Elvira Valerio, Gabriel Jr Jasul, Luisa David, Alvin Penafiel, Myrna Banares,
Joselynna Quimpo Related Institution
Publication Sub Type
Journal Article, Original
Philippine Journal of Internal Medicine
Six times a year (6x/year)
BACKGROUND: Periodic monitoring of lung function has been advocated as a measure of health status and a prognostic indicator of premature death from all causes. The association of reduced lung function with other known diabetes related end organ damage has been observed by number of studies. However, spirometric PFTs in other reviews failed to show differences between patients with diabetes and normal control subjects.
OBJECTIVES: (1) To determine if there is a difference in pulmonary function between Filipino patients with Type 2 DM and non-diabetics; (2) to describe the baseline characteristics of the subject population in terms of age, sex, body mass index(BMI) and glycosylated hemoglobin (HbAlC); and (3) to determine if there is a correlation between diabetes, spirometric measures and glycemic control .
METHODOLOGY: This is a cross-sectional study where pulmonary function test (PFT) of 73 patients with Type 2 diabetes for at least 5 years and 70 non-diabetics from May to October 2005 were compared at St. Luke's Medical Center. The main outcome measures were forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio and HbA1c.
RESULTS: The FEV1 and FVC mean values were significantly lower among diabetics, 77.8 percent (p 0.001) and 69.9 percent (p<0.001) respectively, compared to non-diabetic group,85 percent and 77.9 percent respectively. Using logistic regression, the odds of having abnormal FEV1 among diabetics is 3.13 (95 percent CI 1.41-6.94) times higher than the non-diabetics (p 0.005), the odds of having abnormal FVC is 2.219 (95 percent Cl 1.0-4.92) times higher than non-diabetics (p 0.050). HbAlc is inversely correlated with FEV1.
CONCLUSION: Reduced pulmonary function is seen in Filipino patients with Type 2 DM. The severity of which appears to be related to glycemic exposure.
(1) To determine if there is a difference in pulmonary function between Filipino patients with Type 2 DM and non-diabetics;
(2) to describe the baseline characteristics of the subject population in terms of age, sex, body mass index(BMI) and glycosylated hemoglobin (HbAlC); and
(3) to determine if there is a correlation between diabetes, spirometric measures and glycemic control . References
1. Lange, P , Groth, S , Kastrup, J , Mortensen, J , Appleyard, M , Nyboe, J , et al, . "Diabetes mellitus, plasma glucose and lung function in a cross-sectional population study"
European Respiratory Journal 2, 14 - 19, 1989
2. Barret-Connor, E , Frette, C . "NIDDM, impaired glucose tolerance, and pulmonary function in older adults"
Diabetes Care 19, 1441, 1996
3. Davis, TME , Knuiman, M , Kendall, P , Vu, H , Davis, W A. "Reduced pulmonary function and its association in type 2 diabetes: the fremantle diabetes study"
Diabetes Research and Clinical Practice 50, 153, 2000
4. Ramiriez, L C, Dal Nogare, A , Hsia, C , Aruaz, C , Butt, I , Trowig, S M, et al, . "Relationship between diabetes control and pulmonary function in insulin-dependent diabetes mellitus"
American Journal Medicine 91, 371, 1991
5. Sandler, M . "Is the lung a target organ in diabetes mellitus?"
Archives Internal Medicine 150, 1385, 1990
6. Engstrom, G , Janson, L . "Risk of developing diabetes is inversely related to lung function: A Population-based cohort study"
Diabetes Medicine 19, 167, 2002
7. Weynard, B , Jonckheere, A , Frans, A , Rahier, J . "Diabetes mellitus induces a thickening of the basal lamina"
Respiration 66, 14, 1999
8. Farina, J , Furio, V , Fernandez-Acenero, M J, Muzas, M A. "Nodular fibrosis of the lung in diabetes mellitus"
Virchows Arch 427, 61, 1995
9. Schuyler, M R, Niewoehner, D E, Inkley, S R, Kon, R . "Abnormal lung elasticity in juvenile diabetes mellitus"
American Review Respiratory Diseases 113, 37, 1976
10. Soulis, T , Thallas, V , Youssef, S , Gilbert, R E, McWilliam, B G, Murray-McIntosh, R P, et al, . "Advanced glycation end products and teir receptors co-localise in rat organs susceptible to diabetic microvascular injury"
Diabetologia 40, 619, 1997
11. Villa, M P, Bernardi, F , Cicognani, A , Salardi, S , Zapulla, F . "Bronchial reactivity in diabetic patients: Relationship to duration of diabetes and degree of glycemic control"
American Journal Diseases Children 142, 726, 1988
12. Fleming, D M, Crombie, D L, Cross, K W. "Disease concurrence in diabetes mellitus: A Study of concurrent morbidity over 12 months using diabetes mellitus as an example"
Journal Epidemiol Community Health 45, 73, 1991
13. Fine, M J, Smith, M A, Carson, C A, Mutha, S S, Sankey, S S, Weissfeld, L A, et al, . "Prognosis and outcomes of patients with community-acquired pneumonia: A Meta-analysis"
JAMA 275, 134, 1996
14. Mori, H , Okubo, M , Okamura, M , Yamane, K , Kado, S , Egusa, G , et al, . "Abnormalities of pulmonary function in patients with non-insulin-dependent diabetes mellitus"
Internal Medicine 31, 189, 1992
15. Fuso, L , Cotroneo, P , Basso, S , De la Rosa, M , Manto, A , Ghirlanda, G , et al, . "Postural variations of pulmonary diffusing capacity in insulin-dependent diabetes mellitus"
Chest 110, 1109, 1996
16. Ozmen, B , Celik, P , Yorgancioglu, A , Ozmen, D , Cok, G . "Pulmonary function parameters in patients with diabetes mellitus"
Diabetes Research and Clinical Practice 57, 209, 2001
17. Benbassat, C , Stern, E , Kramer, M , Lebzeller, J , Blum, I , Fink, G . "Pulmonary function in patients with diabetes mellitus"
American Journal Medical Science 322, 127, 2001
18. Davis, W A, Knuiman, M , Kendall, P , Grange, V , Davis, TME . "Glycemic exposure is associated with reduced pulmonary function in type 2 diabetes: Te Fremantle diabetes study"
Diabetes Care 27, 752, 2004
19. Beatty, T H, Coen, B H, Newell, C A, Menkes, H A, Diamond, E L, Chen, C J. "Impaired pulmonary function as a risk factor for mortality"
American Journal Epidemiology 116, 102, 1982
20. Krzyanowski, M , Wysocki, M . "The Relation of 13-mortality to ventilatory impairment and other respiratory symptoms: the Cracow study"
International Journal Epidemiology 15, 56, 1986
21. Ebi-Kryston, K L, Hawthorne, V M, Rose, G , Shipley, M J, Gillis, C R, Holle, D J, et al, . "Breathlessness, chronic bronchitis, and reduced pulmonary function as predictors of cardiovascular disease mortality among men in England, Scotland, and the United States"
International Journal Epidemiology 18, 84, 1989
22. Skyler, J S, Cefalu, W T, Kourides, I A, et al, . "Efficacy of inhaled human insulin in type 2 diabetes mellitus: A Randomized proof-of-concept study"
Lancet 357, 331, 2001
23. Cefalu, W T, Skyler, J S, Kourides, I A, et al, . "Inhaled insulin study group. Report of short-term efficacy and safety of inhaled insulin in adults with type 2 diabetes mellitus"
Annals Internal Medicine 134, 203, 2001
24. Cefalu, W T. "Novel routes of insulin delivery for patients with type I of type 2 diabetes"
Annals Medicine 33, 579, 2001
25. Schanak, C H, Festa, A , Schwarzmaier-Dassie, A , Haber P, , Schernthaner, G . "Pulmonary dysfunction in type 1 diabetes in relation to metabolic long term control and to incipient diabetes nephropathy"
Nephron 74 , 395, 1996
26. Isotani, H , Nakamura, Y , Kameoka, K , et al, . "Pulmonary diffusing capacity, serum angiotensin converting enzyme activity and the nagiotensin converting enzyme gene in Japanese non-insulin diabetes mellitus patients"
Diabetes Res Clin Pract 43, 173, 1999
27. Tantucci, C , Scionti, L , Bottini, P . "Influence of autonomic neuropathy of didderent severities on the hypetension drive to breathing in diebtic patients"
Chest 112, 145, 1997