Oana L. Klein

Systematic review of the association between lung function and Type 2 diabetes mellitus

Diabet. Med. 27, 977–987 (2010)

Lung spirometry parameters and diffusion capacity are decreased in patients with Type 2 diabetes

Diabet. Med. 29, 212–219 (2012)

Reduced diffusion lung capacity in patients with type 2 diabetes mellitus predicts hospitalization for pneumonia.

Among 4164 patients, those with type 2 diabetes mellitus (DM) had lower lung diffusion capacity (DLCO) compared with those without DM (DLCO mean±SE: 15.7±0.3 vs. 17.0±0.2 mL/min/mm Hg, p<0.01). Reduced DLCO predicted hospitalization for pneumonia independent of diabetes control, severity and co-morbidities (OR=2.4, CI 1.08-5.31).

Changes in procoagulants track longitudinally with insulin resistance: findings from the coronary artery risk development in young adults (CARDIA) study.

To examine the association between changes in procoagulants (fibrinogen factors VII and VIII and von Willebrand factor) and the risk of insulin resistance.

Type II diabetes mellitus is associated with decreased measures of lung function in a clinical setting

AIMS Type II diabetes mellitus has been associated with reduced forced expiratory volume in first second (FEV(1)) and forced vital capacity (FVC). We investigated if this relationship is maintained in a clinical setting, independent of respiratory infections and heart failure. METHODS Pulmonary function tests and discharge summaries of 639 adults 18-80 years of age, of different races/ethnicities, seen at an urban hospital during a two years period were reviewed. After selection of patients based on inclusion/exclusion criteria, 286 patients were included in our analysis. Using multivariable linear regression we examined cross-sectional differences of FEV(1) and FVC between patients with and without diabetes, adjusting for age, sex, race/ethnicity, BMI, smoking and respiratory symptoms. RESULTS Patients with diabetes were older (63 ± 1 vs. 56 ± 1), more likely to be African-Americans (30% vs. 25%) and Hispanics (40% vs. 31%), have respiratory symptoms (79% vs. 68%), and a higher BMI (34.2 ± 1.0 vs. 30.1 ± 0.6), compared to patients without diabetes. The distribution of women and smoking among the two groups were similar. The mean unadjusted percent predicted values of FEV(1) and FVC in patients with diabetes were lower than in those without diabetes, and remained significantly reduced after adjustment (77.3 ± 0.5 vs. 82.0 ± 0.3, p < 0.01 for FEV(1) and 73.8 ± 0.6 vs. 82.8 ± 0.3, p < 0.01 for FVC, respectively). CONCLUSIONS In a clinical setting, patients with diabetes have decreased lung function compared to their non-diabetic counterparts, independent of respiratory infections and heart failure.

Long-term change in alcohol-consumption status and variations in fibrinogen levels: the coronary artery risk development in young adults (CARDIA) study.

Objective To examine long-term associations between change in alcohol-consumption status and cessation of alcohol use, and fibrinogen levels in a large, young, biracial cohort. Design Analysis of covariance models were used to analyse participants within the Coronary Artery Risk Development in Young Adults Study (CARDIA) cohort who had fibrinogen and alcohol use data at year 7 (1992–1993; ages 25–37) and year 20 examinations. Setting 4 urban US cities. Patients 2520 men and women within the CARDIA cohort. Main outcome measures 13-year changes in alcohol use related to changes in fibrinogen. Results Over 13 years, mean fibrinogen increased by 71 vs 70 mg/dL (p=NS) in black men (BM) versus white men (WM), and 78 vs 68 mg/dL (p<0.05) in black women (BW) versus white women (WW), respectively. Compared with never-drinkers, there were smaller longitudinal increases in fibrinogen for BM, BW and WW (but a larger increase in WM) who became or stayed drinkers, after multivariable adjustment. For BM, WM and WW, fibrinogen increased the most among persons who quit drinking over 13 years (p<0.001 for WM (fibrinogen increase=86.5 (7.1) (mean (SE))), compared with never-drinkers (fibrinogen increase=53.1 (5.4)). Conclusions In this young cohort, compared with the participants who never drank, those who became/stayed drinkers had smaller increases, while those who quit drinking had the highest increase in fibrinogen over 13 years of follow-up. The results provide a novel insight into the mechanism for the established protective effect of moderate alcohol intake on cardiovascular disease outcomes.

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)

OBJECTIVE Type 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 METHODS The 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. RESULTS Among 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. CONCLUSIONS Hispanics/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.

Reduced lung diffusion capacity in type 2 diabetes is independent of heart failure.

In a case-control analysis comparing 303 patients with diabetes and 303 without (matched on age, race, sex and height), diabetics had reduced lung diffusion (DLCO) independent of smoking, obesity, clinical heart failure, asymptomatic left ventricular systolic and diastolic dysfunction: DLCO (mean±SE: 15.5±0.9 vs. 16.4 ±0.9, p=0.01).

Association of serum lipids and obstructive lung disease in Hispanic/Latino adults of diverse backgrounds:

Rationale Substantial variation in the prevalences of obstructive lung disease exist between Hispanic/Latino heritage groups. Experimental studies have posited biological mechanisms linking serum lipids and lipid-lowering medications with obstructive lung disease. The aim of this study is to examine the associations of serum lipid levels with the prevalences of asthma and chronic obstructive pulmonary disease in the Hispanic Community Health Study/Study of Latinos and how these associations vary by Hispanic/Latino heritage group. Methods The Hispanic Community Health Study/Study of Latinos is a population-based probability sample of 16,415 self-identified Hispanic/Latino persons aged 18–74 years recruited between 2008 and 2011 from randomly selected households in four US field centers. The baseline clinical examination included comprehensive biological testing (fasting serum lipid levels), behavioral and socio-demographic assessments, medication inventory including inhalers, and respiratory data including questionnaires for asthma and standardized spirometry with post-bronchodilator measures for identification of obstructive lung disease. Measurements and main results Hispanic/Latinos with current asthma had lower age- and statin-use-adjusted mean serum total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels than their non-asthmatic counterparts. In analysis adjusted for age plus gender, ethnicity, cigarette smoking, alcohol intake, body mass index, lipid/cholesterol-lowering medications, age at immigration, health insurance status, and use of oral corticosteroids, increasing serum levels of total cholesterol and low-density lipoprotein cholesterol were associated with lower odds of current asthma in the estimated population. Unlike asthma, Hispanic/Latinos with chronic obstructive pulmonary disease had lower mean high-density lipoprotein than their non- chronic obstructive pulmonary disease counterparts. In the fully adjusted analysis no significant associations were found between lipid levels and prevalent chronic obstructive pulmonary disease. Conclusions We showed a modest inverse relationship between serum lipid levels and current asthma. These results highlight some important differences in Hispanics/Latinos and certain serum lipids may be factors or markers of obstructive lung disease.