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Licensed Unlicensed Requires Authentication Published by De Gruyter August 7, 2014

Pulmonary function in children with type 1 diabetes mellitus

  • María Martín-Frías EMAIL logo , Adelaida Lamas , Emma Lara , Milagros Alonso , Purificación Ros and Raquel Barrio

Abstract

Aim: To assess lung function in children and adolescents with type 1 diabetes mellitus (T1DM).

Patients and methods: We conducted a case-control study of 100 patients with T1DM [median age 13 (10.6–14.7), 44% men, 23% prepubertal, and all nonsmokers] and 77 controls. None had evidence of lung disease or any other comorbidity. We performed pulmonary function tests, including spirometry [forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1/FVC ratio], plethysmography [total lung capacity (TLC), residual volume (RV), RV/TLC ratio, and airway resistance (Raw)], and diffusing capacity of carbon monoxide in the lung (TLCO), alveolar volume (AV), and TLCO/AV ratio. The duration of diabetes, degree of metabolic control, insulin dose, and presence of diabetic complications were registered. The χ2-test and analysis of variance were used to compare categorical and quantitative variables, respectively.

Results: The duration of diabetes was 6.2±3.8 years with a median HbA1c of 7.08±0.4%. FEV1/FVC ratio was found to be significantly higher in patients with TIDM than in controls. Patients with diabetes also had a nonsignificant trend towards lower FVC, FEV1, Raw, and TLCO, and higher RV, TLC, and RV/TLC than controls. There were no differences in pulmonary function based on duration of disease or metabolic control. We found differences in pulmonary evaluation when pubertal stage was analyzed.

Conclusions: The lung is functionally involved in children with T1DM. Pubertal development stage influences the evaluation of lung function.


Corresponding author: María Martín-Frías, MD, Pediatric Diabetes and Endocrinology Unit, Hospital Universitario Ramón y Cajal, Carretera Colmenar, Km 9.1, 28034 Madrid, Spain, Phone: +34 913368646, Fax: +34 913368417, E-mail:

References

1. Karvonen M, Viik-Kajander M, Moltchanova E, Libman I, LaPorte R, et al. Incidence of childhood type 1 diabetes worldwide. Diabetes Mondiale (DiaMond) Project Group. Diabetes Care 2000;23:1516–26.10.2337/diacare.23.10.1516Search in Google Scholar

2. The Diabetes Control and Complications Trial Research Group. Effect of the intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus. J Pediatr 1994;125:177–88.10.1016/S0022-3476(94)70190-3Search in Google Scholar

3. The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group. Beneficial effects on intensive therapy of diabetes during adolescence: outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT). J Pediatr 2001;139:804–12.10.1067/mpd.2001.118887Search in Google Scholar

4. Rask-Madsen C, He Z, King GL. Mechanism of diabetic microvascular complications. In: Kahn CR, Weis GC, King GL, Jacobson AM, Moses AC, Smith RJ, editors. Joslin’s diabetes mellitus, 14th ed. Boston: Lippincott Williams & Wilkins, 2005:823–37.Search in Google Scholar

5. Ford E. Body mass index, diabetes and C-reactive protein among U.S. adults. Diabetes Care 1999;22:1971–7.Search in Google Scholar

6. Hsia CC, Raskin P. The diabetic lung: relevance of alveolar microangiopathy for the use of inhaled insulin. Am J Med 2005;118:205–11.10.1016/j.amjmed.2004.09.019Search in Google Scholar

7. Sandler M. Is the lung a “target organ” in diabetes mellitus. Arch Intern Med 1990;150:1385–8.10.1001/archinte.1990.00390190051006Search in Google Scholar

8. Kuziemski K, Gorska L, Jassem E, Madej-Dmochowska A. Lung microangiopathy in diabetes. Pneumonol Alergol Pol 2009;77:394–9.10.5603/ARM.27794Search in Google Scholar

9. Schuyler MR, Niewoehner DE, Inkley SR, Kohn R. Abnormal lung elasticity in juvenile diabetes mellitus. Am Rev Respir Dis 1976;113:37–41.Search in Google Scholar

10. Schernthaner G, Haber P, Kummer R, Ludwig H. Lung elasticity in juvenile onset diabetes mellitus. Am Rev Respir Dis 1977;116:544–6.10.1164/arrd.1977.116.3.544Search in Google Scholar

11. Asanuma Y, Fujiya S, Ide H, Agishi Y. Characteristics of pulmonary function in patients with diabetes mellitus. Diabetes Res Clinical Pract 1985;1:95–101.10.1016/S0168-8227(85)80034-6Search in Google Scholar

12. Schnack C, Festa A, Schwarzmaier-D’Assie A, Haber P, Schernthaner G. Pulmonary dysfunction in type 1 diabetes in relation to metabolic long-term control and to incipient diabetic nephropathy. Nephron 1996;74:395–400.10.1159/000189342Search in Google Scholar PubMed

13. Benbassat CA, Stern E, Kramer M, Lebzelter J, Blum I, et al. Pulmonary function in patients with diabetes mellitus. Am J Med Sci 2001;322:127–32.10.1097/00000441-200109000-00003Search in Google Scholar PubMed

14. Buckingham B, Perejda AJ, Sandborg C, Kershnar AK, Uitto J. Skin, joint and pulmonary changes in type 1 diabetes mellitus. Am J Dis Child 1986;140:420–3.10.1001/archpedi.1986.02140190030018Search in Google Scholar PubMed

15. Primhak RA, Whincup G. Reduced vital capacity in insulin-dependent diabetes. Diabetes 1987;36:324–6.10.2337/diab.36.3.324Search in Google Scholar

16. Villa MP, Cacciari E, Bernardi F, Cicognani A, Salardi S, et al. Bronchial reactivity in diabetic patients. Relationship to duration of diabetes and degree of glycemic control. Am J Dis Child 1988;142:726–9.10.1001/archpedi.1988.02150070040021Search in Google Scholar

17. Verrotti A, Verini M, Chiarelli F, Verdesca V, Misticoni G, et al. Pulmonary function in diabetic children with and without persistent microalbuminuria. Diabetes Res Clin Pract 1993;21:171–6.10.1016/0168-8227(93)90066-ESearch in Google Scholar

18. Van Gent R, Brackel HJ, de Vroede M, Van der Ent CK. Lung function abnormalities in children with type 1 diabetes. Respir Med 2002;96:976–8.10.1053/rmed.2002.1402Search in Google Scholar

19. Villa M, Montesano M. Diffusing capacity for carbon monoxide in children with type 1 diabetes. Diabetologia 2004;47:1931–5.10.1007/s00125-004-1548-7Search in Google Scholar

20. Cazzato S, Bernardi F. Lung function in children with diabetes mellitus. Pediatr Pulmonol 2004;37:17–23.10.1002/ppul.10399Search in Google Scholar

21. Al-Saadi MM, Meo SA, Al-Drees AM, Mohamed S, Shaikh SA, et al. Lung functions in poorly controlled type 1 Saudi diabetic children and adolescents. Saudi Med J 2011;32:778–83.Search in Google Scholar

22. Lujbic S, Metelko Z, Car N, Roglic G, Drazic Z. Reduction of diffusion capacity for carbon monoxide in diabetic patients. Chest 1998;114:1033–5.10.1378/chest.114.4.1033Search in Google Scholar

23. Tanner JM. Growth at adolescence, 2nd ed. Oxford: Blackwell, 1962.Search in Google Scholar

24. ECSS. Report for working party on standardization of lung function tests. Eur Respir J 1993;6:16.Search in Google Scholar

25. Zapletal A, Samanek M, Paul T. Lung function in children and adolescents: methods, reference values. Karger: Basel, 1987.Search in Google Scholar

26. Stam H, Beek A, Grünberg K, Stijnen T, Tiddens HA, et al. Pulmonary diffusing capacity at reduced alveolar volumes in children. Pediatr Pulmonol 1996;21:84–9.10.1002/(SICI)1099-0496(199602)21:2<84::AID-PPUL4>3.0.CO;2-PSearch in Google Scholar

27. Rosenthal M, Bain SH, Cramer D, Helms P, Denison D, et al. Lung function in white children aged 4 to 19 years: I – Spirometry. Thorax 1993;48:794–802.10.1136/thx.48.8.794Search in Google Scholar

28. Rosenthal M, Cramer D, Bain SH, Denison D, Bush A, et al. Lung function in white children aged 4 to 19 years: II – Single breath analysis and plethysmography. Thorax 1993;48:803–8.10.1136/thx.48.8.803Search in Google Scholar

29. Weynand B, Jonckheere A, Frans A, Rahier J. Diabetes mellitus induces a thickening of pulmonary basal lamina. Respiration 1999;66:14–9.10.1159/000029331Search in Google Scholar PubMed

30. Schrader PC, Quanjer PH, van Zomeren BC, Wise ME. Changes in FEV1-height relationship during pubertal growth. Bull Eur Physiopathol Respir 1984;20:381–8.Search in Google Scholar

31. Wheatley CM, Baldi JC, Cassuto NA, Foxx-Lupo WT, Snyder EM. Glycemic control influences lung membrane diffusion and oxygen saturation in exercise-trained subjects with type 1 diabetes: alveolar-capillary membrane conductance in type 1 diabetes. Eur J Appl Physiol 2011;111:567–78.10.1007/s00421-010-1663-8Search in Google Scholar PubMed

Received: 2014-4-1
Accepted: 2014-7-14
Published Online: 2014-8-7
Published in Print: 2015-1-1

©2015 by De Gruyter

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