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Frizzelli A, Aiello M, Calzetta L, Bertorelli G, Chetta A. The interplay between diabetes mellitus and chronic obstructive pulmonary disease. Minerva Med 2023; 114:68-73. [PMID: 35138076 DOI: 10.23736/s0026-4806.22.07742-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM) are common and chronic disorders. COPD is characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities and it is considered currently the fourth leading cause of death worldwide. DM is a systemic disease characterized by a chronic hyperglycemia associated with inflammation and oxidative stress. The relationship between the two conditions is not completely understood and conflicting results are reported in the literature. Many studies have investigated the mechanisms through with the respiratory disease is associated with an increased risk of metabolic condition or whether the incidence risk of COPD in individuals affected by DM is higher. The link between the two chronic conditions has relevant implications in the management of patients affected by the both of them. Respiratory patients should be screened for diabetes mellitus as a frequent comorbidity of lung disease since therapeutic options should be assessed about risk-to-benefit ratios associated with the indication for the steroid use. Furthermore, the role of hyperglycemia on pulmonary function (e.g. infection or inflammatory processes) should be evaluated in DM. Finally, in presence of both diseases potential treatment interactions should be considered. In this overview we explored the common aspects of both clinical chronic illnesses and investigated the interplay between the two conditions.
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Affiliation(s)
- Annalisa Frizzelli
- Unit of Respiratory Disease and Lung Function, Department of Medicine and Surgery, University of Parma, Parma, Italy -
| | - Marina Aiello
- Unit of Respiratory Disease and Lung Function, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Luigino Calzetta
- Unit of Respiratory Disease and Lung Function, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giuseppina Bertorelli
- Unit of Respiratory Disease and Lung Function, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alfredo Chetta
- Unit of Respiratory Disease and Lung Function, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Park SS, Perez Perez JL, Perez Gandara B, Agudelo CW, Rodriguez Ortega R, Ahmed H, Garcia-Arcos I, McCarthy C, Geraghty P. Mechanisms Linking COPD to Type 1 and 2 Diabetes Mellitus: Is There a Relationship between Diabetes and COPD? Medicina (B Aires) 2022; 58:medicina58081030. [PMID: 36013497 PMCID: PMC9415273 DOI: 10.3390/medicina58081030] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 01/09/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) patients frequently suffer from multiple comorbidities, resulting in poor outcomes for these patients. Diabetes is observed at a higher frequency in COPD patients than in the general population. Both type 1 and 2 diabetes mellitus are associated with pulmonary complications, and similar therapeutic strategies are proposed to treat these conditions. Epidemiological studies and disease models have increased our knowledge of these clinical associations. Several recent genome-wide association studies have identified positive genetic correlations between lung function and obesity, possibly due to alterations in genes linked to cell proliferation; embryo, skeletal, and tissue development; and regulation of gene expression. These studies suggest that genetic predisposition, in addition to weight gain, can influence lung function. Cigarette smoke exposure can also influence the differential methylation of CpG sites in genes linked to diabetes and COPD, and smoke-related single nucleotide polymorphisms are associated with resting heart rate and coronary artery disease. Despite the vast literature on clinical disease association, little direct mechanistic evidence is currently available demonstrating that either disease influences the progression of the other, but common pharmacological approaches could slow the progression of these diseases. Here, we review the clinical and scientific literature to discuss whether mechanisms beyond preexisting conditions, lifestyle, and weight gain contribute to the development of COPD associated with diabetes. Specifically, we outline environmental and genetic confounders linked with these diseases.
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Affiliation(s)
- Sangmi S. Park
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
| | - Jessica L. Perez Perez
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
| | - Brais Perez Gandara
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
| | - Christina W. Agudelo
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
| | - Romy Rodriguez Ortega
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
| | - Huma Ahmed
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
| | - Itsaso Garcia-Arcos
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
| | - Cormac McCarthy
- University College Dublin School of Medicine, Education and Research Centre, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland;
| | - Patrick Geraghty
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
- Correspondence: ; Tel.: +1-718-270-3141
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Knobbe TJ, Kremer D, Eisenga MF, van Londen M, Gomes-Neto AW, Douwes RM, Gan CT, Corpeleijn E, Annema C, Navis G, Berger SP, Bakker SJ. Airflow Limitation, Fatigue, and Health-Related Quality of Life in Kidney Transplant Recipients. Clin J Am Soc Nephrol 2021; 16:1686-1694. [PMID: 34750161 PMCID: PMC8729428 DOI: 10.2215/cjn.06600521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/07/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Many kidney transplant recipients suffer from fatigue and poor health-related quality of life. Airflow limitation may be an underappreciated comorbidity among kidney transplant recipients, which could contribute to fatigue and lower health-related quality of life in this population. In this study, we compared the prevalence of airflow limitation between kidney transplant recipients and healthy controls and investigated associations of airflow limitation with fatigue and health-related quality of life in kidney transplant recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data from the ongoing TransplantLines Biobank and Cohort study were used. Airflow limitation was defined as forced exhaled volume in 1 second less than the fifth percentile of the general population. Fatigue and health-related quality of life were assessed using checklist individual strength 20 revised (CIS20-R) and Short Form-36 (SF-36) questionnaires. RESULTS A total of 539 kidney transplant recipients (58% men; mean age 56±13 years) and 244 healthy controls (45% men; mean age 57±10 years) were included. Prevalence of airflow limitation was higher in kidney transplant recipients than in healthy controls (133 [25%] versus 25 [10%]). In multinomial regression models, airflow limitation was independently associated with fatigue severity (odds ratio moderate fatigue, 1.68; 95% confidence interval, 0.92 to 3.09 and odds ratio severe fatigue, 2.51; 95% confidence interval, 1.39 to 4.55; P=0.007) and lower physical health-related quality of life (-0.11 SDs; 95% confidence interval, -0.19 to -0.02; P=0.01) in kidney transplant recipients. In exploratory mediation analyses, fatigue accounted for 79% of the association of airflow limitation with physical health-related quality of life. CONCLUSIONS Airflow limitation is common among kidney transplant recipients. Its occurrence is associated with more than two times higher risk of severe fatigue, and it is associated with lower physical health-related quality of life. Mediation analyses suggest that airflow limitation causes fatigue, which in turn, decreases physical health-related quality of life. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER TransplantLines: The Transplantation Biobank, NCT03272841 PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_11_08_CJN06600521.mp3.
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Affiliation(s)
- Tim J. Knobbe
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daan Kremer
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michele F. Eisenga
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marco van Londen
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - António W. Gomes-Neto
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rianne M. Douwes
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C. Tji Gan
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Coby Annema
- Department of Health Sciences, Section of Nursing Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan P. Berger
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J.L. Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Cazzola M, Rogliani P, Calzetta L, Lauro D, Page C, Matera MG. Targeting Mechanisms Linking COPD to Type 2 Diabetes Mellitus. Trends Pharmacol Sci 2017; 38:940-951. [DOI: 10.1016/j.tips.2017.07.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/10/2017] [Accepted: 07/13/2017] [Indexed: 01/26/2023]
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Abstract
Kidney transplants are the most common solid organ abdominal transplant and are occasionally performed simultaneously with pancreas transplants in diabetic patients. Preoperative evaluation of potential transplant recipients should focus on the potential for occult cardiovascular disease while also screening for other signs of end-organ dysfunction. Intraoperatively, it is of utmost importance to ensure adequate graft perfusion to limit the risk of postoperative graft dysfunction or rejection. Postoperative care of the kidney or pancreas transplant patient should focus on ensuring normalization of volume status, electrolyte concentrations, and glycemic control.
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Affiliation(s)
- Aaron M Mittel
- Department of Anesthesiology, Columbia University Medical Center, College of Physicians & Surgeons, Columbia University, PH 527-B, 630 West 168th Street, New York, NY 10032, USA
| | - Gebhard Wagener
- Department of Anesthesiology, Columbia University Medical Center, College of Physicians & Surgeons, Columbia University, PH 527-B, 630 West 168th Street, New York, NY 10032, USA.
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6
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Kahnert K, Lucke T, Biertz F, Lechner A, Watz H, Alter P, Bals R, Behr J, Holle R, Huber RM, Karrasch S, Stubbe B, Wacker M, Söhler S, Wouters EFM, Vogelmeier C, Jörres RA. Transfer factor for carbon monoxide in patients with COPD and diabetes: results from the German COSYCONET cohort. Respir Res 2017; 18:14. [PMID: 28086884 PMCID: PMC5237203 DOI: 10.1186/s12931-016-0499-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/30/2016] [Indexed: 03/11/2023] Open
Abstract
Background An impairment of CO diffusing capacity has been shown in diabetic patients without lung disease. We analyzed how diffusing capacity in patients with COPD is affected by the concurrent diagnosis of diabetes. Methods Data from the initial visit of the German COPD cohort COSYCONET were used for analysis. 2575 patients with complete lung function data were included, among them 358 defined as diabetics with a reported physician diagnosis of diabetes and/or specific medication. Pairwise comparisons between groups and multivariate regression models were used to identify variables predicting the CO transfer factor (TLCO%pred) and the transfer coefficient (KCO%pred). Results COPD patients with diabetes differed from those without diabetes regarding lung function, anthropometric, clinical and laboratory parameters. Moreover, gender was an important covariate. After correction for lung function, gender and body mass index (BMI), TLCO%pred did not significantly differ between patients with and without diabetes. The results for the transfer coefficient KCO were similar, demonstrating an important role of the confounding factors RV%pred, TLC%pred, ITGV%pred, FEV1%pred, FEV1/FVC, age, packyears, creatinine and BMI. There was not even a tendency towards lower values in diabetes. Conclusion The analysis of data from a COPD cohort showed no significant differences of CO transport parameters between COPD patients with and without diabetes, if BMI, gender and the reduction in lung volumes were taken into account. This result is in contrast to observations in lung-healthy subjects with diabetes and raises the question which factors, among them potential anti-inflammatory effects of anti-diabetes medication are responsible for this finding.
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Affiliation(s)
- Kathrin Kahnert
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Ziemssenstr. 1, 80336, Munich, Germany.
| | - Tanja Lucke
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany
| | - Frank Biertz
- Institute for Biostatistics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Andreas Lechner
- Department of Internal Medicine IV, University of Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Woehrendamm 80, 22927, Grosshansdorf, Germany
| | - Peter Alter
- Department of Respiratory Medicine, University of Marburg, University Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research, Baldingerstraße, 35043, Marburg, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Kirrberger Straße 1, 66424, Homburg, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Ziemssenstr. 1, 80336, Munich, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (CPC-M), Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - Rudolf M Huber
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Ziemssenstr. 1, 80336, Munich, Germany
| | - Stefan Karrasch
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany.,Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - Beate Stubbe
- Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, Scientific Division of Pneumology and Pneumological Epidemiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany
| | - Margarethe Wacker
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (CPC-M), Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - Sandra Söhler
- ASCONET Study Coordination Office, University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands
| | - Claus Vogelmeier
- Department of Respiratory Medicine, University of Marburg, University Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research, Baldingerstraße, 35043, Marburg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany
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Kuziemski K, Pieńkowska J, Słomiński W, Jassem E, Studniarek M. Pulmonary capillary permeability and pulmonary microangiopathy in diabetes mellitus. Diabetes Res Clin Pract 2015; 108:e56-9. [PMID: 25836946 DOI: 10.1016/j.diabres.2015.02.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 02/08/2015] [Accepted: 02/22/2015] [Indexed: 01/24/2023]
Abstract
Significant increase in permeability surface (PS) in patients with diabetes confirms pulmonary microcirculation damage in these patients.
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Affiliation(s)
- Krzysztof Kuziemski
- Department of Allergology and Pneumonology, Medical University of Gdansk, ul. Debinki 7, 80-211 Gdansk, Poland.
| | - Joanna Pieńkowska
- Department of Radiology, Medical University of Gdansk, ul. Debinki 7, 80-211 Gdansk, Poland
| | | | - Ewa Jassem
- Department of Allergology and Pneumonology, Medical University of Gdansk, ul. Debinki 7, 80-211 Gdansk, Poland
| | - Michał Studniarek
- Department of Radiology, Medical University of Gdansk, ul. Debinki 7, 80-211 Gdansk, Poland
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Conway BN, May ME, Fischl A, Frisbee J, Han X, Blot WJ. Cause-specific mortality by race in low-income Black and White people with Type 2 diabetes. Diabet Med 2015; 32:33-41. [PMID: 25112863 PMCID: PMC4307645 DOI: 10.1111/dme.12563] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 04/26/2014] [Accepted: 07/28/2014] [Indexed: 12/30/2022]
Abstract
AIM To investigate, with extended follow-up, cause-specific mortality among low-income Black and White Americans with Type 2 diabetes who have similar socio-economic status. METHODS Black and White Americans aged 40-79 years with Type 2 diabetes (n = 12 498) were recruited from community health centres as part of the Southern Community Cohort Study. Multivariable Cox analysis was used to estimate mortality hazard ratios and 95% CIs for subsequent cause-specific mortality, based on both underlying and contributing causes of death. RESULTS During the follow-up (median 5.9 years), 13.3% of the study population died. The leading causes of death in each race were ischaemic heart disease, respiratory disorders, cancer, renal failure and heart failure; however, Blacks were at a lower risk of dying from ischaemic heart disease (hazard ratio 0.70, 95% CI 0.54-0.91) or respiratory disorders (hazard ratio 0.70, 0.53-0.92) than Whites but had higher or similar mortality attributable to renal failure (hazard ratio 1.57, 95% CI 1.02-2.40), heart failure (hazard ratio 1.47, 95% CI 0.98-2.19) and cancer (hazard ratio 0.87, 95% CI 0.62-1.22). Risk factors for each cause of death were generally similar in each race. CONCLUSIONS These findings suggest that the leading causes of death and their risk factors are largely similar among Black and White Americans with diabetes. For the two leading causes of death in each race, however, ischaemic heart disease and respiratory disorders, the magnitude of risk is lower among Black Americans and contributes to their higher survival rates.
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Affiliation(s)
- B N Conway
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV, USA; Cardiorespiratory Center, West Virginia University, Morgantown, WV, USA
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9
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Kinney GL, Black-Shinn JL, Wan ES, Make B, Regan E, Lutz S, Soler X, Silverman EK, Crapo J, Hokanson JE. Pulmonary function reduction in diabetes with and without chronic obstructive pulmonary disease. Diabetes Care 2014; 37:389-95. [PMID: 24026562 PMCID: PMC3898761 DOI: 10.2337/dc13-1435] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes damages major organ systems through disrupted glycemic control and increased inflammation. The effects of diabetes on the lung have been of interest for decades, but the modest reduction in pulmonary function and its nonprogressive nature have limited its investigation. A recent systematic review found that diabetes was associated with reductions in forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and diffusing capacity for carbon monoxide of the lung and increased FEV1/FVC. They reported pooled results including few smokers. This study will examine measures of pulmonary function in participants with extensive smoking exposure. RESEARCH DESIGN AND METHODS We examined pulmonary function in participants with a >10-pack-year history of smoking with and without diabetes with and without chronic obstructive pulmonary disease (COPD). We measured pulmonary function, exercise capacity, and pulmonary-related quality of life in 10,129 participants in the Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) Study. RESULTS Participants with diabetes were observed to have reduced pulmonary function after controlling for known risk factors and also significant reductions in exercise capacity and quality of life across functional stages of COPD. CONCLUSIONS Pulmonary function in patients with ≥10 pack-years of smoking and diabetes is reduced, and this decrease is associated with significant reductions in activity-related quality of life and exercise capacity.
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10
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van Lunteren E, Moyer M, Spiegler S. Alterations in lung gene expression in streptozotocin-induced diabetic rats. BMC Endocr Disord 2014; 14:5. [PMID: 24423257 PMCID: PMC3945062 DOI: 10.1186/1472-6823-14-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 01/08/2014] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Diabetes profoundly affects gene expression in organs such as heart, skeletal muscle, kidney and liver, with areas of perturbation including carbohydrate and lipid metabolism, oxidative stress, and protein ubiquitination. Type 1 diabetes impairs lung function, but whether gene expression alterations in the lung parallel those of other tissue types is largely unexplored. METHODS Lung from a rat model of diabetes mellitus induced by streptozotocin was subjected to gene expression microarray analysis. RESULTS Glucose levels were 67 and 260 mg/dl (p < 0.001) in control and diabetic rats, respectively. There were 46 genes with at least ± 1.5-fold significantly altered expression (19 increases, 27 decreases). Gene ontology groups with significant over-representation among genes with altered expression included apoptosis, response to stress (p = 0.03), regulation of protein kinase activity (p = 0.04), ion transporter activity (p = 0.01) and collagen (p = 0.01). All genes assigned to the apoptosis and response to stress groups had increased expression whereas all genes assigned to the collagen group had decreased expression. In contrast, the protein kinase activity and ion transporter activity groups had genes with both increased and decreased expression. CONCLUSIONS Gene expression in the lung is affected by type 1 diabetes in several specific areas, including apoptosis. However, the lung is resistant to changes in gene expression related to lipid and carbohydrate metabolism and oxidative stress that occur in other tissue types such as heart, skeletal muscle and kidney.
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Affiliation(s)
- Erik van Lunteren
- Pulmonary, Critical Care and Sleep Division, Department of Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Case Western Reserve University, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - Michelle Moyer
- Pulmonary, Critical Care and Sleep Division, Department of Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Case Western Reserve University, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - Sarah Spiegler
- Pulmonary, Critical Care and Sleep Division, Department of Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Case Western Reserve University, 10701 East Boulevard, Cleveland, OH 44106, USA
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11
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Sin DD, van Eeden S, Man SP. Reply to Letter From Mirrakhimov and Mirrakhimov. Can J Cardiol 2013; 29:639.e11. [DOI: 10.1016/j.cjca.2012.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 11/17/2012] [Indexed: 10/27/2022] Open
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12
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Lerner SM. Kidney and pancreas transplantation in type 1 diabetes mellitus. ACTA ACUST UNITED AC 2008; 75:372-84. [DOI: 10.1002/msj.20056] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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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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