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

Abstract

Diabetes mellitus is a public health problem in developing and developed world. There is an alarming increase in the incidence and prevalence of diabetes mellitus particularly in Asian Indians. According to WHO India will be world diabetic capital in 2025. 1 Diabetes mellitus is associated with widespread hormonal, metabolic, and microvascular abnormalities, as well as with disturbances of the function of many organ systems. The macroangiopathic and microangiopathic complications affect eyes, kidneys, nerves, cardiovascular system and respiratory system. The biochemical and structural change in basement membrane proteins of different body organ systems are the mainstay for development of diabetic complications. Chronic hyperglycaemia causes non-enzymatic glycosylation of 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.

The Impact of Type 2 Diabetes Mellitus on Respiratory System

“…These changes increase the thickness of collagen molecules as well as the pulmonary capillary network, thereby narrowing the alveolar-capillary membrane. These results were in line with the findings obtained by Zineldin et al, Fuso et al, and Singh et al [13,19,20]. They reported dimin- ished pulmonary volumes and end tidal carbon dioxide pressure in patients with type 2 diabetes compared with healthy individuals.…”

“…Meanwhile, these studies assess volumetric parameters of lung such as Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second (FEV1) using a spirometer [10,11]. Also, this diminished function in the lungs shows an inverse relationship with the blood sugar level and duration of having diabetes [12,13].…”

Effects of incentive spirometry on cardiopulmonary parameters, functional capacity and glycemic control in patients with Type 2 diabetes

“…They argued that glycated Haemoglobin (HbA1c) level is an indicator of glycemic control for a short period of one to two months and that short duration of hyperglycemia was not adequate to in°uence PFTs. However, Davis et al, 14 Jamatia et al 45 and Singh et al 46 observed a negative correlation between pulmonary function and glycemic levels, indicating that a poor lung function was associated with a poor glycemic control. These authors did not explain the exact pathophysiological mechanism for this association.…”

“…45 and Singh et al. 46 observed a negative correlation between pulmonary function and glycemic levels, indicating that a poor lung function was associated with a poor glycemic control. These authors did not explain the exact pathophysiological mechanism for this association.…”

“…These authors did not explain the exact pathophysiological mechanism for this association. Concerning DOD, Shah et al, 13 Yadav et al 44 and Singh et al 46 established that there was no relationship between pulmonary function and DOD, hence explaining that DOD did not a®ect pulmonary function. On the other hand, Davis et al 14 in their community-based cohort documented that pulmonary function decreased at an average of between 1.1% and 3.1% per year.…”