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Dwivedi J, Wal P, Dash B, Ovais M, Sachan P, Verma V. Diabetic Pneumopathy- A Novel Diabetes-associated Complication: Pathophysiology, the Underlying Mechanism and Combination Medication. Endocr Metab Immune Disord Drug Targets 2024; 24:1027-1052. [PMID: 37817659 DOI: 10.2174/0118715303265960230926113201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/03/2023] [Accepted: 07/20/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND The "diabetic lung" has been identified as a possible target organ in diabetes, with abnormalities in ventilation control, bronchomotor tone, lung volume, pulmonary diffusing capacity, and neuroadrenergic bronchial innervation. OBJECTIVE This review summarizes studies related to diabetic pneumopathy, pathophysiology and a number of pulmonary disorders including type 1 and type 2 diabetes. METHODS Electronic searches were conducted on databases such as Pub Med, Wiley Online Library (WOL), Scopus, Elsevier, ScienceDirect, and Google Scholar using standard keywords "diabetes," "diabetes Pneumopathy," "Pathophysiology," "Lung diseases," "lung infection" for review articles published between 1978 to 2023 very few previous review articles based their focus on diabetic pneumopathy and its pathophysiology. RESULTS Globally, the incidence of diabetes mellitus has been rising. It is a chronic, progressive metabolic disease. The "diabetic lung" may serve as a model of accelerated ageing since diabetics' rate of respiratory function deterioration is two to three-times higher than that of normal, non-smoking people. CONCLUSION Diabetes-induced pulmonary dysfunction has not gained the attention it deserves due to a lack of proven causality and changes in cellular properties. The mechanism underlying a particular lung illness can still only be partially activated by diabetes but there is evidence that hyperglycemia is linked to pulmonary fibrosis in diabetic people.
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Affiliation(s)
- Jyotsana Dwivedi
- PSIT- Pranveer Singh Institute of Technology (Pharmacy), Kanpur, India
| | - Pranay Wal
- PSIT- Pranveer Singh Institute of Technology (Pharmacy), Kanpur, India
| | - Biswajit Dash
- Department of Pharmaceutical Technology, ADAMAS University, West Bengal, India
| | | | - Pranjal Sachan
- PSIT- Pranveer Singh Institute of Technology (Pharmacy), Kanpur, India
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Dai Y, Zhou S, Qiao L, Peng Z, Zhao J, Xu D, Wu C, Li M, Zeng X, Wang Q. Non-apoptotic programmed cell deaths in diabetic pulmonary dysfunction: the new side of advanced glycation end products. Front Endocrinol (Lausanne) 2023; 14:1126661. [PMID: 37964954 PMCID: PMC10641270 DOI: 10.3389/fendo.2023.1126661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 09/26/2023] [Indexed: 11/16/2023] Open
Abstract
Diabetes mellitus (DM) is a chronic metabolic disorder that affects multiple organs and systems, including the pulmonary system. Pulmonary dysfunction in DM patients has been observed and studied for years, but the underlying mechanisms have not been fully understood. In addition to traditional mechanisms such as the production and accumulation of advanced glycation end products (AGEs), angiopathy, tissue glycation, oxidative stress, and systemic inflammation, recent studies have focused on programmed cell deaths (PCDs), especially the non-apoptotic ones, in diabetic pulmonary dysfunction. Non-apoptotic PCDs (NAPCDs) including autophagic cell death, necroptosis, pyroptosis, ferroptosis, and copper-induced cell death have been found to have certain correlations with diabetes and relevant complications. The AGE-AGE receptor (RAGE) axis not only plays an important role in the traditional pathogenesis of diabetes lung disease but also plays an important role in non-apoptotic cell death. In this review, we summarize novel studies about the roles of non-apoptotic PCDs in diabetic pulmonary dysfunction and focus on their interactions with the AGE-RAGE axis.
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Affiliation(s)
- Yimin Dai
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Shuang Zhou
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Lin Qiao
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Zhao Peng
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jiuliang Zhao
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Dong Xu
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Chanyuan Wu
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Qian Wang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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Kopf S, Kumar V, Kender Z, Han Z, Fleming T, Herzig S, Nawroth PP. Diabetic Pneumopathy-A New Diabetes-Associated Complication: Mechanisms, Consequences and Treatment Considerations. Front Endocrinol (Lausanne) 2021; 12:765201. [PMID: 34899603 PMCID: PMC8655305 DOI: 10.3389/fendo.2021.765201] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/22/2021] [Indexed: 01/04/2023] Open
Abstract
Patients with diabetes are over-represented among the total cases reported with "idiopathic" pulmonary fibrosis (IPF). This raises the question, whether this is an association only or whether diabetes itself can cause pulmonary fibrosis. Recent studies in mouse models of type 1 and type 2 diabetes demonstrated that diabetes causes pulmonary fibrosis. Both types of diabetes trigger a cascade, starting with increased DNA damage, an impaired DNA repair, and leading to persistent DNA damage signaling. This response, in turn, induces senescence, a senescence-associated-secretory phenotype (SASP), marked by the release of pro-inflammatory cytokines and growth factors, finally resulting in fibrosis. Restoring DNA repair drives fibrosis into remission, thus proving causality. These data can be translated clinically to patients with type 2 diabetes, characterized by long-term diabetes and albuminuria. Hence there are several arguments, to substitute the term "idiopathic" pulmonary fibrosis (IPF) in patients with diabetes (and exclusion of other causes of lung diseases) by the term "diabetes-induced pulmonary fibrosis" (DiPF). However, future studies are required to establish this term and to study whether patients with diabetes respond to the established therapies similar to non-diabetic patients.
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Affiliation(s)
- Stefan Kopf
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Varun Kumar
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- European Molecular Biology Laboratory, Advanced Light Microscopy Facility, Heidelberg, Germany
| | - Zoltan Kender
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Zhe Han
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Fleming
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Stephan Herzig
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute for Diabetes and Cancer, Helmholtz Center Munich, Munich-Neuherberg, Germany
- Joint Heidelberg-Institute for Diabetes and Cancer (IDC) Translational Diabetes Programme, Helmholtz-Zentrum, Munich, Germany
| | - Peter P. Nawroth
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Joint Heidelberg-Institute for Diabetes and Cancer (IDC) Translational Diabetes Programme, Helmholtz-Zentrum, Munich, Germany
- *Correspondence: Peter P. Nawroth,
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Correia MA, Silva GO, Longano P, Trombetta IC, Consolim-Colombo F, Puech-Leão P, Wolosker N, Cucato GG, Ritti-Dias RM. In peripheral artery disease, diabetes is associated with reduced physical activity level and physical function and impaired cardiac autonomic control: A cross-sectional study. Ann Phys Rehabil Med 2020; 64:101365. [PMID: 32145411 DOI: 10.1016/j.rehab.2020.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 12/23/2019] [Accepted: 01/29/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Diabetes has been considered a major risk factor for peripheral artery disease (PAD). The effect of diabetes on daily physical activity level and cardiovascular function in PAD patients is poorly known. OBJECTIVE To analyze the effect of diabetes on physical activity level, physical function and cardiovascular health parameters in patients with PAD and claudication symptoms. METHODS Cross-sectional study of 267 PAD patients, 146 without and 121 with diabetes. Physical activity levels were objectively measured by using an accelerometer, and time spent in sedentary (0-100 counts/min), light (101-1040 counts/min) and moderate to vigorous (≥1041 counts/min) physical activity was obtained. Physical function assessment included the 6-min walk test, handgrip strength test and short physical performance battery. Cardiovascular health parameters measured were brachial blood pressure, heart rate variability, and arterial stiffness. RESULTS Diabetic PAD patients spent more time in sedentary behavior (P=0.001, effect size [ES] 0.234) and less time in light (P=0.003, ES=0.206) and moderate-to-vigorous physical activity (P<0.001, ES=0.258) than non-diabetic PAD patients. Diabetic PAD patients presented lower 6-min walk distance (P=0.005, ES=0.194) and impaired cardiac autonomic modulation (standard deviation of all NN intervals [SDNN], P<0.001, ES=0.357; square root of the mean of the sum of the squares of differences between adjacent NN intervals [RMSSD], P<0.001, ES=0.280; and NN50 count divided by the total number of all NN intervals [pNN50], P<0.001, ES=0.291) as compared with non-diabetic PAD patients. After adjustment for confounders, diabetes remained associated with sedentary behavior (P=0.011), light (P=0.020) and moderate-to-vigorous physical activity (P=0.008), 6-min walk distance (P=0.030), SDNN (P<0.001), RMSSD (P=0.004), and PNN50 (P=0.004). CONCLUSION Diabetic PAD patients presented lower physical activity level, reduced physical function and impaired autonomic modulation as compared with non-diabetic PAD patients.
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Affiliation(s)
| | | | | | | | | | - Pedro Puech-Leão
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
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Abstract
Diabetes mellitus is a chronic, progressive, incompletely understood metabolic disorder whose prevalence has been increasing steadily worldwide. Even though little attention has been paid to lung disorders in the context of diabetes, its prevalence has recently been challenged by newer studies of disease development. In this review, we summarize and discuss the role of diabetes mellitus involved in the progression of pulmonary diseases, with the main focus on pulmonary fibrosis, which represents a chronic and progressive disease with high mortality and limited therapeutic options.
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Affiliation(s)
- Saeed Kolahian
- Department of Pharmacology and Experimental Therapy, Institute of Experimental and Clinical Pharmacology and Toxicology, and Interfaculty Center of Pharmacogenomics and Drug Research (ICePhA), Eberhard Karls University Hospitals and Clinics, Tübingen, Germany.
- Department of Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Eberhard Karls University Hospitals and Clinics, Tübingen, Germany.
- Department of Pharmacogenomics, University of Tübingen, Wilhelmstrasse. 56, D-72074, Tübingen, Germany.
| | - Veronika Leiss
- Department of Pharmacology and Experimental Therapy, Institute of Experimental and Clinical Pharmacology and Toxicology, and Interfaculty Center of Pharmacogenomics and Drug Research (ICePhA), Eberhard Karls University Hospitals and Clinics, Tübingen, Germany
| | - Bernd Nürnberg
- Department of Pharmacology and Experimental Therapy, Institute of Experimental and Clinical Pharmacology and Toxicology, and Interfaculty Center of Pharmacogenomics and Drug Research (ICePhA), Eberhard Karls University Hospitals and Clinics, Tübingen, Germany
- Department of Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Eberhard Karls University Hospitals and Clinics, Tübingen, Germany
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Kuziemski K, Słomiński W, Jassem E. Impact of diabetes mellitus on functional exercise capacity and pulmonary functions in patients with diabetes and healthy persons. BMC Endocr Disord 2019; 19:2. [PMID: 30606177 PMCID: PMC6318966 DOI: 10.1186/s12902-018-0328-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 12/17/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Chronic diabetic complications may afflict all organ tissues, including those of the respiratory system. The six-minute walk test (6MWT) is an alternative and widely used method of assessing functional capacity and is simple to perform. However, to our knowledge, the impact of diabetes mellitus on 6MWT performance has not been investigated previously. This research aimed to compare the functional exercise capacity and pulmonary functions in patients with diabetes and in healthy persons. METHODS The study included 131 participants: 64 patients with type 1 and 2 diabetes mellitus (DM) and 67 healthy participants (CG). All of the participants were nonsmoking and did not have pulmonary disorders that affected the pulmonary function tests or 6MWT. Metabolic parameters and biochemical markers of inflammation were assessed. Full lung function tests and a 6MWT were performed. RESULTS In the DM group, the walking distance was 109 m shorter than that in the CG (P < 0.001). Moreover, compared to the CG, the DM group showed lower values of forced expiratory volume in one second (FEV1 (l) 3.6 vs. 2.8, P < 0.001) and total lung capacity (TLC (l) 6.6 vs. 5.6, P < 0.001), as well as a decrease in diffusion capacity (DLCO (mmol/min/kPa), 10.0 vs. 8.6, P < 0.001). CONCLUSIONS The 6MWT is a valuable test that complements the assessment of daily physical capacity in patients with diabetes, irrespective of type. Pulmonary function and the capacity for physical exertion varied between patients with diabetes mellitus and the healthy participants in the CG.
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Affiliation(s)
- Krzysztof Kuziemski
- Department of Pulmonology and Allergology, Faculty of Medicine, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland
| | | | - Ewa Jassem
- Department of Pulmonology and Allergology, Faculty of Medicine, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland
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George C, Ducatman AM, Conway BN. Increased risk of respiratory diseases in adults with Type 1 and Type 2 diabetes. Diabetes Res Clin Pract 2018; 142:46-55. [PMID: 29802957 DOI: 10.1016/j.diabres.2018.05.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 05/09/2018] [Accepted: 05/17/2018] [Indexed: 01/09/2023]
Abstract
AIMS Diabetes is linked with decreases in lung elasticity and in capacity to transfer carbon monoxide. Systemic inflammation, a common concern with diabetes, may contribute to airflow obstruction. We examined the association of self-reported diabetes with self-reported respiratory diseases (RDs) among 53,146 adults from the C8 Health Project. METHODS Participants were categorized into three groups: Type 1 (T1D, n = 781), Type 2 (T2D, n = 4277), or no diabetes (n = 48,088). ORs (95% CIs) for the association of diabetes with four RDs were computed: emphysema, chronic obstructive pulmonary disease (COPD), chronic bronchitis (CB), and asthma. Covariates controlled for were age, sex, estimated glomerular filtration rate, C-reactive protein, smoking history, BMI, and perfluorooctonaoic acid (C8). RESULTS RDs were present in 26%, 21% and 13% of persons with T1D, T2D, and no diabetes, respectively. In multivariable analyses, persons with T1D were 62% more likely to have any RD (OR: 1.62, CI: (1.36-1.93)), while those with T2D were 1.3 times as likely (OR: 1.26, CI: 1.15-1.37)). Compared to those without diabetes, in those with T1D and T2D diabetes respectively, ORs (CIs) for COPD were 1.89 (1.38-2.57), 1.45 (1.23-1.71), asthma: 1.51 (1.21-1.87), 1.38 (1.24-1.53), CB: 1.96 (1.57-2.45), 1.35 (1.20-1.52) and emphysema: 1.25 (0.85-1.82), 1.31 (1.10-1.56). Population attributable risks for any RDs associated with a history of smoking were 19%, 30%, and 26% for those with Type 1, Type 2, and no diabetes respectively. CONCLUSIONS Diabetes, more so in T1D, appears to increase RD risk. Smoking is an important risk factor, but not as informative in Type 1 diabetes.
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Affiliation(s)
- Chelsey George
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV, United States
| | - Alan M Ducatman
- Department of Occupational and Environmental Health, School of Public Health, West Virginia University, Morgantown, WV, United States
| | - Baqiyyah N Conway
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV, United States; Department of Epidemiology and Biostatistics, School of Rural and Community Health, University of Texas Health Science Center at Tyler, Tyler, TX, United States.
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Zheng H, Wu J, Jin Z, Yan LJ. Potential Biochemical Mechanisms of Lung Injury in Diabetes. Aging Dis 2017; 8:7-16. [PMID: 28203478 PMCID: PMC5287388 DOI: 10.14336/ad.2016.0627] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 06/27/2016] [Indexed: 12/17/2022] Open
Abstract
Accumulating evidence has shown that the lung is one of the target organs for microangiopathy in patients with either type 1 or type 2 diabetes mellitus (DM). Diabetes is associated with physiological and structural abnormalities in the diabetic lung concurrent with attenuated lung function. Despite intensive investigations in recent years, the pathogenic mechanisms of diabetic lung injury remain largely elusive. In this review, we summarize currently postulated mechanisms of diabetic lung injury. We mainly focus on the pathogenesis of diabetic lung injury that implicates key pathways, including oxidative stress, non-enzymatic protein glycosylation, polyol pathway, NF-κB pathway, and protein kinase c pathway. We also highlight that while numerous studies have mainly focused on tissue or cell damage in the lung, studies focusing on mitochondrial dysfunction in the diabetic lung have remained sketchy. Hence, further understanding of mitochondrial mechanisms of diabetic lung injury should provide invaluable insights into future therapeutic approaches for diabetic lung injury.
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Affiliation(s)
- Hong Zheng
- 1Department of Pharmaceutical Sciences, UNT System College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; 2Department of Basic Theory of Traditional Chinese Medicine, College of Basic Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, 250355, China
| | - Jinzi Wu
- 1Department of Pharmaceutical Sciences, UNT System College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Zhen Jin
- 1Department of Pharmaceutical Sciences, UNT System College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Liang-Jun Yan
- 1Department of Pharmaceutical Sciences, UNT System College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
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Ďurdík P, Vojtková J, Michnová Z, Turčan T, Šujanská A, Kuchta M, Čiljaková M. Pulmonary function tests in type 1 diabetes adolescents with diabetic cardiovascular autonomic neuropathy. J Diabetes Complications 2016; 30:79-84. [PMID: 26597599 DOI: 10.1016/j.jdiacomp.2015.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 10/17/2015] [Accepted: 10/19/2015] [Indexed: 01/25/2023]
Abstract
Chronic diabetic complications may afflict all organ tissues including cardiovascular and respiratory system. The aim of the study was to establish if the presence of cardiovascular autonomic neuropathy (CAN) was associated with impaired pulmonary function tests in adolescents with type 1 diabetes (T1D). 46 adolescents with T1D and 25 healthy subjects at the age 15-19years were enrolled to the study. Basic anthropometric data, diabetes onset and duration, plasma glucose and A1c were established. Pulmonary function tests were measured by spirometry and the presence of CAN was examined by heart rate variability. Adolescents with T1D had significantly lower pulmonary function test parameters - FVC (p<0.01), FEV1 (p<0.01), MMEF (p<0.05) and PEFR (p<0.05) compared to the control subjects. In diabetic group, patients with CAN (CAN+, n=19) had significantly lower FVC (p<0.05), FEV1 (p<0.05) and PEFR (p<0.05) compared to patients without CAN (CAN-, n=27). All spirometric parameters were significantly lower in CAN+ subjects compared to healthy controls; however, no significant difference was found in these parameters between CAN- subjects and healthy controls. Spirometric parameters (FVC, FEV1) significantly positively correlated with diabetes onset and body mass index; and negatively correlated with diabetes duration and resting heart rate. Our results indicate that CAN may be associated with reduced pulmonary functions in adolescents with T1D.
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Affiliation(s)
- Peter Ďurdík
- Pediatric Department, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Slovakia; Centre of Experimental and Clinical Respirology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Slovakia
| | - Jarmila Vojtková
- Pediatric Department, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Slovakia; Pediatric Department, University Hospital Martin, Slovakia.
| | | | - Tomáš Turčan
- Pediatric Department, University Hospital Martin, Slovakia
| | - Anna Šujanská
- Pediatric Department, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Slovakia; Centre of Experimental and Clinical Respirology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Slovakia
| | - Milan Kuchta
- Department of Pediatrics and Adolescent Medicine, Pavol Jozef Šafárik University in Košice, Faculty of Medicine, Slovakia
| | - Miriam Čiljaková
- Pediatric Department, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Slovakia; Centre of Experimental and Clinical Respirology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Slovakia
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Fuso L, Pitocco D, Condoluci C, Conte E, Contu C, Rizzi A, Angeletti G, Bibi BF, Antonelli-Incalzi R. Decline of the lung function and quality of glycemic control in type 2 diabetes mellitus. Eur J Intern Med 2015; 26:273-8. [PMID: 25770074 DOI: 10.1016/j.ejim.2015.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 02/09/2015] [Accepted: 02/24/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim of this study was to verify to which extent in type 2 diabetes mellitus respiratory function and respiratory muscle efficiency decline over time in relation to the quality of glycemic control (GC). METHODS Forty-five non-smoker diabetic patients without pulmonary diseases performed a complete respiratory function assessment at baseline and after a follow-up of 4.9±0.6 years. The respiratory muscle efficiency was assessed by maximal inspiratory pressure (MIP) and maximum voluntary ventilation (MVV). Patients with an average yearly value of glycosylated hemoglobin≥7.5% at least in two years during follow-up were considered to have a poor GC. RESULTS Residual volume and pulmonary diffusing capacity significantly declined over time in the whole sample of patients (p=0.049 and 0.025, respectively), but without difference between patients with poor (n. 12) and good (n. 33) GC. MIP declined in patients with poor GC (from 83.75±32.42 to 71.16±30.43% pred), and increased in those with good GC (from 76.22±26.00 to 82.42±30.34% pred), but the difference between groups was not significant (p=0.091). Finally, MVV significantly declined in patients with poor GC (from 70.60±25.49 to 68.10±18.82% pred) and increased in those with good GC (from 66.40±20.39 to 84.00±23.09% pred) with a significant difference between the two groups (p=0.003). CONCLUSION These results show that, in type 2 diabetic patients, respiratory muscle efficiency, but not lung volumes and diffusing capacity, might suffer from a poor GC over time.
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Affiliation(s)
- Leonello Fuso
- Pulmonary Medicine Unit, Catholic University, Rome, Italy.
| | | | | | - Emanuele Conte
- Pulmonary Medicine Unit, Catholic University, Rome, Italy
| | - Chiara Contu
- Pulmonary Medicine Unit, Catholic University, Rome, Italy
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d’Annunzio G, Tosca M, Pistorio A, Silvestri M, Romanisio G, Lorini R, Rossi G, Ciprandi G. Type 1 diabetes mellitus and asthma: A follow-up study. Allergol Immunopathol (Madr) 2015; 43:225-7. [PMID: 24948182 DOI: 10.1016/j.aller.2014.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/04/2014] [Accepted: 01/13/2014] [Indexed: 11/26/2022]
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Verrotti A, Prezioso G, Scattoni R, Chiarelli F. Autonomic neuropathy in diabetes mellitus. Front Endocrinol (Lausanne) 2014; 5:205. [PMID: 25520703 PMCID: PMC4249492 DOI: 10.3389/fendo.2014.00205] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 11/17/2014] [Indexed: 12/14/2022] Open
Abstract
Diabetic autonomic neuropathy (DAN) is a serious and common complication of diabetes, often overlooked and misdiagnosed. It is a systemic-wide disorder that may be asymptomatic in the early stages. The most studied and clinically important form of DAN is cardiovascular autonomic neuropathy defined as the impairment of autonomic control of the cardiovascular system in patients with diabetes after exclusion of other causes. The reported prevalence of DAN varies widely depending on inconsistent definition, different diagnostic method, different patient cohorts studied. The pathogenesis is still unclear and probably multifactorial. Once DAN becomes clinically evident, no form of therapy has been identified, which can effectively stop or reverse it. Prevention strategies are based on strict glycemic control with intensive insulin treatment, multifactorial intervention, and lifestyle modification including control of hypertension, dyslipidemia, stop smoking, weight loss, and adequate physical exercise. The present review summarizes the latest knowledge regarding clinical presentation, epidemiology, pathogenesis, and management of DAN, with some mention to childhood and adolescent population.
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Affiliation(s)
| | | | | | - Francesco Chiarelli
- Department of Pediatrics, University of Chieti, Chieti, Italy
- *Correspondence: Francesco Chiarelli, Department of Pediatrics, University of Chieti, Via dei Vestini 5, Chieti 66013, Italy e-mail:
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Pitocco D, Fuso L, Conte EG, Zaccardi F, Condoluci C, Scavone G, Incalzi RA, Ghirlanda G. The diabetic lung--a new target organ? Rev Diabet Stud 2012; 9:23-35. [PMID: 22972442 DOI: 10.1900/rds.2012.9.23] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Several abnormalities of the respiratory function have been reported in patients with type 1 and type 2 diabetes. These abnormalities concern lung volume, pulmonary diffusing capacity, control of ventilation, bronchomotor tone, and neuroadrenergic bronchial innervation. Many hypotheses have emerged, and characteristic histological changes have been described in the "diabetic lung", which could explain this abnormal respiratory function. Given the specific abnormalities in diabetic patients, the lung could thus be considered as a target organ in diabetes. Although the practical implications of these functional changes are mild, the presence of an associated acute or chronic pulmonary and/or cardiac disease could determine severe respiratory derangements in diabetic patients. Another clinical consequence of the pulmonary involvement in diabetes is the accelerated decline in respiratory function. The rate of decline in respiratory function in diabetics has been found to be two-to-three times faster than in normal non-smoking subjects, as reported in longitudinal studies. This finding, together with the presence of anatomical and biological changes similar to those described in the aging lung, indicates that the "diabetic lung" could even be considered a model of accelerated aging. This review describes and analyses the current insight into the relationship of diabetes and lung disease, and suggests intensifying research into the lung as a possible target organ in diabetes.
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Affiliation(s)
- Dario Pitocco
- Diabetes Care Unit, Catholic University of Rome, Rome, Italy.
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Affiliation(s)
- LME Kuitert
- London Chest Hospital, Barts and the London NHS Trust, London, UK
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Kaparianos A, Argyropoulou E, Sampsonas F, Karkoulias K, Tsiamita M, Spiropoulos K. Pulmonary complications in diabetes mellitus. Chron Respir Dis 2008; 5:101-8. [DOI: 10.1177/1479972307086313] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Clear decrements in lung function have been reported in patients with diabetes over the past two decades, and many reports have suggested plausible pathophysiological mechanisms. However, there are no reports of functional limitations of activities of daily living ascribable to pulmonary disease in patients with diabetes. This review attempts to summarize the available information from the present literature, to describe the nature of the lung dysfunction in diabetes and the emerging clinical implications of such dysfunction.
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Affiliation(s)
- A Kaparianos
- Division of Pneumonology, Internal Medicine Department, Medical School of Patras, Regional University Hospital, Patras, Greece
| | - E Argyropoulou
- Division of Pneumonology, Internal Medicine Department, Medical School of Patras, Regional University Hospital, Patras, Greece
| | - F Sampsonas
- Division of Pneumonology, Internal Medicine Department, Medical School of Patras, Regional University Hospital, Patras, Greece
| | - K Karkoulias
- Division of Pneumonology, Internal Medicine Department, Medical School of Patras, Regional University Hospital, Patras, Greece
| | - M Tsiamita
- Division of Pneumonology, Internal Medicine Department, Medical School of Patras, Regional University Hospital, Patras, Greece
| | - K Spiropoulos
- Division of Pneumonology, Internal Medicine Department, Medical School of Patras, Regional University Hospital, Patras, Greece,
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Ghirlanda G, Mancini L. Current perioperative treatment of patients with type 1 and type 2 diabetes. Clin Podiatr Med Surg 2007; 24:365-82; vii. [PMID: 17613381 DOI: 10.1016/j.cpm.2007.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Diabetes mellitus is rapidly increasing, diabetic patients are likely to undergo surgical procedures more than non-diabetic patients, the hospital stay of diabetic patients is longer, and diabetic patients have increased mortality and morbidity. The correct treatment of diabetic patients in the perioperative period is crucial to improve clinical outcomes. Diabetic patients must be carefully evaluated for cardiovascular risk, keeping in mind micro- and macroangiopathic diabetic complications. Metabolic control deserves great attention because hyperglycemia is related to increased complications and worse outcomes. Insulin infusion regimens to achieve near normoglycemia must be implemented in surgical and critically ill patients.
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Affiliation(s)
- Giovanni Ghirlanda
- Università Cattolica del Sacro Cuore, Roma, Italy; Diabetes Clinic, Policlinico A. Gemelli, Roma, Italy.
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Abstract
Diabetic microangiopathy targets the lung as it does other organs. Even though respiratory dysfunction in most patients with diabetes is subclinical and rarely the presenting complaint, there are several reasons why pulmonary assessment is important: (1) Pulmonary function testing noninvasively quantifies physiological reserves in a large microvascular bed that is not clinically devastated by diabetes. (2) Subclinical loss of pulmonary reserves becomes overtly debilitating under conditions of stress, such as with aging, chronic hypoxia due to lung disease or high altitude exposure, or volume overload secondary to cardiac and renal failure. (3) Unlike myocardial or skeletal muscle function, pulmonary indices are largely independent of physical fitness. (4) Interpretation of pulmonary function indices is not complicated by secondary sequelae of diabetic end-organ failure or prior therapy. Lung function could provide useful measures of the progression of systemic microangiopathy. (5) Chronic use of inhaled insulin may affect long-term pulmonary function, while preexisting pulmonary dysfunction may alter the absorption and bioavailability of inhaled insulin. This review will discuss the changes in lung function observed in diabetes, their underlying mechanisms, and their physiological and clinical implications.
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Affiliation(s)
- Connie C W Hsia
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9034, USA.
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