Pulmonary function assessment in patients with type 2 diabetes mellitus

Pulmonary function assessment in patients with type 2 diabetes mellitus Maqsood S.1, Mehani R.2* DOI: https://doi.org/10.17511/ijmrr.2021.i01.03 1 Sheema Maqsood, Assistant Professor, Department of Pulmonary Medicine, RKDF Medical college & hospital, Bhopal, Madhya Pradesh, India. 2* Rekha Mehani, Associate professor, Department of pharmacology, RKDF Medical college & hospital, Bhopal, Madhya Pradesh, India.


Introduction
Diabetes mellitus is a metabolic disorder of multiple etiologies with disturbance of carbohydrates, fat and protein metabolism due to which there are defects in insulin secretion and or insulin action, characterized by chronic hyperglycemia [1].
Diabetes mellitus is a leading public health care problem in developing countries and the developing world, along with increasing incidence and longterm complications.
Today an epidemic of diabetes mellitus (DM), globally and nationally is been witnessed. DM and its complications have become the most important challenging health problem. There are 150 million diabetics worldwide where In India more than 3 crores have been affected.
According to etiopathogenic categories, it is classified as Type-1 and Type-2 diabetes mellitus. In Type-1 insulin secretion is deficient whereas in Type-2 there is a combination of resistance to insulin action and inadequate compensatory insulin secretory response. Diabetes is multisystem disorders that affect several organs of the body [2].
There is an alarming increase in the incidence and  Parasympathetic regulation of airway calibre may be destroyed in diabetes mellitus characterizing a bronchomotor dysautonomia [12].
The alveolar-capillary network because of its large size is protected against overt respiratory complication at a given level of systemic microvascular destruction. Therefore lung function could provide a useful measure of progression of systemic microangiopathy and noninvasively quantifies physiological reserve in large microvascular bed [13].
An improved understanding of the natural history of diabetic lung function is needed when pulmonary delivery of insulin is actively being pursued as a treatment option [14].

Methodology
The present study was conducted in the Department Parameters recorded in the subjects were The subject was informed about the procedure, and consent has been taken before recording. For each test, three readings are taken. The highest reading was taken for the calculation. All tests are recorded in a sitting posture at room temperature, in the morning hours.
The following parameters are recorded:

Statistical analysis
The data obtained was subjected to statistical analysis with the consult of a statistician. The data so obtained was compiled systematically. A master

Results
A total number of 108 cases were suitable for analysis. There were 54 diabetics in STUDY GROUP and 54 non-diabetics in the control group.                Pulmonary function tests were performed on 108 subjects who were divided into 2 groups, 54 DM patients and 54 healthy adult subjects. All the subjects were in between the age group of 15-60 years. DM patients were again grouped into many groups based on the BMI fasting blood sugar level and postprandial blood sugar level. The differences in the mean value of each parameter between DM patients and healthy controls, the difference between each parameter in DM patients based on Age, Gender, BMI, FBS and PPBS level were analysed and discussed [12].

FVC:
In our study there was a statistically significant decrease in the level of FVC in DM patients compared to healthy male subjects. It is also shown that the level of FVC decreases more with an increase in the level of FBS and PPBS. In diabetes mellitus thickening of the alveolar epithelium and pulmonary capillary basal lamina leads to pulmonary microangiopathy and reduced pulmonary elastic recoiling of the lung caused by nonenzymatic glycosylation of the connective tissue which reduces the FVC in diabetes mellitus [13].

FEV1:
In our study there was no statistically significant difference in the level of FEV1 in DM patients compared to healthy male adults. There was a decrease in 14.2% (0.88 L) of predicted FEV1 value in DM Patients.
It was observed that FEV1 decreases more with the increase in the level of FBS and PPBS [14]. In diabetes mellitus thickening of the alveolar epithelium and pulmonary capillary basal lamina occurs leading to pulmonary microangiopathy and reduced pulmonary elastic recoil caused by nonenzymatic glycosylation of the connective tissue which also reduces the FEV1 in diabetes mellitus.

The ratio of FEV1/ FVC :
In our study there was a statistically significant increase in the level of ratio of FEV1/FVC. DM patients showed an increase of 10.5% when compared to healthy adult male subjects. It shows that the ratio of FEV1/FVC was significantly increased with an increase in the level of FBS and PPBS, which was statistically significant (p < 0.05).
The present study correlates with Robert WE et al who studied the relationship between diabetes mellitus and pulmonary function and showed a 1.5% increase in the FEV1/FVC ratio with a P-value < 0.05% which is statistically significant, suggesting a restrictive pattern of pulmonary dysfunction. FEV1/ FVC ratio is a more sensitive index of early disease. As mentioned above diabetes leads to changes in FVC and FEV1, therefore this ratio is affected.

PEFR :
Our study shows a statistically significant decrease in the level of PEFR (14.1% of percentage predicted). It has also shown that, the PEFR decreases more with an increase in the level of FBS and PPBS. The reduced flow rate is due to a reduction in the force-generating capacity of expiratory muscles, higher airway resistance, reduced recoiling nature of lung and thorax and decrease in muscle strength. As mentioned above, PEFR significantly decreases with an increase in the level of FBS and PPBS.

Limitations and scope
It seems to be necessary to repeat PFTs and to assess the changes in pulmonary functions among the same subjects.

Conclusions
This study was undertaken to study the effect of diabetes mellitus on pulmonary functions. Pulmonary functions in diabetes mellitus and controls were statistically compared to resolve this. The following conclusion can be drawn from the results of the present study.
Hence, we conclude that strict glycaemic control & regular breathing exercises to strengthen the respiratory muscles may improve the pulmonary function test in patients.
What does the study add to the existing knowledge?
Over a long observation course, the relationship between the plasma glucose concentration and the PFTs can be elucidated.

Contribution of authors
Both authors contributed similarly to the study process, conduct and manuscript preparation. 05. There was a mean decline of FVC of 200 ml among diabetic males. And a decline of 240 ml among diabetic females as compared to diabetic controls. There was a decline of FEV1 of 180 ml among men and 120 L among women.