https://doi.org/10.4081/monaldi.2024.2912

Impaired glycemic control as a risk factor for reduced lung function in the Indian diabetic population

Early Access
Submitted: January 21, 2024
Accepted: June 3, 2024
Published: July 24, 2024
Restrictive lung disease, chronic inflammation, pulmonary function tests, uncontrolled diabetes mellitus, diabetic pneumopathy
Abstract Views: 236
PDF_EARLY VIEW: 47
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Rozandeep Kaur
Department of Biochemistry, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India.
Neha Uppal
Department of Biochemistry, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India.
Vibha Uppal
vuppal_girotra@yahoo.co.in
https://orcid.org/0000-0001-6697-7496
Department of Biochemistry, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India.
Anju Sharma
Department of Biochemistry, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India.

Diabetes mellitus (DM) is a metabolic syndrome associated with chronic hyperglycemia, which results in various acute and chronic complications. DM leads to a state of chronic low-grade inflammation, which can have adverse effects on pulmonary functions. There have been contradictory studies related to the relationship between defects in lung functions in diabetic individuals and their correlation with glycemic control and systemic inflammatory markers. The present study aims to compare pulmonary function in controlled and uncontrolled diabetes in the Indian population while exploring the link between inflammatory markers and lung functions in diabetic patients. This observational, case-control study was conducted in the Department of Biochemistry at Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar, Punjab, on 116 subjects suffering from DM in the age group of 30-65 years. 58 diabetic patients with poor glycemic control [glycated hemoglobin (HbA1c)>7%] and 58 diabetic patients with good glycemic control served as controls (HbA1c≤7%). The duration of the study was two years. Blood samples of each patient were investigated for glycemic control, high-sensitivity C-reactive protein (hsCRP), and serum fibrinogen. Spirometry as a pulmonary function test was undertaken for all participants. The statistical analysis of good and poor glycemic control diabetics showed that the average duration of disease (in years) was 8±5 and 10.2±5.4, respectively. A significant positive correlation was found between inflammatory markers (hsCRP and fibrinogen) and HbA1c and fasting blood glucose. A substantial decline in forced vital capacity and normal values of forced expiratory volume in the first second was observed in poor glycemic control diabetics, depicting a restrictive pattern of lung disease. Lung damage is seen to be more prevalent in patients with a longer duration of disease and increased levels of inflammatory markers. Chronic inflammation due to DM can lead to fibrosis and destruction of lung tissue, resulting in the development of diabetic lung disease, which includes a decline in lung function, an increased risk of infection, and an increased risk of respiratory failure. Therefore, it is essential for individuals with DM to have regular pulmonary function tests and to manage their diabetes to minimize the impact on their lung health.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2013;36:S67-74. DOI: https://doi.org/10.2337/dc13-S067
Irfan M, Jabbar A, Haque AS, et al. Pulmonary functions in patients with diabetes mellitus. Lung India 2011;28:89-92. DOI: https://doi.org/10.4103/0970-2113.80314
Dennis RJ, Maldonado D, Rojas MX, et al. Inadequate glucose control in type 2 diabetes is associated with impaired lung function and systemic inflammation: a cross-sectional study. BMC Pulm Med 2010;10:38 DOI: https://doi.org/10.1186/1471-2466-10-38
Oh IH, Park JH, Lee CH, Park JS. The association of normal range glycated hemoglobin with restrictive lung pattern in the general population. PLoS One 2015;10:e0117725. DOI: https://doi.org/10.1371/journal.pone.0117725
Park SS, Perez Perez JL, Perez Gandara B, et al. Mechanisms Linking COPD to type 1 and 2 diabetes mellitus: is there a relationship between diabetes and COPD?. Medicina 2022;58:1030. DOI: https://doi.org/10.3390/medicina58081030
Li CI, Li TC, Liu CS et al. Extreme values of hemoglobin a1c are associated with increased risks of chronic obstructive pulmonary disease in patients with type 2 diabetes: a competing risk analysis in a national cohort of Taiwan diabetes study. Medicine 2015;94:e367. DOI: https://doi.org/10.1097/MD.0000000000000367
Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J 2005;26:319-38. DOI: https://doi.org/10.1183/09031936.05.00034805
Kaplan LA, Pesce AJ. Interferences in chemical analysis. In: Kaplan LA, Pesce AJ, eds. Clinical chemistry-theory, analysis and correlation. 2nd ed. St. Louis, USA: The C.V. Mosby Company; 1989. pp. 808-19.
Fawcett JK, Scott JE. A rapid and precise method for determination of urea. J Clin Path 1960;13:156-9. DOI: https://doi.org/10.1136/jcp.13.2.156
Toora BD, Rajagopal G. Measurement of creatinine by Jaffe's reaction--determination of concentration of sodium hydroxide required for maximum color development in standard, urine and protein free filtrate of serum. Indian J Exp Biol 2002;40:352-4.
Jeppsson JO, Kobold U, Barr J, et al. Approved IFCC reference method for the measurement of HbA1c in Human Blood. Clin Chem Lab Med 2002;40:78-89. DOI: https://doi.org/10.1515/CCLM.2002.016
Raifai N, Ridker PM. Population distributions of c-reactive protein in apparently healthy men and women in the United States: implication for clinical interpretation. Clin Chem 2003;49:666-9. DOI: https://doi.org/10.1373/49.4.666
Lowe GD, Rumley A, Mackie IJ. Plasma fibrinogen. Ann Clin Biochem 2004;41:430-40. DOI: https://doi.org/10.1258/0004563042466884
Vanidassane I, Malik R, Jain N. Study of pulmonary function tests in type 2 diabetes mellitus and their correlation with glycemic control and systemic inflammation. Adv Respir Med 2018;86:172-8. DOI: https://doi.org/10.5603/ARM.a2018.0026
Mohamad IL, Saad K, Abdel-Azeem A, et al. Evaluation of pulmonary function changes in children with type 1 diabetes mellitus in Upper Egypt. Ther Adv Endocrinol Metab 2015;6:87-91. DOI: https://doi.org/10.1177/2042018815580514
Goldman MD. Clinical application of forced oscillation. Pulm Pharmacol Ther 2001;14:341-50. DOI: https://doi.org/10.1006/pupt.2001.0310
Sandler M, Bunn AE, Stewart RI. Cross-section study of pulmonary function in patients with insulin-dependent diabetes mellitus. Am Rev Respir Dis 1987;135:223-9.
Khan MA, Sinha N. Assessment of lung functions by spirometry in diabetics with no respiratory complaints. J Assoc Physicians India 2022;70:11-2.
Shah SH, Sonawane P, Nahar P, et al. Pulmonary function tests in type 2 diabetes mellitus and their association with glycemic control and duration of the disease. Lung India 2013;30:108-12. DOI: https://doi.org/10.4103/0970-2113.110417
Gläser S, Ittermann T, Koch B, et al. Airflow limitation, lung volumes and systemic inflammation in a general population. Eur Respir J 2012;39:29-37. DOI: https://doi.org/10.1183/09031936.00009811
Ahmadi-Abhari S, Kaptoge S, Luben RN, et al. Longitudinal association of C-reactive protein and lung function over 13 years: the EPIC-Norfolk study. Am J Epidemiol 2014;179:48-56. DOI: https://doi.org/10.1093/aje/kwt208
Rasmussen F, Mikkelsen D, Hancox RJ, et al. High-sensitive C-reactive protein is associated with reduced lung function in young adults. Eur Respir J 2009;33:382-8. DOI: https://doi.org/10.1183/09031936.00040708
Hancox RJ, Gray AR, Sears MR, Poulton R. Systemic inflammation and lung function: a longitudinal analysis. Respir Med 2016;111:54-9. DOI: https://doi.org/10.1016/j.rmed.2015.12.007
M RK, L H. Fibrinogen levels in type 2 diabetes mellitus and it's correlation with microvascular complications. J Assoc Physicians India 2022;70:11-2.
Tanaka T, Narazaki M, Kishimoto T. IL-6 in inflammation, immunity, and disease. Cold Spring Harb Perspect Biol 2014;6:a016295. DOI: https://doi.org/10.1101/cshperspect.a016295
Baines KJ, Backer V, Gibson PG, et al. Impaired lung function is associated with systemic inflammation and macrophage activation. Eur Respir J 2015;45:557-9. DOI: https://doi.org/10.1183/09031936.00187514
Lim SY, Rhee EJ, Sung KC. Metabolic syndrome, insulin resistance and systemic inflammation as risk factors for reduced lung function in Korean nonsmoking males. J Korean Med Sci 2010;25:1480-6. DOI: https://doi.org/10.3346/jkms.2010.25.10.1480
Talpur AS, Kavanoor Sridhar K, Shabbir K, et al. Restrictive pulmonary disease in diabetes mellitus type II patients. Cureus 2022;14:e23820. DOI: https://doi.org/10.7759/cureus.23820
Kuziemski K, Słomiński W, Jassem E. Impact of diabetes mellitus on functional exercise capacity and pulmonary functions in patients with diabetes and healthy persons. BMC Endocr Disord 2019;19:2. DOI: https://doi.org/10.1186/s12902-018-0328-1
Kolahian S, Leiss V, Nürnberg B. Diabetic lung disease: fact or fiction?. Rev Endocr Metab Disord 2019;20:303-9. DOI: https://doi.org/10.1007/s11154-019-09516-w

Ethics Approval

The study protocol was approved by the ethics review committee of Sri Guru Ram Das Institute of Medical Sciences and Research (SGRDIMSR) Amritsar, Punjab (protocol number 1063/Tig/2020, dated 30/06/2020). The committee assessed the planned project as ethically unobjectionable.

How to Cite

Kaur, Rozandeep, Neha Uppal, Vibha Uppal, and Anju Sharma. 2024. “Impaired Glycemic Control As a Risk Factor for Reduced Lung Function in the Indian Diabetic Population”. Monaldi Archives for Chest Disease, July. https://doi.org/10.4081/monaldi.2024.2912.
Copyright (c) 2024 The Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.


Similar Articles

1 2 3 4 5 6 7 8 9 10 > >> 

You may also start an advanced similarity search for this article.