorganisms and more likely to host severe episodes of pneumonia than a normal, non-diabetic lung. This is a review of current knowledge on the impact of diabetes mellitus in lung health. We have paid special attention to the role of metabolic control in preventing damage to the lung by sustained hyperglycemia.

Association of Hyperglycemia on Admission and During Hospitalization with Mortality in Diabetic Patients Admitted for Pneumonia

“…Due to the evidence showing that better glycemic control improves immune mechanisms and reduces the predisposition to and severity of infection (39,40), clinicians should pay attention to the glucose level during hospitalization. In previous studies, changes in the serum glucose levels during hospitalization were not examined; therefore, the results were based only on admission serum glucose values, and it is likely that the risks associated with hyperglycemia among diabetic patients during admission for pneumonia were underestimated.…”

The relationship between nitric oxide and leptin in the lung of rat with streptozotocin‐induced diabetes

“…3,[21][22][23] Animals with STZ-induced diabetes, which selectively destroys insulin-producing b cells of the pancreas, are characterized by hyperglycaemia, and both insulin deficiency and resistance, plus low plasma leptin concentrations. 18,19 Similarly, the diabetic rats of our study displayed high glucose levels and low insulin and leptin levels in the blood.…”

“…6,8,24,25 Previous studies report that the diabetic rat lung shows alveolar basement membrane thickening and interstitial enlargement, depending on hyperglycaemia, 21 non-enzymatic protein glycosylation 3 and fibroblast growth factor overproduction. 26 These and other structural changes reverted to normal after treatment with insulin.…”

Screening for cystic fibrosis-related diabetes: a systematic review.

“…[90][91][92][105][106][107] Effect on the lungs Subjects with diabetes mellitus have been shown to have higher morbidity and mortality from pulmonary infection than those with normal BG. [108][109][110][111] A review by Ardigo et al 112 concluded that although the effect on lung function might be quite small (a reduction of 8%, related to vessel wall thickness, leading to stiffness and impaired gas exchange), this would be enough to cause problems when lung function was threatened by other comorbidities. They also noted the poorer outcomes in pneumonia in people with diabetes.…”