|Year : 2014 | Volume
| Issue : 2 | Page : 69-72
Effect of glycemic status on lung function tests in type 2 diabetes mellitus
SN Naithok Jamatia1, Kanan Wangkheimayum1, W Asoka Singh2, Govindaraj Yumnam1
1 Department of Physiology, Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
2 Department of Respiratory Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
|Date of Web Publication||18-Sep-2014|
Dr. S N Naithok Jamatia
Department of Physiology, Regional Institute of Medical Sciences, Imphal - 795 004, Manipur
Source of Support: None, Conflict of Interest: None
Background: Diabetes Mellitus is a metabolic disorder precipitating micro vascular, macro vascular complications and peripheral vascular diseases. Pulmonary complications of diabetes mellitus have been poorly characterized. Although some authors have reported normal pulmonary function, others found abnormalities in lung volumes, pulmonary mechanics, and diffusing capacity. Glycemic status have shown varied impact on lung functions. Objective: To measure lung volumes of type 2 diabetic patients and correlate with their glycemic status. Materials and Methods: Cross-sectional study was carried out among 30 type 2 diabetic patients and 30 age and sex matched non-diabetic controls in the Department of Physiology, Regional Institute of Medical Sciences (RIMS), Imphal. Spirometric recordings were estimated by using Computerized Spirometer-HELIOS 701. Blood glucose level was determined by glucose oxidase method and glycated hemoglobin (HbA1c) was estimated by using Glycohemoglobin HbA1-Test kit; Fast Ion-Exchange Resin Separation Method. Data was analyzed using Student's 't' test and Pearson correlation. Results: The pulmonary functions forced vital capacity (FVC), forced expired volume in one second (FEV 1 ), peak expiratory flow rate (PEFR) and forced mid-expiratory flow (FEF) 25-75% were decreased while FEV 1 /FVC was increased in the cases as compared to the controls. Lung functions exhibited rough negative correlation with post prandial blood sugar (PPBS) and HbA1c. Conclusion: The findings demonstrated modest albeit statistically significant impaired lung functions in restrictive pattern. The significant negative correlation between PPBS and FVC was seen. On correlating with HbA1c a significant negative correlation is seen with FVC and FEV 1 , suggesting that there is a definite association between the glycemic status and decreased lung function, but the exact pathophysiological mechanism to explain this association requires further research.
Keywords: Glycemic status, Spirometric lung parameters, Type 2 diabetes mellitus
|How to cite this article:|
Naithok Jamatia S N, Wangkheimayum K, Singh W A, Yumnam G. Effect of glycemic status on lung function tests in type 2 diabetes mellitus. J Med Soc 2014;28:69-72
|How to cite this URL:|
Naithok Jamatia S N, Wangkheimayum K, Singh W A, Yumnam G. Effect of glycemic status on lung function tests in type 2 diabetes mellitus. J Med Soc [serial online] 2014 [cited 2021 May 11];28:69-72. Available from: https://www.jmedsoc.org/text.asp?2014/28/2/69/141071
| Introduction|| |
Diabetes mellitus is accompanied by widespread biochemical, morphological and functional abnormalities, which may precipitate certain complications that may affect neural, cardiovascular, renal systems and also organs and tissues like skin, liver, collagen and elastic fibers. Thus diabetes is a multisystem disorders that affect many organs of the body. 
There is alarming increase in the incidence and prevalence of diabetes mellitus globally. The prevalence of diabetes for all age groups, worldwide, was 2.8% in 2000 and is estimated to reach 4.4% by 2030. The total number of diabetics is projected to rise from 171 million in 2000 to 366 million in 2030. In India alone, the prevalence of diabetes is about 12.1%. Diabetes is expected to increase from 31.7 million in 2000 to 79.4 million in 2030.  A study conducted by Singh et al. in 2001 reported the prevalence of diabetes mellitus in peri-urban population of Manipur to be 4.0%. 
Pulmonary function tests in type 2 diabetes have demonstrated varied, and frequently conflicting results with some studies indicating a reduction in lung volumes, whereas others have demonstrated no change compared with healthy controls. Despite the unclear nature, the relationship between diabetes and lung function remains important because of potential epidemiological and clinical implications. 
In Type 1 diabetes, lung function has been investigated in several clinical studies and evidenced reduced elastic recoil, reduced lung volumes, diminished respiratory muscle performance, decreased in pulmonary diffusion capacity for carbon monoxide. But there are few data concerning pulmonary function abnormalities in patients with type 2 diabetes mellitus. The purpose of the present study was to highlight the spirometric lung function changes in the patients of type 2 diabetes mellitus and to find out its association with the glycemic status.
| Materials and Methods|| |
A cross-sectional study was conducted during January 2013 to March 2013 in the department of Physiology, Regional Institute of Medical Sciences (RIMS), Imphal after getting approval from the Institutional Ethics Committee. The study included 30 diagnosed cases of type 2 diabetic patients with age group 20 and above attending Diabetic clinic, RIMS, Imphal with duration of diabetes not less than 2 years at the time of diagnosis and 30 healthy controls (age and sex matched).
H/o any respiratory and cardiovascular diseases, smoking and alcohol consumption, diabetic complications and unwilling to participate.
Spirometer model, RMS 701 with Helios software (Recorders and Medicare System, Chandigarh). Following lung parameters were considered for the study: FVC (Lit)-forced vital capacity, FEV 1 -forced expiratory volume in 1 st second, PEFR (Lit/sec)-peak expiratory flow rate, FEF 25-75% -mean forced expiratory flow during the middle of FVC. Blood glucose level was determined by glucose oxidase method and glycated hemoglobin (HbA1c) level was assessed by using glycohemoglobin HbA1-Test kit; Fast Ion-Exchange Resin Separation Method.
Statistical analysis was performed using Statistical Package for the Social Sciences software (SPSS version 20). Student's 't' test and Pearson correlation were used. Data were presented in the form of Mean and Standard Deviation. Level of statistical significance was set at P < 0.05. Prior to the test, all the subjects (controls and patients) underwent a detail history taking, general physical examination and systemic examinations. The nature and purpose of the study was explained. Verbal and written consents were taken and confidentiality maintained.
| Results|| |
In all, 30 type 2 diabetic patients and 30 matched controls were included in this study. The general characteristics of the subjects are shown in [Table 1]. After Spirometry, a significant reduction in FVC and PEFR were seen and a significant increase in FEV 1 /FVC was seen in the cases when compared to the controls. A larger reduction in FVC than FEV 1 was seen. The consequent larger FEV 1 /FVC ratio suggested restrictive physiology [Table 2].
|Table 2: Comparison of (Means ± S.D) lung parameter of diabetics with the parameters|
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Functional lung impairment was observed in 54% of patients, which was graded according to American thoracic society (ATS) criteria of restrictive lung diseases based on FVC%. The FVC % predicted values <80-≥70, <70-≥60, <60-≥50, <50-≥34 and <34 represent mild, moderate, moderately severe, severe and very severe restriction. In the present study, 23 (46%) number of the cases have normal lung function; 21 (42%) have mild, 4 (8%) have moderate and 2 (4%) have moderately severe restrictive lung impairment. None of the diabetics have severe or very severe restrictive pattern of lung impairment [Figure 1].
|Figure 1: Frequency of severity of restriction in diabetics on the bases of FVC% predicted|
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There was no correlation between the lung parameters and the FBS. However, a rough negative correlation was seen between post prandial blood sugar (PPBS) and lung parameter; with a significant negative correlation with FVC. Significant negative correlation was also seen between lung parameters (FVC and FEV 1 ) with HbA1c; [Table 3].
| Discussion|| |
The mean values of FVC and PEFR were found to be higher in the non-diabetics as compared to the diabetics. Mean FVC was lower in the diabetics as compared to the non-diabetics, with a significant P value of < 0.05. The results of this study were in agreement with those of Sanjeev et al and Maurizio et al. studies. , They had demonstrated a consistent FVC reduction in their studies on noninsulin-dependent diabetic patients. This reduction can be explained on the basis that in diabetes, thickening of the basal lamina occurs in the alveolar epithelium and the pulmonary capillary. Also, due to the non-enzymatic glycosylation of the connective tissue, the elastic recoil of lung is reduced. This leads to the reduced FVC in diabetics.
Study by Davis TM et al.,  showed reduction in FEV 1 , which may attribute to the thickening of the alveolar epithelium and the pulmonary capillary basal lamina and also due to the reduced recoiling of the lung caused by non enzymatic glycosylation of the connective tissue. However, in the present study the reduction in mean FEV 1 was seen to be not significant.
FEV 1 /FVC% is the volume of air expired in the first second, expressed as percentage of FVC. It is a more sensitive indicator of airway obstruction, than FVC or FEV 1 alone. The alteration in collagen and elastin ratio is the main factor in the diabetic patients. In the present study, the FEV 1 /FVC% is significantly increased indicating the reduction in FVC is more than the reduction in FEV 1 .
PEFR is reduced in diabetics, with a significant P value of < 0.05. This finding was in agreement with those of the study of Davis WA et al.,  who showed decreased PEFR values. The possible explanation for this reduction is the reduced force generating capacity of the expiratory muscle and the reduced recoiling of the lungs. 
FEF 25-75% is the average flow rate during middle 50% of FVC. It indicates patency of the small airways. In the present study, there is reduction in the FEF 25-75% in the diabetic patients, which shows a lower airway caliber and higher airway resistance. This finding is similar to Gajbhiye et al.,  who showed that FEF 25-75% was significantly reduced in the type 1 diabetics. FEF 25-75% depends on non-bronchopulmonary factors like, neuromuscular factors and mechanical equipment factors of inertial distortion of lungs. The thickening of alveolar wall due to the increased amounts of collagen and elastin in basal lamina results in microangiopathy. Thus decrease in muscular and recoiling forces of the respiratory system because of increased glycosylation is responsible for significant decrease in FEF 25-75% .
On comparison of the FBS and the PPBS values with the Spirometric variables, no statistical significance was found but a rough correlation was observed between lung parameters and PPBS. On comparison of HbA1c with the Spirometric values, a significant association was observed between HbA1C and the declining FVC and FEV1 values. This finding was in agreement with that of the Fremantile Diabetes Study done by Davis et al. that indicated a poor lung function was associated with a poor glycemic control.
| Conclusion|| |
Diabetic patients showed modest, albeit statistically significant impaired lung function in restrictive pattern. The pulmonary functions FVC, FEV 1 , PEFR and FEF 25-75% were decreased while FEV 1 /FVC was increased in the cases as compared to the controls. Lung functions exhibited rough negative correlation with PPBS and HbA1c. In summary, our study also supports the other studies that diabetic patients showed impaired lung function. This reduced lung function is likely to be a chronic complication of diabetes mellitus. Lung functions need to be checked periodically to assess the severity of impairment. However, a need of larger prospective study with long observational course to confirm these observations is required.
| Acknowledgment|| |
The article authors consider it necessary to appreciate the support from the Diabetic clinic, Department of Medicine, RIMS, Imphal, Manipur.
| References|| |
|1.||Larsen PR, Kronenberg HM, Melmed S and Polonsky KS. Williams Textbook of Endocrinology. 10 th ed. India: Elsevier India Publisher; 2003. p. 1428-31. |
|2.||Bennett PH, Knowler WC. Definition, Diagnosis, and classification of diabetes mellitus and glucose homeostasis. In: Kahn CR, Weir GC, King GL, Jacobson AM, Moses AC, Smith RJ, editors. Joslin's Diabetes Mellitus. 14 th Indian ed. Noida: Gapsons Paper Ltd; 2006. p. 331. |
|3.||Singh TP, Singh AD, Singh TB. Prevalence of diabetes mellitus in Manipur. In: Shah SK, editor. Diabetes Update Guwahati, India. North Eastern Diabetes Society; 2001. p. 13-9. |
|4.||Fouty B. Diabetes and the pulmonary circulation. Am J Physiol Lung Cell Mol Physiol 2008;295:L725-6. |
|5.||Marvisi M, Bartolini L, del Borrello P, Brianti M, Marani G, Guariglia A, et al. Pulmonary function in non-insulin dependent diabetes mellitus. Respiration 2001;68:268-72. |
|6.||Sinha S, Guleria R, Misra A, Pandey RM, Yadav R, Tiwari S. Pulmonary functions in patients with type 2 diabetes mellitus and their correlation with anthropometry and microvascular complications. Indian J Med Res 2004;119:66-71. |
|7.||Davis TM, Knuiman M, Kendall P, Vu H, Davis WA. Reduced pulmonary function and its association in type 2 diabetes: The Fremantle Diabetes Study. Diabetes Res Clin Pract 2000;50:153-9. |
|8.||Davis WA, Knuiman M, Kendell P, Grange V, Davis TM. Fremantle Diabetes Study. Glycaemic exposure is associated with reduced pulmonary function in type 2 diabetes: The Fremantile Diabetes Study. Diabetes Care 2004;27:752-7. |
|9.||Agarwal V, Gupta B, Dev P, Kumar Y, Ahmad N, Gupta KK. Deterioration of the lung functions in type 2 diabetic subjects from Northern India. Indian J Physiol Pharmacol 2009;53:189-91. |
|10.||Gajbhiye RN, Tambe AS. Pulmonary function test in type 1 diabetics. Al Ameen J Med Sci 2013;6:285-9. |
[Table 1], [Table 2], [Table 3]
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