Monday October 02, 2006
DIABETIC LUNG

Pulmonary impairment in diabetes mellitus is under-recognized. The alveolar-capillary network receives the entire cardiac output and constitutes the largest microvascular organ in the body, making it highly susceptible to systemic microangiopathy. Owing to its large reserves, symptoms and disability develop later in the lung than in smaller microvasculature such as the kidney or retina despite a comparable severity of anatomic involvement.

It is not a new concept and numbers of classic studies are available. We just choose to ignore it !


* Investigators from the Copenhagen City Heart Study enrolled nearly 12,000 subjects ages 20 and older. Among them were 284 with clinician-diagnosed diabetes and 177 with abnormal glucose tolerance. On average, patients with diabetes had lower lung function values and a more rapid rate of decline than those without diabetes. At the five-year follow up lung function loss among diabetes patients exceeded that of the non-diabetes cohort by 29 ml (FVC) and 25 ml (FEV1) per year, a rate of decline comparable to that of smokers.


(Lange P, Groth S, Montensen J, et al. Diabetes mellitus and ventilatory capacity: a five year follow-up study, Eur Respir J. 1990;3:288-292)



* The Fremantle Diabetes Study from Australia plotted lung function values from 125 non-smokers with type II diabetes and no pre-existing lung disease over a seven-year period. During this time, the rate of lung function decline was about twice that expected (mean decrease, 68 ml/year for FVC and 71 ml/year for FEV1)

(Davis WA, Knuiman M, Kendall P, et al. Glycemic exposure is associated with reduced pulmonary function in type 2 diabetes: the Fremantle Study. Diabetes Care. 2004;27:752-757)


Other recommended readings: click to get articles

1. 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.

2. Lung Dysfunction in Diabetes Goldman, Diabetes Care 2003;26:1915-1918.