Chest
Volume 138, Issue 2, August 2010, Pages 393-406
Journal home page for Chest

Original Research
Pulmonary Function in Diabetes
Pulmonary Function in Diabetes: A Metaanalysis

https://doi.org/10.1378/chest.09-2622Get rights and content

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 FEV1, 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 FEV1/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.

Section snippets

Data Sources and Searches

This metaanalysis was performed according to the guidelines of the Meta-analysis of Observational Studies in Epidemiology.13 We conducted a systematic search in PubMed (1966 through September 2009), EMBASE (1989 through September 2009), The Cochrane Library (through September 2009), and in online conference databases of the American Diabetes Association (2004-2009), European Association for the Study of Diabetes (2001-2008), International Diabetes Federation (2003), American Thoracic Society

Results

A flowchart of study selection is presented in Figure 1. Briefly, the PubMed search yielded 732 hits, from which 133 potentially relevant hits were identified. The EMBASE search yielded 498 hits, from which another 15 unique potentially relevant articles were identified. The search in The Cochrane Library did not yield any new citations. Scanning of reference lists added another 21 unique hits. Based on the abstracts from these 169 hits, we excluded 37 titles. Searches in online conference

Discussion

Our metaanalysis shows that diabetes, in the absence of overt pulmonary disease, is associated with a modest, albeit statistically significant, impaired pulmonary function in a restrictive pattern. The results were irrespective of BMI, smoking, diabetes duration, and HbA1c levels. In subanalyses, the association seemed to be more pronounced in type 2 diabetes than in type 1 diabetes. Our study adds evidence for yet another organ system to be involved in both type 1 and type 2 diabetes. As a

Acknowledgments

Author contributions: Dr van den Borst: contributed to designing the study, was responsible for data acquisition, was involved in data analyses and interpretation, compiled the original draft including tables and figures, led revisions, and was responsible for editing and final formatting.

Dr Gosker: contributed to designing the study, assisted in data analyses and interpretation of data, revised the manuscript, and assisted in technical support.

Dr Zeegers: contributed to designing the study,

References (74)

  • BG Cooper et al.

    Lung function in patients with diabetes mellitus

    Respir Med

    (1990)
  • J Vandevoorde et al.

    Early detection of COPD: a case finding study in general practice

    Respir Med

    (2007)
  • AA Litonjua et al.

    Lung function in type 2 diabetes: the Normative Aging Study

    Respir Med

    (2005)
  • R Antonelli Incalzi et al.

    Neuroadrenergic denervation of the lung in type I diabetes mellitus complicated by autonomic neuropathy

    Chest

    (2002)
  • World Health Organization

    Fact sheet: diabetes. No.312, November 2008

  • DM Nathan

    Long-term complications of diabetes mellitus

    N Engl J Med

    (1993)
  • L Ceglia et al.

    Meta-analysis: efficacy and safety of inhaled insulin therapy in adults with diabetes mellitus

    Ann Intern Med

    (2006)
  • J Rosenstock et al.

    Two-year pulmonary safety and efficacy of inhaled human insulin (Exubera) in adult patients with type 2 diabetes

    Diabetes Care

    (2008)
  • J Rosenstock 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

    Diabetes Care

    (2008)
  • LM Kuitert

    The lung in diabetes—yet another target organ?

    Chron Respir Dis

    (2008)
  • CC Hsia et al.

    Lung involvement in diabetes: does it matter?

    Diabetes Care

    (2008)
  • JG Teeter et al.

    Cross-sectional and prospective study of lung function in adults with type 2 diabetes: the Atherosclerosis Risk in Communities (ARIC) study: response to Yeh et al

    Diabetes Care

    (2008)
  • A Kaparianos et al.

    Pulmonary complications in diabetes mellitus

    Chron Respir Dis

    (2008)
  • CC Hsia et al.

    Lung function changes related to diabetes mellitus

    Diabetes Technol Ther

    (2007)
  • M Sandler

    Is the lung a ‘target organ’ in diabetes mellitus?

    Arch Intern Med

    (1990)
  • D Ardigo et al.

    Pulmonary complications in diabetes mellitus: the role of glycemic control

    Curr Drug Targets Inflamm Allergy

    (2004)
  • DF Stroup et al.

    Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group

    JAMA

    (2000)
  • R Pellegrino et al.

    Interpretative strategies for lung function tests

    Eur Respir J

    (2005)
  • JP Higgins et al.

    Quantifying heterogeneity in a meta-analysis

    Stat Med

    (2002)
  • M Egger et al.

    Bias in meta-analysis detected by a simple, graphical test

    BMJ

    (1997)
  • S Cazzato et al.

    Lung function in children with diabetes mellitus

    Pediatr Pulmonol

    (2004)
  • MS Boulbou et al.

    Diabetes mellitus and lung function

    Med Princ Pract

    (2003)
  • MS Boulbou et al.

    Pulmonary function and circulating adhesion molecules in patients with diabetes mellitus

    Can Respir J

    (2003)
  • C Maiolo et al.

    Is altered body fat distribution responsible for reduced pulmonary function in obese type 2 diabetic adult women?

    Diabetes Care

    (2001)
  • HJ Kabitz et al.

    Diabetic polyneuropathy is associated with respiratory muscle impairment in type 2 diabetes

    Diabetologia

    (2008)
  • H El-Jundi et al.

    Insulin therapy preserves pulmonary diffusing capacity [abstract]

    ERS

    (2005)
  • TM McKeever et al.

    Lung function and glucose metabolism: an analysis of data from the Third National Health and Nutrition Examination Survey

    Am J Epidemiol

    (2005)
  • Cited by (179)

    • Associations between spirometric measures and exercise capacity in type 2 diabetes

      2023, Diabetes and Metabolic Syndrome: Clinical Research and Reviews
    • Interaction of polycyclic aromatic hydrocarbon exposure and high-fasting plasma glucose on lung function decline in coke oven workers: a cross-lagged panel analysis

      2022, Environmental Toxicology and Pharmacology
      Citation Excerpt :

      It is generally thought that lung function and blood glucose levels can interact through pathophysiological and metabolic mechanisms (Wannamethee et al., 2010). In recent years, pulmonary impairment has become a growing concern as a potential complication of diabetes (Klein et al., 2010; van den Borst et al., 2010). Epidemiological studies have shown that diabetic patients have higher rates of respiratory morbidity and mortality than nondiabetic patients (Colbay et al., 2015; Klekotka et al., 2015).

    View all citing articles on Scopus

    Funding/Support: This study was performed within the framework of Top Institute Pharma project T1-201. The research of Dr Gosker is supported by a grant from the Netherlands Asthma Foundation [NAF 3.4.05.038]. Dr Zeegers is sponsored by Cancer Research UK [A7098, A6135, A6835, A5738], Birmingham Children's Hospital Research Foundation, England [102f], and the Institute for the Stimulation of Innovation by Science and Technology, Belgium [070699].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

    View full text