Chronic obstructive pulmonary disease, asthma, and risk of type 2 diabetes in women.

OBJECTIVE Inflammation plays a key role in chronic obstructive pulmonary disease (COPD) and asthma. Increasing evidence points toward a role of inflammation in the pathogenesis of type 2 diabetes. We wanted to determine the relation of COPD and asthma with the development of type 2 diabetes. RESEARCH DESIGN AND METHODS The Nurses' Health Study is a prospective cohort study. From 1988-1996, 103,614 female nurses were asked biennially about a physician diagnosis of emphysema, chronic bronchitis, asthma, and diabetes. RESULTS During 8 years of follow-up, we documented a total of 2,959 new cases of type 2 diabetes. The risk of type 2 diabetes was significantly higher for patients with COPD than those without (multivariate relative risk 1.8, 95% CI 1.1-2.8). By contrast, the risk of type 2 diabetes among asthmatic patients was not increased (1.0, 0.8-1.2). The asthma results remained nonsignificant even when we evaluated diabetes risk by duration of asthma exposure. CONCLUSIONS Our findings suggest that COPD may be a risk factor for developing type 2 diabetes. Differences in the inflammation and cytokine profile between COPD and asthma might explain why COPD, but not asthma, is associated with increased risk of type 2 diabetes.

[1]  J. Hux,et al.  Quantification of the risk of corticosteroid-induced diabetes mellitus among the elderly , 2002, Journal of general internal medicine.

[2]  E. Wouters,et al.  Chronic obstructive pulmonary disease • 5: Systemic effects of COPD , 2002, Thorax.

[3]  P. Barnes,et al.  Mechanisms in COPD: differences from asthma. , 2000, Chest.

[4]  J. Congleton,et al.  The pulmonary cachexia syndrome: aspects of energy balance , 1999, Proceedings of the Nutrition Society.

[5]  M. Decramer,et al.  Systemic effects of COPD. , 2005, Respiratory medicine.

[6]  S. Haffner,et al.  Elevated levels of acute-phase proteins and plasminogen activator inhibitor-1 predict the development of type 2 diabetes: the insulin resistance atherosclerosis study. , 2002, Diabetes.

[7]  P. Barnes,et al.  Chronic obstructive pulmonary disease. , 2000, The New England journal of medicine.

[8]  S. Weiss,et al.  Baseline ventilatory function predicts the development of higher levels of fasting insulin and fasting insulin resistance index: the Normative Aging Study. , 1998, The European respiratory journal.

[9]  Nader Rifai,et al.  Inflammatory markers and risk of developing type 2 diabetes in women. , 2004, Diabetes.

[10]  A. Ionescu,et al.  Inflammatory response and body composition in chronic obstructive pulmonary disease. , 2001, American journal of respiratory and critical care medicine.

[11]  R. Grimble.  Inflammatory status and insulin resistance , 2002, Current opinion in clinical nutrition and metabolic care.

[12]  L. Jorfeldt,et al.  Insulin resistance is not exhibited by advanced chronic obstructive pulmonary disease patients. , 1995, Clinical physiology.

[13]  L. Jorfeldt,et al.  Fat metabolism and its response to infusion of insulin and glucose in patients with advanced chronic obstructive pulmonary disease. , 1995, Clinical physiology.

[14]  M. Mador.  Muscle mass, not body weight, predicts outcome in patients with chronic obstructive pulmonary disease. , 2002, American journal of respiratory and critical care medicine.

[15]  Classification and Diagnosis of Diabetes Mellitus and Other Categories of Glucose Intolerance , 1979, Diabetes.

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

[17]  R. Jorde,et al.  Impaired glucose tolerance in patients with chronic hypoxic pulmonary disease. , 1996, Diabetes & metabolism.

[18]  M. Fantone,et al.  Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus , 1997, Diabetes Care.

[19]  I. Rahman.  Oxidative stress, chromatin remodeling and gene transcription in inflammation and chronic lung diseases. , 2003, Journal of biochemistry and molecular biology.

[20]  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.

[21]  J. Manson,et al.  Cigarette smoking and the risk of diabetes in women. , 1993, American journal of public health.

[22]  M. Corradi,et al.  Predominant TH1 cytokine pattern in peripheral blood from subjects with chronic obstructive pulmonary disease. , 1999, The Journal of allergy and clinical immunology.

[23]  W. MacNee,et al.  Oxidative stress and TNF-alpha induce histone acetylation and NF-kappaB/AP-1 activation in alveolar epithelial cells: potential mechanism in gene transcription in lung inflammation. , 2002, Molecular and cellular biochemistry.

[24]  C. Meisinger,et al.  C-Reactive Protein as a Predictor for Incident Diabetes Mellitus Among Middle-aged Men , 2003 .

[25]  K. Chung,et al.  Cytokines in chronic obstructive pulmonary disease , 2001, European Respiratory Journal.

[26]  P. Argyropoulou,et al.  Tumor necrosis factor-alpha serum levels, weight loss and tissue oxygenation in chronic obstructive pulmonary disease. , 2002, Respiratory medicine.

[27]  R. Casaburi,et al.  Endocrinological disturbances in chronic obstructive pulmonary disease , 2003, European Respiratory Journal.

[28]  D. Mannino,et al.  Obstructive and restrictive lung disease and markers of inflammation: data from the Third National Health and Nutrition Examination. , 2003, The American journal of medicine.

[29]  D. Coultas,et al.  The health impact of undiagnosed airflow obstruction in a national sample of United States adults. , 2001, American journal of respiratory and critical care medicine.

[30]  Anson,et al.  DIET , LIFESTYLE , AND THE RISK OF TYPE 2 DIABETES MELLITUS IN WOMEN , 2001 .

[31]  J. Renauld.  New insights into the role of cytokines in asthma , 2001, Journal of clinical pathology.

[32]  H. Saito,et al.  The Relationship between Chronic Hypoxemia and Activation of the Tumor Necrosis Factor- α System in Patients with Chronic Obstructive Pulmonary Disease , 2000 .

[33]  F. Speizer,et al.  Validation of self-reported chronic obstructive pulmonary disease in a cohort study of nurses. , 2002, American journal of epidemiology.

[34]  R. Pauwels,et al.  Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: National Heart, Lung, and Blood Institute and World Health Organization Global Initiative for Chronic Obstructive Lung Disease (GOLD): executive summary. , 2001, Respiratory care.

[35]  E. Wouters.  Muscle weakness in chronic obstructive pulmonary disease , 2000 .

[36]  B. Spiegelman,et al.  Tumor necrosis factor alpha inhibits signaling from the insulin receptor. , 1994, Proceedings of the National Academy of Sciences of the United States of America.

[37]  H. Saito,et al.  The relationship between chronic hypoxemia and activation of the tumor necrosis factor-alpha system in patients with chronic obstructive pulmonary disease. , 2000, American journal of respiratory and critical care medicine.

[38]  C. Östenson,et al.  Pancreatic beta cells are important targets for the diabetogenic effects of glucocorticoids. , 1997, The Journal of clinical investigation.

[39]  G. Hotamisligil.  The role of TNFalpha and TNF receptors in obesity and insulin resistance. , 1999, Journal of internal medicine.

[40]  G. Hotamisligil.  The role of TNFα and TNF receptors in obesity and insulin resistance , 1999 .

[41]  G. King,et al.  The role of oxidative stress in the onset and progression of diabetes and its complications: asummary of a Congress Series sponsored byUNESCO‐MCBN, the American Diabetes Association and the German Diabetes Society , 2001, Diabetes/metabolism research and reviews.

[42]  W. Willett,et al.  Prospective study of body mass index, weight change, and risk of adult-onset asthma in women. , 1999, Archives of internal medicine.

[43]  J. Avorn,et al.  Glucocorticoids and the risk for initiation of hypoglycemic therapy. , 1994, Archives of internal medicine.

[44]  G A Colditz,et al.  Obesity, Fat Distribution, and Weight Gain as Risk Factors for Clinical Diabetes in Men , 1994, Diabetes Care.

[45]  J. Manson,et al.  Physical activity and incidence of non-insulin-dependent diabetes mellitus in women , 1991, The Lancet.

[46]  P. Raskin,et al.  Report of the expert committee on the diagnosis and classification of diabetes mellitus. , 1999, Diabetes care.

[47]  J. Manson,et al.  C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. , 2001, JAMA.

[48]  E. Wouters,et al.  Evidence for a relation between metabolic derangements and increased levels of inflammatory mediators in a subgroup of patients with chronic obstructive pulmonary disease. , 1996, Thorax.

[49]  E. Wouters,et al.  Effects of an acute exacerbation on nutritional and metabolic profile of patients with COPD. , 1997, The European respiratory journal.

[50]  T. Płusa.  [Epidemiology of chronic obstructive pulmonary disease]. , 2004, Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego.

[51]  J. Hokanson,et al.  The Insulin Resistance Atherosclerosis Study Family Study , 2004 .

[52]  Joachim Spranger,et al.  Inflammatory cytokines and the risk to develop type 2 diabetes: results of the prospective population-based European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study. , 2003, Diabetes.