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http://www.medscape.com/viewarticle/471442

Glycemic Exposure Reduces Pulmonary Function

Laurie Barclay, MD

March 12, 2004 — Reduced lung volumes and airflow are
a complication of type 2 diabetes, according to the
results of a prospective trial published in the March
issue of Diabetes Care.

"Several cross-sectional studies have shown that type
2 diabetes is associated with reduced lung function,"
write Wendy A. Davis, MPH, from the University of
Western Australia and Fremantle Hospital. "This may
mean that diabetes and impaired lung function share
common pathophysiologic determinants rather than the
lung being a target organ in diabetes."

From a community-based cohort, 495 patients of
European origin with type 2 diabetes and no history of
pulmonary disease had baseline spirometry between 1993
and 1994. Repeat spirometry was performed in 125
patients at a mean follow-up of 7.0 years, and outcome
measures were corrected for body temperature, air
pressure, and water saturation.

At baseline, the mean percentage-predicted values of
forced vital capacity (FVC), forced expiratory volume
in one second (FEV1), vital capacity (VC), and peak
expiratory flow (PEF) were decreased more than 10% in
the overall cohort. In the 125 prospectively studied
patients, mean FVC declined at 68 mL/year, FEV1 at 71
mL/year, VC at 84 mL/yr, and PEF at 17 L/min/year.

Higher updated mean HbA1c, follow-up HbA1c, or
follow-up fasting plasma glucose reflecting poor
glycemic control predicted declining lung function
measures. Cox proportional hazards analysis revealed
that decreased FEV1 percentage-predicted value was an
independent predictor of all-cause mortality.

Study limitations include selection of healthy
survivors for the prospective study, use of two
different spirometers at baseline and at follow-up,
and possible effects of chronic illness on
effort-dependent measures. However, duration of
diabetes was not consistently associated with changes
in lung function.

"Reduced lung volumes and airflow limitation are
likely to be chronic complications of type 2 diabetes,
the severity of which relates to glycemic exposure,"
the authors write. "Our data support the suggestion
that the lung is a target organ in diabetes and that
glycemic exposure is a strong determinant of reduced
pulmonary function in type 2 patients. Furthermore,
because measures of airflow limitation predict
all-cause mortality in type 2 diabetes, intensive
glycemic management may reduce the risk of death
through improved ventilatory function independent of
other beneficial effects."

The Raine Foundation of the University of Western
Australia funded the Fremantle Diabetes Study. The
senior author is a member of the AERx (inhaled
insulin) Advisory Board for Novo Nordisk
Pharmaceuticals.

In an accompanying editorial, David A. Kaminsky, from
the University of Vermont in Burlington, puts these
findings in the context of other research
demonstrating that lung function is an independent
risk factor of cardiovascular, pulmonary, and
all-cause mortality.

"If a low FEV1 is a marker of diabetes or poor
glycemic control, then efforts should be focused on
identifying and modifying known risk factors for
cardiopulmonary disease and diabetes," Dr. Kaminsky
writes. "If a low FEV1 reflects a causative role
played by the lungs in the development of diabetes,
then optimizing lung health through smoking cessation,
avoidance of irritant and toxic exposures, control of
underlying airway inflammation, and promotion of
physical activity seems warranted. Indeed, it's time
to add the spirometer to the tools available for
monitoring diabetes and its important sequelae."

Diabetes Care. 2004;27:752-757



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