Pulmonary function in diabetes: a metaanalysis.

BACKGROUND Research into the association between diabetes and pulmonary function has resulted in inconsistent outcomes among studies. We performed a metaanalysis to clarify this association. METHODS From a systematic search of the literature, we included 40 studies describing pulmonary function data of 3,182 patients with diabetes and 27,080 control subjects. Associations were summarized pooling the mean difference (MD) (standard error) between patients with diabetes and control subjects of all studies for key lung function parameters. RESULTS For all studies, the pooled MD for FEV(1), FVC, and diffusion of the lungs for carbon monoxide were -5.1 (95% CI, -6.4 to -3.7; P < .001), -6.3 (95% CI, -8.0 to -4.7; P < .001), and -7.2 (95% CI, -10.0 to -4.4; P < .001) % predicted, respectively, and for FEV(1)/FVC 0.1% (95% CI, -0.8 to 1.0; P = .78). Metaregression analyses showed that between-study heterogeneity was not explained by BMI, smoking, diabetes duration, or glycated hemoglobin (all P > .05). CONCLUSIONS Diabetes is associated with a modest, albeit statistically significant, impaired pulmonary function in a restrictive pattern. Since our results apply to the diabetic subpopulation free from overt pulmonary disease, it would next be interesting to investigate the potential clinical implications in those patients with diabetes who carry a pulmonary diagnosis, such as COPD or asthma.

[1]  R. Vracko,et al.  Basal lamina of alveolar epithelium and capillaries: quantitative changes with aging and in diabetes mellitus. , 2015, The American review of respiratory disease.

[2]  Claudio Pedone,et al.  Comorbidities of chronic obstructive pulmonary disease , 2011, Current opinion in pulmonary medicine.

[3]  Uzma F Mehdi,et al.  Anemia, Diabetes, and Chronic Kidney Disease , 2009, Diabetes Care.

[4]  Debbie A Lawlor,et al.  Birth weight and risk of type 2 diabetes: a systematic review. , 2008, JAMA.

[5]  R. Poulton,et al.  Associations between birth weight, early childhood weight gain and adult lung function , 2008, Thorax.

[6]  D. Klonoff,et al.  Efficacy and Safety of Technosphere Inhaled Insulin Compared With Technosphere Powder Placebo in Insulin-Naive Type 2 Diabetes Suboptimally Controlled With Oral Agents , 2008, Diabetes Care.

[7]  N. Wong,et al.  Association of C-Reactive Protein With Reduced Forced Vital Capacity in a Nonsmoking U.S. Population With Metabolic Syndrome and Diabetes , 2008, Diabetes Care.

[8]  J. Teeter,et al.  Cross-Sectional and Prospective Study of Lung Function in Adults With Type 2 Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study , 2008, Diabetes Care.

[9]  P. Raskin,et al.  Diminished Alveolar Microvascular Reserves in Type 2 Diabetes Reflect Systemic Microangiopathy , 2008, Diabetes Care.

[10]  R. Little,et al.  Statistical methods for monitoring the relationship between the IFCC reference measurement procedure for hemoglobin A1c and the designated comparison methods in the United States, Japan, and Sweden. , 2008, Clinical chemistry.

[11]  M. C. Liu,et al.  Effects of inhaled human insulin on airway lining fluid composition in adults with diabetes , 2008, European Respiratory Journal.

[12]  L. Kuitert,et al.  The lung in diabetes – yet another target organ? , 2008, Chronic respiratory disease.

[13]  M. Tsiamita,et al.  Pulmonary complications in diabetes mellitus , 2008, Chronic respiratory disease.

[14]  P. Raskin,et al.  Lung Involvement in Diabetes , 2008, Diabetes Care.

[15]  F. Beuschlein,et al.  Diabetic polyneuropathy is associated with respiratory muscle impairment in type 2 diabetes , 2007, Diabetologia.

[16]  P. Raskin,et al.  Lung function changes related to diabetes mellitus. , 2007, Diabetes technology & therapeutics.

[17]  J. Rosenstock,et al.  Two-Year Pulmonary Safety and Efficacy of Inhaled Human Insulin (Exubera) in Adult Patients With Type 2 Diabetes , 2007, Diabetes Care.

[18]  J. D. de Backer,et al.  Early detection of COPD: a case finding study in general practice. , 2007, Respiratory medicine.

[19]  J. Lau,et al.  Meta-Analysis: Efficacy and Safety of Inhaled Insulin Therapy in Adults with Diabetes Mellitus , 2006, Annals of Internal Medicine.

[20]  A. Tuğrul,et al.  Evaluation of pulmonary alveolo-capillary permeability in Type 2 diabetes mellitus: using technetium 99mTc-DTPA aerosol scintigraphy and carbon monoxide diffusion capacity. , 2006, Journal of diabetes and its complications.

[21]  Alma Rosa Ortíz-Aguirre,et al.  Cambios espirométricos relacionados con la edad en pacientes diabéticos , 2006 .

[22]  Louette R. Johnson Lutjens.  Research , 2006 .

[23]  S. Weiss,et al.  Lung function in type 2 diabetes: the Normative Aging Study. , 2005, Respiratory medicine.

[24]  J. Hankinson,et al.  Interpretative strategies for lung function tests , 2005, European Respiratory Journal.

[25]  Hsin-Chieh Yeh,et al.  Vital capacity as a predictor of incident type 2 diabetes: the Atherosclerosis Risk in Communities study. , 2005, Diabetes care.

[26]  D. Green,et al.  Abnormal ventilatory responses to hypoxia in Type 2 diabetes , 2005, Diabetic medicine : a journal of the British Diabetic Association.

[27]  R. Hubbard,et al.  Lung function and glucose metabolism: an analysis of data from the Third National Health and Nutrition Examination Survey. , 2005, American journal of epidemiology.

[28]  D. Mannino,et al.  Prospective association between lung function and the incidence of diabetes: findings from the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. , 2004, Diabetes care.

[29]  D. Ardigò,et al.  Pulmonary complications in diabetes mellitus: the role of glycemic control. , 2004, Current drug targets. Inflammation and allergy.

[30]  M. Barreto,et al.  Diffusing capacity for carbon monoxide in children with type 1 diabetes , 2004, Diabetologia.

[31]  K. Wasserman,et al.  Altered exercise gas exchange as related to microalbuminuria in type 2 diabetic patients. , 2004, Chest.

[32]  R. Pandey,et al.  Pulmonary functions in patients with type 2 diabetes mellitus & correlation with anthropometry & microvascular complications. , 2004, The Indian journal of medical research.

[33]  F. Bernardi,et al.  Lung function in children with diabetes mellitus , 2004, Pediatric pulmonology.

[34]  N. Guvener,et al.  Alveolar gas exchange in patients with type 2 diabetes mellitus. , 2003, Endocrine journal.

[35]  P. Nilsson,et al.  Lung function, insulin resistance and incidence of cardiovascular disease: a longitudinal cohort study , 2003, Journal of internal medicine.

[36]  K. Gourgoulianis,et al.  Diabetes mellitus and Lung Function , 2003, Medical Principles and Practice.

[37]  P. Schnohr,et al.  Copenhagen City Heart Study: longitudinal analysis of ventilatory capacity in diabetic and nondiabetic adults , 2002, European Respiratory Journal.

[38]  M. Guazzi,et al.  Diabetes worsens pulmonary diffusion in heart failure, and insulin counteracts this effect. , 2002, American journal of respiratory and critical care medicine.

[39]  S. Thompson,et al.  Quantifying heterogeneity in a meta‐analysis , 2002, Statistics in medicine.

[40]  G. Engström,et al.  Risk of developing diabetes is inversely related to lung function: a population‐based cohort study , 2002, Diabetic medicine : a journal of the British Diabetic Association.

[41]  C. Maiolo,et al.  Neuroadrenergic denervation of the lung in type I diabetes mellitus complicated by autonomic neuropathy. , 2002, Chest.

[42]  C. Benbassat,et al.  Pulmonary Function in Patients with Diabetes Mellitus , 2001, The American journal of the medical sciences.

[43]  E. I. Mohamed,et al.  Is altered body fat distribution responsible for reduced pulmonary function in obese type 2 diabetic adult women? , 2001, Diabetes care.

[44]  L. Provinciali,et al.  Cerebrovascular reactivity and hypercapnic respiratory drive in diabetic autonomic neuropathy. , 2001, Journal of applied physiology.

[45]  R. Agrawal,et al.  Ventilatory pulmonary function tests in type 1 diabetes mellitus. , 2000, The Journal of the Association of Physicians of India.

[46]  I. Romagnoli,et al.  Hypoxic and hypercapnic breathlessness in patients with type I diabetes mellitus. , 2000, Chest.

[47]  Y. Nakamura,et al.  Pulmonary diffusing capacity, serum angiotensin-converting enzyme activity and the angiotensin-converting enzyme gene in Japanese non-insulin-dependent diabetes mellitus patients. , 1999, Diabetes research and clinical practice.

[48]  P. Raskin,et al.  Glycemic control and cardiopulmonary function in patients with insulin-dependent diabetes mellitus. , 1997, The American journal of medicine.

[49]  A. Scheen,et al.  Reactivite bronchique chez les patients diabetiques. , 1997 .

[50]  G. Smith,et al.  Bias in meta-analysis detected by a simple, graphical test , 1997, BMJ.

[51]  E. Puxeddu,et al.  Influence of autonomic neuropathy of different severities on the hypercapnic drive to breathing in diabetic patients. , 1997, Chest.

[52]  M Marvisi,et al.  [Pulmonary complications in diabetes mellitus]. , 1996, Recenti progressi in medicina.

[53]  R. Pistelli,et al.  Postural variations of pulmonary diffusing capacity in insulin-dependent diabetes mellitus. , 1996, Chest.

[54]  K. Eriksson,et al.  Poor physical fitness, and impaired early insulin response but late hyperinsulinaemia, as predictors of NIDDM in middle-aged Swedish men , 1996, Diabetologia.

[55]  F. Vannucci,et al.  Indications of reduced pulmonary function in type 1 (insulin-dependent) diabetes mellitus. , 1994, Diabetes research and clinical practice.

[56]  D. Nathan,et al.  Long-term complications of diabetes mellitus. , 1993, The New England journal of medicine.

[57]  D. Giugliano,et al.  Respiratory Function in IDDM Patients , 1993, Diabetes Care.

[58]  D. Ziora,et al.  Pulmonary complications of Type 1 (insulin-dependent) diabetic patients , 1992, Diabetologia.

[59]  E. Baraldi,et al.  Gas exchange during exercise in diabetic children , 1992, Pediatric pulmonology.

[60]  Tang Mq,et al.  Pulmonary function and artery blood analysis of diabetes mellitus , 1990 .

[61]  M. Sandler.  Is the lung a 'target organ' in diabetes mellitus? , 1990, Archives of internal medicine.

[62]  K. Alberti,et al.  Lung function in patients with diabetes mellitus. , 1990, Respiratory medicine.

[63]  J. Assal,et al.  [Long-term complications in diabetes mellitus]. , 1989, Acta medica portuguesa.

[64]  J. Kastrup,et al.  Diabetes mellitus, plasma glucose and lung function in a cross-sectional population study. , 1989, The European respiratory journal.

[65]  R. Primhak,et al.  Reduced Vital Capacity in Insulin-Dependent Diabetes , 1987, Diabetes.

[66]  R. Stewart,et al.  Pulmonary function in young insulin-dependent diabetic subjects. , 1986, Chest.

[67]  V. Bykerk,et al.  Consensus Statement , 2004, Pediatric Clinical Practice Guidelines & Policies.

[68]  M. H. Vargas,et al.  [Age related spirometric changes in diabetic patients]. , 2006, Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion.

[69]  K. Gourgoulianis,et al.  Pulmonary function and circulating adhesion molecules in patients with diabetes mellitus. , 2003, Canadian respiratory journal.

[70]  C. Zamarrón,et al.  [Pulmonary diffusion of carbon monoxide in 2 clinical situations: bronchial asthma and diabetes mellitus]. , 2001, Anales de medicina interna.

[71]  I. Olkin,et al.  Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. , 2000, JAMA.

[72]  P. Haber,et al.  Pulmonary dysfunction in type 1 diabetes in relation to metabolic long-term control and to incipient diabetic nephropathy. , 1996, Nephron.

[73]  M. Tan,et al.  [Pulmonary function and artery blood analysis of diabetes mellitus]. , 1990, Zhonghua nei ke za zhi.

[74]  R. Stewart,et al.  Cross-section study of pulmonary function in patients with insulin-dependent diabetes mellitus. , 1987, The American review of respiratory disease.

[75]  D. Niewoehner,et al.  Abnormal lung elasticity in juvenile diabetes mellitus. , 1976, The American review of respiratory disease.