Pulmonary Function Should Be Target in Diabetes Care, Researchers Report

Doctors treating patients with type 2 diabetes should consider pulmonary function when providing care to these patients, according to a paper recently published in Endocrine Reviews.

The review, by Albert Lecube, of the Universitat de Lleida, Spain, et al, points out that the lung is not usually included in the list of organs affected by type 2 diabetes. However, the authors write, “[the lung’s] great vascularization and abundant collagen and elastin fibers make the lung parenchyma a potential target for chronic hyperglycemia.”  The authors go on to write that there are good reasons to believe the same physiologic problems disturbances that account for complications in other organs may also affect pulmonary function.

According to the review, type 2 diabetes hinders pulmonary function, and that reduced lung function is negatively associated with fasting plasma glucose, glycated hemoglobin, and diabetes duration and severity. Type 2 diabetes also affects breathing during sleep, so it becomes a risk factor for sleep apnea.

Based on this review of the literature, the authors write that the central issue is whether normalizing blood glucose levels can improve lung function and sleep breathing. “However,” they write, “only experimental data and pilot interventional studies aimed at exploring the impact on respiratory parameters of some therapeutic options such as the effect of improving glycemic control on sleep breathing are currently available. Therefore, further research on this issue is warranted.”

There’s also the issue of which patients with type 2 diabetes are at risk for pulmonary disease and how to screen for these patients in the most cost-effective manner. The authors also raise the question of whether lung dysfunction will modify therapy for type 2 diabetes and how lung dysfunction and sleep-breathing disorders affect patients with type 2 diabetes. “In summary,” the authors conclude, “the current evidence strongly supports the link between [type 2 diabetes] and respiratory dysfunction and indicates that pulmonary function should be taken into consideration by health care providers. Specific pilot screening programs would be very useful for obtaining preliminary results, which could provide further general guidance on this issue. The current evidence points to the lung as an end target for [type 2 diabetes] complications and supports the recommendation that patients with [type 2 diabetes] be considered a vulnerable group for pulmonary dysfunction.”