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Cross-Sectional and Prospective Study of Lung Function in Adults with Type 2 Diabetes Mellitus: The Atherosclerosis Risk in Communities (ARIC) Study

¹Epidemiology, and
²Medicine of the Johns Hopkins University, Baltimore, Maryland
³the Division of Epidemiology and Community Health, University of Minnesota
⁴the Social Medicine Department, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil; and
⁵the Division of Pulmonary and Critical Care Medicine, Duke University Medical Center

fbrancat{at}jhmi.edu

ABSTRACT

Objective: To test the hypothesis that diabetes is independently associated with reduced lung function, both cross-sectionally and longitudinally.

Methods: We conducted cross-sectional and prospective analyses of diabetes status and lung function decline using baseline and 3-year follow-up data on 1,100 diabetic and 10,162 non-diabetic middle-aged adults from the Atherosclerosis Risk in Communities (ARIC) Study. Forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁) were measured at baseline and 3-year follow-up using standard spirometry.

Results: At baseline, adults with diabetes had significantly lower predicted FVC (96% vs. 103%, p< 0.001) and predicted FEV₁ (92% vs. 96%, p < 0.001) than those without diabetes. These differences remained significant after adjustment for demographic characteristics, adiposity, smoking, physical activity index, education, and ARIC field center. Graded, inverse associations were observed between hyperglycemia, diabetes severity (i.e. duration of diabetes and types of anti-diabetes medications) and FVC and FEV₁ (all p for trend < 0.001). In prospective analyses, FVC declined faster in diabetic adults than in their non-diabetic counterparts (64 vs. 58 ml/year, p= 0.01). Diabetes severity as indicated by intensity of anti-diabetic treatment also showed graded relationships with rate of FVC decline (p< 0.01).

Conclusions: These data support the notion that the lung is a target organ for diabetic injury. Additional research is required to identify pathophysiologic mechanisms and to determine clinical significance.

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