Cross-Sectional and Prospective Study of Lung Function in Adults With Type 2 Diabetes

The Atherosclerosis Risk in Communities (ARIC) Study

  1. Hsin-Chieh Yeh, PHD12,
  2. Naresh M. Punjabi, MD, PHD12,
  3. Nae-Yuh Wang, PHD2,
  4. James S. Pankow, PHD3,
  5. Bruce B. Duncan, MD, PHD4,
  6. Christopher E. Cox, MD, MPH5,
  7. Elizabeth Selvin, PHD, MPH1 and
  8. Frederick L. Brancati, MD, MHS12
  1. 1Department of Epidemiology, The Johns Hopkins University, Baltimore, Maryland
  2. 2Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
  3. 3Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
  4. 4Division of Social Medicine Department, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
  5. 5Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina
  1. Address correspondence and reprint requests to Dr. Frederick L. Brancati, Division of General Internal Medicine, The Johns Hopkins University, 2024 E. Monument St., Suite 2-600, Baltimore, MD 21205. E-mail: fbrancat{at}


OBJECTIVE—The aim of this study was to test the hypothesis that diabetes is independently associated with reduced lung function, both cross-sectionally and longitudinally.

RESEARCH DESIGN AND 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 nondiabetic middle-aged adults from the Atherosclerosis Risk in Communities (ARIC) Study. Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were measured at baseline and at the 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 antidiabetes medications), and FVC and FEV1 (all Ptrend < 0.001). In prospective analyses, FVC declined faster in diabetic adults than in their nondiabetic counterparts (64 vs. 58 ml/year, P = 0.01). Diabetes severity as indicated by intensity of antidiabetic treatment also showed graded relationships with the 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.


  • Published ahead of print at on 4 December 2007. DOI: 10.2337/dc07-1464.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    See accompanying editorial, p. 828.

    • Accepted November 22, 2007.
    • Received July 29, 2007.
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  1. Diabetes Care vol. 31 no. 4 741-746
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