Pulmonary function reduction in diabetes with and without chronic obstructive pulmonary disease

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.

Figure 1

The prevalence of diabetes (type 1 or type 2) by GOLD classification.

Figure 2

The results of the 6-min walk test in feet by GOLD classification and diabetes status. Levels are least squares means adjusted for study site, age, sex, smoking status, pack-years of smoking, BMI, diabetes, GOLD stage, and the interaction between diabetes and GOLD stage. *P < 0.05; **P < 0.01; ***P < 0.0001.