Pulmonary Function Tests in Type 2 Diabetes

IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 10 Ver. IX (Oct. 2015), PP 44-47
www.iosrjournals.org
Pulmonary Function Tests in Type 2 Diabetes

Pramodh V1., Akhila NR.2
1
Professor, Department of Physiology, MVJ Medical college, Hoskote, Bangalore Rural-562114, Karnataka,
India
2
Assistant Professor Department of Physiology, MVJ Medical college, Hoskote, Bangalore Rural-562114,
Karnataka, India
Abstract:
Background and objective: Diabetes mellitus(DM) is a metabolic disorder leading to various microvascular
and macrovascular complications. This study is intended to know the extent of impairment of lung function in
diabetics among rural population around Bangalore.
Methods: 100 patients with diabetes mellitus and 100 non diabetics from rural areas of bangalore were
included in the study. Pulmonary function tests were performed using computerized spirometer and random
blood sugar was estimated via glucometer.
Results: Diabetic patients have significantly lesser values of Forced Vital Capacity(FVC), Forced Expiratory
Volume1( FEV1) and FEV1/ FVC as compared to normoglycemic subjects.
Conclusion: Our study showed that diabetic patients had reduced pulmonary functions compared to
normoglycemicsubjects which was of restrictive pattern.
Keywords: Diabetes Mellitus,Forced Vital Capacity(FVC), Forced Expiratory Volume1( FEV1)
I.
Introduction
Type 2 DiabetesMellitus (T2DM) is increasing alarmingly in the world and India has more than 62
million people suffering from it.India ranks next to china and it is increasing upto 2 million every year.1
Accumulating clinical evidence suggests that there is increased incidence of impaired lung function in
diabetes mellitus (DM). Some studies have demonstrated the association between both obstructive and
restrictive lung impairment and insulin resistanceor DM. However, an accelerated decline of lung function has
been observedin patients with DM.
Diabetes leads to microvascular and macrovascularcomplications which results in many of the systemic
functional derangements. DM causes glycosylation of alveolar-capillary proteins leading to microangiopathy
in the lungs. Experimental studies on lung tissue from diabetic rats, autopsy and transbronchial biopsy
studies in a few diabetics confirmed this hypothesis. Patientswith DM had increased thickness of the
alveolar capillary and bronchial-capillary basement membranes.These biological changes translate into
clinical findings such as impairement in pulmonary functions. 2
Though studies have been conducted for estimating the lung functions in diabetes in small groups, not
many large scale studies are done in early diabetes. To our knowledge, such a community based study has not
been conducted in any of the rural areas of Bangalore. We studied the effect of diabetes on the lung function
tests in the rural area of Bangalore.
Aim:
To assess the pulmonary function in diabetic patients
II.
Objectives Of The Study:
To study the effect of diabetes mellitus of 5-10 yrs duration on lung function in diabetics.
III.
Materials And Methods
Study period:
The present study was carried out in March 2015 for a period of one month.
Study design and participants:
Computerized PFT was conducted on 100 diabetic and 100 normoglycaemicmale subjects who were
age, BMI matched. These subjects were selected from rural areas of Bangalore.
100 male diabetics were selected based on the inclusion and exclusion criteria.
Inclusion Criteria:
DOI: 10.9790/0853-141094447
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1. Type 2 Diabetic males for more than 5years but less than 10 years.
2. Age between 40 to 60 years.
3. HbA1c value > 6% but <8%.
Exclusion Criteria:
1. Smokers.
2. History of any lung diseases, restrictive or obstructive such as asthma or any other COPD.
3. Tobacco users.
4. Deformities of chest wall or spine
5. History of or symptoms of any neuromuscular disorders
6. Hypertensive patients.
7. Those with severe or communicable lung infections like tuberculosis.
100 normoglycemic subjects who were age , gender and BMI matched were included in the study.subjects were
selected based on similar criteria and :
1. Fasting blood sugar < 100mg/ dl
2. Post prandial blood sugar <140 mg/dl.
The procedure of Pulmonary Function Test was explained to the subject in his own language and a
written informed consent was taken. The anthropometric parameters and blood pressure values were recorded.
The random blood sugar was estimated using a glucometer. The PFT was conducted using a computerised
spirometer: RMS Helios 401. Sufficient care was taken to sterilise the filters and disposable mouth pieces were
used.
Various PFT parameters were recorded and studied such as :
FEV 1, FVC, FEV 1/ FVC , PEFR .
Data thus obtained were analyzed by unpaired t-test using the statistical software namely SPSS version
20.0.
IV.
Results:
The study group included 100 diabetics and control group included 100 healthy controls.
There was no statistical significance in the differences between the mean age and BMI of the study
group and the control group (p>0.05).
In our study we found that diabetic patients have significantly lesser values of FVC, FEV 1, FEV1/ FVC
and PEFR(p<0.05) as compared to normoglycaemic subjects (Table 1).
Table.1: PFT parameters in normoglycemic subjects and diabetic patients
PFT Parameter
FVC ( litres)
FEV1 ( litres)
FEV1/FVC
PEFR
Normoglycemic
Subjects
3.15 0.27
2.530.29
0.860.12
5.210.73
V.
Diabetic
Patients
2.820.34
2.310.39
0.780.07
4.590.65
Significance
(p value)
<0.05
<0.05
<0.05
<0.05
Discussion:
Diabetes is a disease which leads to microvascular and macrovascular complications resulting in

multisystem dysfunction.These microvascular changes in lung tissue will lead toimpairement in pulmonary
functions. Few studies have shown that T2DM with microangiopathies show reduced diffusion capacity for
carbon monoxide (DLCO).The study further suggested that hyperglycaemia and dyslipidaemia might have a
contributory role in its pathogenesis.3
In this study we found that diabetics had reduced lung function compared to normoglycemic subjects.
FVC, FEV1,FVC/FEV1 & PEFR werestatististically significantly lower in diabetic patients than in normal
controls (p<0.05): [Table: 1].
Similar to our study Gregory L. Kinney et al have observed a moderate reduction in FVC,FEV1 and
diffusing capacity for carbon monoxide of the lung in patients with type 1 and type 2 diabetes.4Similarly,Mori H
et al have found that increased duration of diabetes is associated with proportionate loss of %DLco. They also
suggested that pulmonary function tests such as %VC, FEV1 and PaCO2 had no significant association with
duration of diabetes.5
It is also suggested by some earlier studies that collagen and elastin changes seen in diabetic patients
could be attributed to the small vessel involvement which may eventually lead to significant structural changes.
Chronic high levels of circulating glucose is also believed to cause an increase in non-enzymatic glycation of
proteins and peptides in the pulmonary extracellular matrix . These factors may be involved in the pathological
changes of the pulmonary parenchyma of T2DM patients.3
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Some studies state that chronic low grade tissue inflammation along with microangiopathy and
accumulation of advancedglycation end products can result in lung restriction in diabetesfinally leading to
diabetic morbidity and mortality.6
YehHC et al have suggested that a PFT test in middle aged nondiabetic adult showing a restrictive
pattern of lung pathology is predictive of subsequent type 2 diabetes.7Similarly, researchers have found that the
risk for the development of prediabetes is more in subjects with increased IGT( Impaired Glucose Tolerance
)and with Low lung volume. They also state that IGT, was significantly associated with reduced lung
volumeand not IFG ( Impaired Fasting Glucose ). 8Hsin-ChiehYehetal , in their study have found that reduced
vital capacity independently predicts the onset of type 2 diabetes. It is also suggested that vital capacity be
considered as an important risk factor for developing insulin resistance and diabetes.9
Bruce B. Duncan et al have found in their study that an increase in leves of interleukin-6 signifying a
low-grade inflammation may predict an impending onset of type 2 diabetes1. 10
Connie C.W. Hsia have stated that moderate lung restriction is seen in type 2 diabetes as in type 1
diabetes. FVC and FEV1 are proportionately reduced as the increase in glycemic levels and loss of lung
diffusing capacity (DLCO).6
Similarly, The Copenhagen City Heart Study done over 15 years showed that there was consistently
lower (FEV1) and (FVC) in diabetics compared to normal individuals.11
Muhammad Irfan et al., studied PFT in diabetics and showed that there was a significant reduction in
forced vital capacity(FVC),FEV1 and slow vital capacity. They also studied that impaired lung function was
independent of smoking and is likely to be a complication of diabetes itself.12This study concurs with our study.
Research done by Wendy A. Davis et al., showed that reduced lung volumes are the result of chronic
complications of DM and is related to glycemic exposure. They also revealed that airflow limitation is a
predictor of mortality.13
David A. Kaminskyhas opined that lung function is an important marker of increased risk of mortality
in diabetic patients .Further, it is suggested that low FEV1 is a marker of diabetes or poor glycemic control , it
is better to add the spirometer to the equipments available for monitoring the control of diabetes and its
important complications.14
VI.
Limitations
In this study we were not able to measure the diffusing capacity for carbon monoxide as well as total
lung capacity in our subjects.
VII.
Conclusion
Our studyconfered that diabetic patients had reduced pulmonary functions compared to normoglycemic
subjects which was of restrictive pattern.
Pulmonary impairment leads to decreased physical working capacity in diabetics. Since majority of the
work force in our country is in 30s and 40s age group, the pulmonary dysfunction in the early years of diabetes
could affect productivity drastically at both individual and community levels. Hence it is important to do
periodic lung function as part of diabetes check up for early detection of lung abnormalities.
Acknowledgement
We hereby thank the management of our hospital for all the support and equipments they have
provided. We are thankful to our HoD, Department of Physiology and the entire staff of the department for their
guidance and support.
References
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