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Diabetes Care 27:752-757, 2004
© 2004 by the American Diabetes Association, Inc.

Pathophysiology/Complications
Original Article

Glycemic Exposure Is Associated With Reduced Pulmonary Function in Type 2 Diabetes

The Fremantle Diabetes Study

Wendy A. Davis, MPH1,2, Matthew Knuiman, PHD2, Peter Kendall, MB, BS3, Valerie Grange, EN1 and Timothy M.E. Davis, DPHIL1

1 University of Western Australia, School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Australia
2 University of Western Australia, School of Population Health, Perth, Australia
3 Department of Respiratory Medicine, Fremantle Hospital, Fremantle, Australia

Address correspondence and reprint requests to Professor T.M.E. Davis, School of Medicine and Pharmacology, Fremantle Hospital, P.O. Box 480, Fremantle, Western Australia 6959, Australia. E-mail: tdavis{at}cyllene.uwa.edu.au

OBJECTIVE—To examine prospectively the relationship between diabetes, glycemic control, and spirometric measures.

RESEARCH DESIGN AND METHODS—From a community-based cohort, 495 Europid (i.e., of European descent) patients with type 2 diabetes who had no history of pulmonary disease underwent baseline spirometry between 1993 and 1994. A subset of 125 patients was restudied a mean of 7.0 years later. The main outcome measures included forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), vital capacity (VC), and peak expiratory flow (PEF) corrected for body temperature, air pressure, and water saturation and were expressed either in absolute terms or as percentage-predicted value for age, sex, and height.

RESULTS—Mean percentage-predicted values of each spirometric measure were decreased >10% in the whole cohort at baseline and absolute measures continued to decline at an annual rate of 68, 71, and 84 ml/year and 17 l/min for FVC, FEV1, VC, and PEF, respectively, in the 125 prospectively studied patients. Declining lung function measures were consistently predicted by poor glycemic control in the form of a higher updated mean HbA1c, follow-up HbA1c, or follow-up fasting plasma glucose. In a Cox proportional hazards model, decreased FEV1 percentage-predicted value was an independent predictor of all-cause mortality.

CONCLUSIONS—Reduced lung volumes and airflow limitation are likely to be chronic complications of type 2 diabetes, the severity of which relates to glycemic exposure. Airflow limitation is a predictor of death in type 2 diabetes after adjusting for other recognized risk factors.

Abbreviations: CHD, coronary heart disease • FDS, Fremantle Diabetes Study • FVC, forced vital capacity • FEV1, forced expiratory volume in 1 s • PEF, peak expiratory flow • VC, vital capacity


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