Diabetic pneumopathy: A study of induced sputum and pulmonary function in patients with type 2 diabetes mellitus
Published 2020-01-03
Keywords
- Diabetes mellitus type 2,
- Induced sputum,
- Lymphocytes
How to Cite
Copyright (c) 2020 Brazilian Journal of Health and Biomedical Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
Objective: To evaluate the cellularity, and albumin and interleukin (IL)-1 levels in induced sputum (IS), and to determine respiratory function parameters in patients with type 2 diabetes mellitus (DM2). Design: A cross-section study in type 2 diabetes mellitus. Participants: Patients with type 2 diabetes mellitus and healthy people. Methods: Patients in both groups had normal chest x-ray findings. Exclusion criteria for both groups were: the presence of current pulmonary disease or sequelae, smoking, respiratory atopy, or respiratory infection in the past 3 months. The study consisted of two sub-studies. In sub-study 1 (SS1), measurements of pulmonary volume and flow, and diffusion capacity for carbon monoxide (DLCO) were performed. In sub-study 2 (SS2), analysis of cellularity, albumin, and IL-1 in IS was performed. Results: In all, 60 patients (45 women, 75%) with DM2 with a mean age of 59.52 years (SD, 9.03) were included in SS1. The DM2 group included 8 patients with airway obstruction (13.33%) without reversibility with bronchodilators, and 9 with restrictive disease (15.00 %) (p = 0.026). The DLCO was reduced in 17 patients (28.33%) in the DM2 group. In the control group, all individuals had values within the reference intervals. Lymphocytosis was found in the IS of patients with DM2 (p = 0.028). The levels of sputum albumin showed no statistical difference between the two groups. Conclusion: Our findings indicate the presence of pulmonary impairment in DM2, characterized by changes in the respiratory function and a lymphocytosis in IS.
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References
- GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1545-1602.
- American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36:1033-1046.
- OECD (2011), “Diabetes prevalence and incidence”, in Health at a Glance 2011: OECD Indicators, OECD Publishing. http:// dx.doi.org/10.1787/health_glance-2011-13-en. doi: 10.1787/ health_glance-2011-en
- Nucci LB, Toscano CM, Maia AL, et al. Brazilian National Campaign for Diabetes Mellitus Detection Working Group. A nationwide population screening program for diabetes in Brazil. Rev Panam Salud Publica. 2004;16:320-327.
- Hsia CC, Raskin P. Lung function changes related to diabetes mellitus. Diabetes Technol Ther. 2007;9:S74-82.
- Chance WW, Rhee C, Yilmaz C, et al. Diminished alveolar microvascular reserves in type 2 diabetes reflect systemic microangiopathy. Diabetes Care. 2008;31:1596-601.
- Kuziemski K, Specjalski K, Jassem E. Diabetic pulmonary microangiopathy – Fact or Fiction? Pol J Endocrinol. 2011;62:171-175.
- American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33:s62- s69.
- Miller MR, Hankinson J, Brusasco V, et al. ATS/ERS Task Force. Standardization of spirometry. Eur Respir J. 2005;26:319–338.
- Neder JA, Andreoni S, Castelo-Filho A, et al. Reference values for lung function tests. I. Static volumes. Braz J Med Biol Res. 1999;32:703–717.
- Pin I, Gibson PG, Kolendowicz R, et al. Use of induced sputum cell counts to investigate airway inflammation in asthma. Thorax. 1999;47:25-29.
- Clavant SP, Sastra SA, Osicka TM, et al. The analysis and characterisation of immuno-unreactive urinary albumin in healthy volunteers. Clin Biochem. 2006;39:143-151.
- Enomoto T, Usuki J, Azuma A, et al. Diabetes mellitus may increase risk for idiopathic pulmonary fibrosis. Chest. 2003;123:2007-11.
- Kurth L, Hnizdo E. Change in prevalence of restrictive lung impairment in the U.S. population and associated risk factors: National Health and Nutrition Examination Survey (NHANES) 1988-1994 and 2007-2010. Multidiscip Respir Med. 2015;28;10:7.
- Bottini P, Scionti L, Santeusanio F, et al. Impairment of the respiratory system in diabetic autonomic neuropathy. Diabetes Nutr Metab. 2000;13:165-172.
- Langeron O, Birenbaum A, Le Saché F, et al. Airway management in obese patient. Minerva Anestesiol. 2014;80:382-392.
- van der Borst B, Gosker HR, Zeegers MP, et al. Pulmonary function in diabetes. A meta-analysis. Chest. 2010;138:393- 406. doi: 10.1378/chest.09-2622.
- Hanson C, Rutten EP, Wouters EF, et al. Influence of diet and obesity on COPD development and outcomes. Int J Chron Obstruct Pulmon Dis. 2014;5;723-733.
- Davis WA, Knuiman M, Kendall P, et al; Fremantle Diabetes Study. Fremantle Diabetes Study. Glycemic exposure is associated with reduced pulmonary function in type 2 diabetes. Diabetes Care. 2004;27:525-757.
- Tsiligianni IG, van der Molen T. A systematic review of the role of vitamin insufficiencies and supplementation in COPD. Respir Res. 2010;6:171.
- Hersh CP, Make BJ, Lynch DA, et al. COPDGene and ECLIPSE Investigators. Non-emphysematous chronic obstructive pulmonary disease is associated with diabetes mellitus. BMC Pulm Med. 2014;24;14:164.
- Marvisi M, Bartolini L, del Borrello P, et al. Pulmonary function in non-insulin-dependent diabetes mellitus. Respiration. 2001;68: 268-272.
- Vracko R, Thorning D, Huang TW. Basal lamina of alveolar epithelial and capillaries. Quantitative changes with aging and diabetes mellitus. Am Rev Respir Dis. 1979;120:973-983.
- Agarwal AS, Fuladi AB, Mishra G, et al. Spirometry and diffusion studies in patients with type-2 diabetes mellitus and their association with microvascular complications. Indian J Chest Dis Allied Sci. 2010;52:213-216.
- Saler T, Cakmak G, Saglam ZA, et al. The assessment pulmonary diffusing capacity in diabetes mellitus with regard to microalbuminuria. Inter Med. 2009;48:1939-1943.
- Klein OL, Jones M, Lee J, et al. Reduced lung diffusion capacity in type 2 diabetes is independent of heart failure. Diabetes Res Clin Pract. 2012;96:e73-75.
- Guvener N, Tutuncu NB, Akcay S, et al. Alveolar gas exchange in patients with type 2 diabetes mellitus. Endocr J. 2003;50(6):663-667.
- Anandhalakshmi S, Manikandan S, Ganeshkumar P. Alveolar gas exchange and pulmonary functions in patients with type 2 diabetes mellitus. J Clin Diagn Res. 2013; 7:1874-1877.
- Meyer KC, Raghu G, Baughman RP, et al. American Thoracic Society Committee on BAL in Interstitial Lung Disease. An official American Thoracic Society clinical practice guideline: The clinical utility of bronchoalveolar lavage cellular analysis in interstitial lung disease. Am J Respir Crit Care Med. 2012;185:1004-1014.