Relationship Between Blood Glucose Level and Carbonmonoxide Diffusion Capacity in Patients with Type 2 Diabetes

Year 2022, Volume: 17 Issue: 3, 22 - 29, 02.11.2022

Hatice Şahin , Hasan Kahraman

https://doi.org/10.17517/ksutfd.928447

Abstract

Abstract
Objective: Diabetes mellitus is a chronic disease that causes complications and affects many organs. Even though retinopathy, neuropathy, nephropathy and macrovascular complication of diabetes are well known. There are less study about lung involvement. In this study our aim was to investigate the effects of diabetes on respiratory function tests.
Material and Methods: Fifty one diabetic patients (15 male, 36 female) and 49 healthy controls (24 male, 25 female), total 100 participants were involved to our study. Fasting blood glucose, HbA1c, after meal blood glucose, creatinine, hemogram, alanine transaminase (ALT), spot urine albumin and spot urine
creatinine samples were taken from diabetic patients. All patients were screened for microvascular complications and data was recorded. Respiratory function tests were performed in all participants and Forced expiratory volume in 1st second (FEV1), Forced expiratory volume in 1st second/forced vital capacity (FEV1/FVC), carbon monoxide diffusing capacity (DLCO%) were measured and compared between two groups.
Results: FEV1 values of diabetic group and control group were 92.84±8.94 ml and 96.95±9.2 ml respectively, FEV1 values of diabetic group were statistically significant (p=0.026). DLCO levels in diabetic group and control group were 96.21±10.8 mmol/kPa/min, and 97.95±10.1 mmol/kPa/min respectively, even
though diabetic group has lower DLCO levels, this finding was not statistically significant (p=0.41). FEV1/FVC levels of diabetic and control group were 82.15±6.77 and 83.73±5.87 respectively and difference was not statistically different (p=0.21).
Conclusion: Chronic hyperglycemia in diabetes may cause microangiopathic damage and leads to microvascular complications such as retinopathy, nephropathy and neuropathy. Studies about effects of diabetes on lungs is quite limited. In our study we detected lower FEV1 levels in diabetic patients compared with healthy controls. More studies are required to clarify lung involvement in diabetes.

Keywords

DIABETES MELLITUS, TYPE 2 DIABETES, RESPIRATORY FUNCTION TESTS, FEV1, FEV1/FVC

Tip 2 Diyabetli Hastalarda Kan Glukoz Düzeyi ile Karbonmonoksit Difüzyon Kapasitesi Arasındaki İlişki

Abstract

Özet
Amaç: Diyabetes mellitus birçok organı etkileyen komplikasyonlarla giden bir hastalıktır. Diyabetin retinopati, nefropati, nöropati ve makrovasküler komplikasyonları iyi bilinmekle birlikte akciğer üzerine etkileri yeteri kadar çalışılmamıştır. Bizim bu çalışmamızda amacımız tip 2 diyabetes mellitus’un solunum fonksiyon testlerine etkisin incelemektir.
Gereç ve Yöntemler: Tip 2 diyabetli 51hasta (15’i erkek, 36’sı kadın) ve 49 sağlıklı kontrol (24’ü erkek, 25’i kadın) olmak üzere toplam 100 kişi çalışmaya dâhil edildi. Diyabetli hastalardan 8-12 saatlik açlık kan şekeri, HbA1c, tokluk kan şekeri, kreatinin, alanin Transaminaz (ALT), hemogram, spot albümin, spot
kreatinin tahlilleri istendi. Tüm hastaların göz ve nörolojik muayeneleri ilgili branşlarda yaptırıldı ve diyabetik nöropati, nefropati veya retinopati saptanan hastalar kaydedildi. Tüm katılanların solunum fonksiyon testleri yapılarak 1 saniyedeki zorlu ekspiratuar volüm (FEV1), zorlu ekspiratuar volüm 1 sn/zorlu
vital kapasite (FEV1/FVC), karbonmonoksit difüzyon kapasitesi (DLCO%) değerler ölçüldü ve iki grup arasında karşılaştırmalar yapıldı.
Bulgular: Diyabetli hastalarda FEV1 değeri ortalama 92.84±8.94 ml iken, kontrol grubunda 96.95±9.2 ml olarak saptandı. Diyabetli grupta FEV1 daha düşük bulundu ve arasındaki fark istatistiksel olarak anlamlıydı (p=0.026). Diyabetli hastalarda DLCO değeri 96.21±10.8 mmol/kPa/dk iken kontrol grubunda bu değer 97.95±10.1 mmol/kPa/dk idi ve tip 2 diyabetlilerde daha düşük olmasına rağmen aralarındaki fark anlamlı değildi (p=0.41). Diyabetli hastalarda FEV1/FVC oranı 82.15±6.77 iken, kontrol grubunda ise 83.73±5.87 olarak saptandı ve aralarındaki fark anlamlı değildi (p=0.21).
Sonuç: Tip 2 diyabetli hastalarda kronik hiperglisemi olması mikroanjiopatik hasara yol açarak özellikle retinopati, nöropati ve nefropati gibi komplikasyonlara sebebiyet vermektedir. Diyabetin akciğer üzerindeki etkilerini inceleyen çalışma sayısı çok azdır. Çalışmamızda tip 2 diyabetli olanlarda kontrol grubuna göre solunum fonksiyonlarında sadece FEV1 değerlerinde bozulma olduğunu saptadık. Bununla birlikte bu konuda daha geniş kapsamlı çalışmalara ihtiyaç olduğunu düşünmekteyiz.

Keywords

DİYABETES MELLİTUS, TİP 2 DİYABET, SOLUNUM FONKSİYON TESTİ, FEV1, FEV1/FVC, DLCO

References

• Khateeb J, Fuchs E, Khamaisi M. Diabetes and lung disease: An underestimated relationship. Rev Diabet Stud. 2019;15:1-15.
• Malte Rasmussen S, Brok J, Backer V, Francis Thomsen S, Meteran H. Association between chronic obstructive pulmonary disease and Type 2 Diabetes: A systematic review and meta-analysis. COPD 2018;15(5):526-535.
• Ljubić S, Metelko Ž, Car N, Roglić G, Dražić Z. Reduction of diffusion capacity for carbon monoxide in diabetic patients. Chest 1998;114(4):1033–1035.
• Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature . 2001;414(6865):813-820.
• Weynand B, Jonckheere A, Frans A, Rahier J. Diabetes mellitus induces a thickening of the pulmonary basal lamina. Respiration. 1999;66(1):14–19.
• Isotani H, Nakamura Y, Kameoka K, Tanaka K, Furukawa K, Kitaoka H et al. Pulmonary diffusing capacity, serum angiotensin-converting enzyme activity and the angiotensin-converting enzyme gene in Japanese non-insulin- dependent diabetes mellitus patients. Diabetes Res Clin Pract. 1999;43(3):173–177.
• Mauricio D, Alonso N, Gratacòs M. Chronic diabetes complications: The need to move beyond classical concepts. Trends Endocrinol Metab. 2020;31(4):287-295.
• Watanabe K, Senju S, Toyoshima H, Yoshida M. Thickness of the basement membrane of bronchial epithelial cells in lung diseases as determined by transbronchial biopsy. Respir Med.1997;91(7):406–410.
• Davis WA, Knuiman M, Kendall P, Grange V, Davis TME. Glycemic exposure ıs associated with reduced pulmonary function in type 2 diabetes: The Fremantle Diabetes Study. Diabetes Care. 2004;27(3):752–757.
• McKeever TM, Weston PJ, Hubbard R, Fogarty A. Lung function and glucose metabolism: An analysis of data from the Third National Health and Nutrition Examination Survey. Am J Epidemiol 2005;161:546–556.
• International Diabetes Federation (IDF) 2009. Diabetes Atlas, 4th Edition. [Internet]. Available from: https://www.coffeeandhealth.org/abstract/international-diabetes-federation-idf-2009-diabetes-atlas-4th-edition/
• Keleş İ, Onat A, Sansoy V, Aksu H, Çetinkaya A, Yıldırım Bve ark. TEKHARF 1997/98 Taraması Yeni Kohortunda Risk Faktörleri ve Kalp Hastalıkları Prevalansı. Türk Kardiyol Dem Arş 1999;27:104-109.
• Perkins BA, Bril V. Diagnosis and management of diabetic neuropathy. Curr Diab Rep 2002;2:495–500.
• Liu Z, Fu C, Wang W, Xu B. Prevalence of chronic complications of type 2 diabetes mellitus in outpatients- a cross-sectional hospital based survey in urban China. Health Qual Life Outcomes. 2010;8:62.
• Schuyler MR, Niewoehner DE, Inkley SR, Kohn R. Abnormal lung elasticity in juvenile diabetes mellitus. Am Rev Respir Dis. 1976;113(1):37–41.
• Schnack C, Festa A, Schwarzmaier-D-Assie A, Haber P, Scliernthaner G. Pulmonary dysfunction in type 1 diabetes in relation to metabolic long-term control and to incipient diabetic nephropathy? Nephron 1996;74(2):395–400.
• Turaçlar UT, Candan F, Sümer H. Tip II diyabetik hastalarda solunum fonksiyon testleri. Tüberküloz ve Toraks Dergisi 1999;47:54-57.
• Gardner RM, Hankinson JL. Standardization of spirometry—1987 ATS update. Am Rev Respir Dis.1988;30:272–273.
• Özmen B, Çelik P, Yorgancioǧlu A, Özmen B, Özmen D, Çok G. Pulmonary function parameters in patients with diabetes mellitus. Diabetes Res Clin Pract. 2002;57:209–211.
• American Thoracic Society. Single-breath carbon monoxide diffusing capacity (transfer factor). Recommendations for a standard technique-1995 update. Am J Respir Crit Care Med. 1995;152:2185–2198.
• Asanuma Y, Fujiya S, Ide H, Agishi Y. Characteristics of pulmonary function in patients with diabetes mellitus. Diabetes Res Clin Pract. 1985;1(2):95–101.
• Kumari K, Nataraj S, DevarajH S. Correlation of duration of diabetes and pulmonary function tests in type 2 diabetes mellitus patients.(2011).