Pulmonary Infectious Diseases in Association with Diabetes Mellitus

Cheepsattayakorn, Attapon

doi:10.15406/jlprr.2017.04.00127

“…This metabolic disorder is identified by hyperglycemia resulting from reduced insulin secretion, reduced glucose usage, and increased glucose production [ 2 , 3 ]. The hyperglycemic state, lowered immunity, pulmonary microangiopathy, and pulmonary dysfunction are frequently accompanied by sequelae such as severe hospital-acquired pneumonia, severe pulmonary infections with antimicrobial resistance, and chronic complications such as renal failure, coronary disease, diabetic nephropathy, and diabetic retinopathy [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical and Radiological Presentations of Various Pulmonary Infections in Hospitalized Diabetes Mellitus Patients: A Prospective, Hospital-Based, Comparative, Case Series Study

Vishwakarma

¹

,

Usman

²

,

Garg

³

et al. 2021

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Background. Diabetes mellitus is associated with increased rate of respiratory tract infections. The objective was to compare demographic, clinical, serum biochemical, and typical and atypical radiological profiles among hospitalized diabetics and nondiabetics with lower respiratory tract infection. Material and Methods. A prospective, hospital-based, consecutive, comparative observational study of 12-month study duration was conducted. Patients aged 13–90 years diagnosed with lower respiratory tract infection with or without diagnosed diabetes mellitus participated in the study. Demographic, clinical, serum biochemistry, and radiological profiles of diabetics ( n = 44 ) and nondiabetics ( n = 53 ) were compared. Results. Diabetics were older than nondiabetics at presentation ( p < 0.0001 ). Difference in mean random blood sugar (RBS) ( p < 0.001 ), fasting blood sugar (FBS) ( p < 0.001 ), and postprandial blood sugar (PPBS) ( p < 0.0001 ) was significant between diabetics and nondiabetics. Nondiabetics more frequently presented with fever ( p = 0.0032 ), chest pain ( p = 0.0002 ), and hemoptysis ( p = 0.01 ) as compared to diabetics. Diabetics more frequently presented with extreme temperatures (hypothermia or hyperpyrexia) ( p = 0.022 ), lower serum sodium levels ( p = 0.047 ), and lower partial arterial pressure ( p < 0.001 ) than nondiabetics. The mean pneumonia patient outcomes research team (PORT) risk score was higher in diabetics ( 124.84 ± 41.31 ) compared to nondiabetics ( 77.85 ± 39.77 ) ( p < 0.001 ). Diabetics more commonly displayed bilateral lesions with multilobe or lower lobe involvement, the most common type of lesion being exudative. Conclusion. Diabetic patients usually had severe pulmonary infection and poor prognosis as suggested by higher mean PORT risk score. They also more frequently presented with bilateral lesions with multilobe or lower lobe involvement as evidenced by radiography as compared to nondiabetic patients.

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“…Since currently known mechanisms for HPV development are based on changes in the glycolytic pathways of metabolism, a significant deterioration in the condition of patients with diabetes is quite predictable. In such cases, taking into account the specific features of pulmonary artery reactivity is very important for both the adequate correction of circulatory disor-ders and treatment of concomitant diseases [2][3][4]. Many researchers consider pulmonary hypertension (PH) to be one of these diseases [5,6].…”

mentioning

confidence: 99%

Influence of type 2 diabetes mellitus on the development of hypoxic pulmonary vasoconstriction

Khromov

¹

,

Dobrelia

²

,

Паршиков

³

et al. 2020

Фармакологія та лікарська токсикологія

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Hypoxia is currently considered to be an universal factor involved in the development of complications in many diseases including diabetes mellitus (DM). Acute hypoxia causes a systemic reaction with the large circulatory system developing vasodilation and the lesser circulatory system arteries developinghypoxic pulmonary vasoconstriction (HPV), which demonstrates the arteries' ability to regulate pulmonary circulation and maintain normal ventilation-perfusion ratio. Lack of the adequate response to hypoxic effects may be an additional mechanism for the diabetic complications in the cardiovascular system. Despite years of study, the mechanisms of HPV remain largely unclear, as does the effect of diabetes on pulmonary artery reactivity.The aim of the study was to evaluate the effect of high-fat diet and diabetes on the development of the HPV reaction in vivo and in vitro.Studies in rats divided into three groups (control group, a group of rats on a high-fat diet (HFD), and a group of animals with experimental type 2 diabetes mellitus (T2DM)) showed that in rats kept on the high-fat diet, an injection of streptozotocin leads to significant increase in blood glucose levels. In rats kept on the high-fat diet only, this parameter did not differ from the levels in the control animals. In rats kept on HFD and in rats with T2DM model, the right ventricular pressure was significantly higher compared to the control rats.The lung ventilation with a hypoxic gas mixture led to decrease in blood pressure in the systemic circulation in animals of all groups. In the control rats, the pressure in the right ventricular cavity of the heart increased indicating the development of hypoxic pulmonary vasoconstriction. In HFD rats, hypoxic hypoxiahad virtually no effect on the right ventricular pressure. In T2DM rats, an inversion of the hypoxic pulmonary vasoconstriction reaction with decrease in the right ventricular pressure was observed.These results have been confirmed in the in vitro experiments. In lung sections, the responses of the intrapulmonary arteries to hypoxic effects were multi-directional: the pulmonary artery luminal area decreased in the control animals, almost did not change in HFD animals, and increased in T2DM animals.In the rats with experimental diabetes mellitus, the contractile responses of the pulmonary artery ring segments to hypoxia were significantly suppressed compared to the vessels from the control animals.Finding out the exact mechanisms involved in the inversion of the pulmonary vasoconstriction response in diabetes will contribute to a better understanding of the fundamental pathophysiological processes that will promote development of pathogenetically justified approaches to the treatment of this disease and its complications.

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Hypoxic pulmonary vasoconstriction is lacking in rats with type 1 diabetes

Soloviev

¹

,

Ivanova

²

,

Melnyk

³

et al. 2019

Clin Exp Pharma Physio

1

0

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Hypoxic pulmonary vasoconstriction (HPV) is the most important feature of intact lung circulation that matches local blood perfusion to ventilation. The main goal of this work was to study the effects of diabetes on the development of HPV in rats. The experimental design comprised diabetes mellitus induction by streptozotocin, video‐morphometric measurements of the lumen area of intrapulmonary arteries (iPAs) using perfused lung tissue slices and patch‐clamp techniques. It was shown that iPA lumen size was significantly reduced under physical and chemical hypoxia (7–10 mm Hg) in normal iPA, but, on the contrary, it clearly increased in diabetic lung slices. The amplitude of the outward K+ current in diabetic iPAs smooth muscle cells (SMCs) was two‐fold greater than that seen in healthy cells. Chemical hypoxia led to significant decrease in the amplitude of the K+ outward current in healthy iPA SMCs while it was without effect in diabetic cells. The data obtained clearly indicate a significant dysregulation of vascular tone in pulmonary circulation under diabetes, ie diabetes damages the adaptive mechanism for regulating blood flow from poorly ventilated to better ventilated regions of the lung under hypoxia. This effect could be clinically important for patients with diabetes who have acute or chronic lung diseases associated with the lack of blood oxygenation.

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Pulmonary Infectious Diseases in Association with Diabetes Mellitus

Cited by 4 publications

References 35 publications

Clinical and Radiological Presentations of Various Pulmonary Infections in Hospitalized Diabetes Mellitus Patients: A Prospective, Hospital-Based, Comparative, Case Series Study

Clinical and Radiological Presentations of Various Pulmonary Infections in Hospitalized Diabetes Mellitus Patients: A Prospective, Hospital-Based, Comparative, Case Series Study

Influence of type 2 diabetes mellitus on the development of hypoxic pulmonary vasoconstriction

Hypoxic pulmonary vasoconstriction is lacking in rats with type 1 diabetes

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