Bidirectional relationship between diabetes and pulmonary function: a systematic review and meta-analysis.

Rui-Heng Zhang, Yao-Hua Cai, Lin-Ping Shu, Jinkui Yang, Lu Qi, Min Han, Jianbo Zhou, Rafael Simó, Albert Lecube

Journal: Diabetes & metabolism 2021;47(5):101186

PMID: 32889114

Full Text on Elsevier Science View on PubMed

Abstract

AIM

Evidence of the lungs being a target organ of diabetes-related pathophysiology is increasing, and decreased pulmonary function increases the risk of diabetes after adjusting for demographic and metabolic factors. This systematic review and meta-analysis evaluates the bidirectional relationship between diabetes and pulmonary function.

METHODS

MEDLINE, Embase, The Cochrane Library and Web of Science databases were searched, and all studies describing this bidirectional relationship were identified. Two reviewers independently extracted study characteristics and assessed the risk of bias.

RESULTS

A total of 93 studies were included in the meta-analysis. The pooled weighted mean difference (WMD) between diabetes patients and non-diabetic participants for forced expiratory volume in 1 s (FEV) and forced vital capacity (FVC) were -5.65% and -5.91%, respectively, of predicted values. Diabetes-related microvascular complications and poor glycaemic control were associated with poorer pulmonary function in those with diabetes. In addition, diabetes was associated with a restrictive spirometry pattern (RSP) in both cross-sectional studies [odds ratio (OR): 2.88, 95% confidence interval (CI): 2.18-3.81, I = 0.0%] and prospective cohort studies [hazard ratio (HR): 1.57, 95% CI: 1.04-2.36]. In five longitudinal studies, the conclusions were inconsistent as to whether or not diabetes accelerates pulmonary function decline. However, every 10% decrease in baseline predicted FVC value was associated with a 13% higher risk of incident diabetes (HR: 1.13, 95% CI: 1.09-1.17, I = 0.0%).

CONCLUSION

There is a bidirectional relationship between diabetes and pulmonary function. However, further investigations into whether dynamic changes in glycaemic levels before and shortly after diabetes onset mediate the deleterious effects on pulmonary function, or vice versa, are now required.

Address: Beijing Tongren Hospital, Capital Medical University, Beijing, China.; Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.; Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.; Department of Nephrology, Tongji Medical College, Huazhong University of Science and Technology, China.; Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA. Electronic address: [email protected].; Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain.; Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Catalonia, Spain.

DOI: 10.1016/j.diabet.2020.08.003

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MeSH Terms: Cross-Sectional Studies, Diabetes Mellitus, Humans, Lung, Prospective Studies, Spirometry