Hispanics/Latinos With Type 2 Diabetes Have Functional and Symptomatic Pulmonary Impairment Mirroring Kidney Microangiopathy: Findings From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Abstract

OBJECTIVEType 2 diabetes mellitus (DM) has been associated with lung dysfunction, but this association has not been explored in Hispanics/Latinos. The relation between diabetic nephropathy and lung function and symptoms has not been explored.RESEARCH DESIGN AND METHODSThe Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a large, multicenter, observational study, recruited 16,415 participants aged 18–74 years (14,455 with complete data on variables of interest), between 2008 and 2011 from four U.S. communities through a two-stage area household probability design. Baseline measurements were used for analyses. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and dyspnea score were compared between individuals with and without DM, overall, and stratified by albuminuria. The analyses were performed separately for those with and without preexisting lung disease (chronic bronchitis, emphysema, asthma). Linear regression with sampling weights was used for all analyses.RESULTSAmong Hispanics/Latinos without lung disease, those with DM had lower mean FEV1 and FVC values and a higher mean dyspnea score than those without DM (mean [95% CI] FEV1 3.00 [2.96–3.04] vs. 3.10 [3.09–3.11] L, P < 0.01; FVC 3.62 [3.59–3.66] vs. 3.81 [3.79–3.83] L, P < 0.001; dyspnea score 0.60 [0.49–0.71] vs. 0.41 [0.34–0.49], P < 0.001). Hispanics/Latinos with DM and macroalbuminuria showed 10% lower FVC (P < 0.001), 6% lower FEV1 (P < 0.001), and 2.5-fold higher dyspnea score (P = 0.04) than those without DM and with normoalbuminuria. Similar findings but with higher impairment in FVC were found in Hispanics/Latinos with lung disease.CONCLUSIONSHispanics/Latinos with DM have functional and symptomatic pulmonary impairment that mirror kidney microangiopathy. The progression of pulmonary impairment in adults with DM needs to be investigated further.

Clinical characteristics and outcomes of patients with severe covid-19 with diabetes

“…Patients with diabetes were more likely to develop covid-19, which may be due to the fact that patients with diabetes had low pulmonary function. 13 But the mechanisms explaining lung dysfunction in diabetes remain vague. Animal studies suggested that alveolar capillary microangiopathy and interstitial fibrosis were induced by glycosylation of the lung tissue collagen in the diabetes model, and this process was mediated by nicotinamide adenine dinucleotide phosphate (NADPH) oxidase and angiotensin II.…”

“…In addition, diabetes may lead to lung dysfunction, such as decreased forced expiratory volume and forced vital capacity. 13 Therefore, diabetes could possibly be a risk factor for covid-19. Our study aims to investigate the clinical characteristics of patients with severe covid-19 with diabetes mellitus, and the association of diabetes with the outcome in patients with severe covid-19.…”

Factors Associated with the Poor Outcomes in Diabetic Patients with COVID-19

“…These biochemical abnormalities point to that covid-19 infection may be lead to progressive systemic injuries and consequently death in diabetic patients. The mechanisms linking diabetes with high risk of mortality were pulmonary dysfunction and deleterious in ammation which has been indicated in results of comparison between survivors and non-survivors [15,18]. Chen et al indicated CRP as the only risk factor for mortality in diabetic patients with COVID-19 as a clinical manifestation of systemic in ammation [19].…”

MECHANISMS OF ENDOCRINOLOGY: Mechanisms of disease: the endocrinology of obstructive sleep apnoea

“…Several possible mechanisms make it plausible that dysglycaemia/diabetes can lead to the development or worsening of OSA as summarised in Fig. 3 (7,11,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130,131,132).…”

“…One plausible mechanism in patients with pre-diabetes or diabetes is autonomic neuropathy, which might impact on UA innervation (6), ventilatory drive and central respiratory responses to hypercapnia (109,110). In addition, T2D is associated with reduced pulmonary volumes and functions compared to healthy individuals which could affect UA stability (111,112,113,114,115,116,117,118,119,120,121) and diffusion capacity for carbon monoxide (112,113,122,123). The impact of T2D on the lungs seems to be related to the severity of hyperglycaemia independently of obesity and smoking (123), which raises the possibility that improvements in glycaemic control might have a favourable impact on OSA.…”