Thangadhurai, A (2012) Assessment of Pulmonary Function Tests in Type 2 Diabetes Mellitus (Spirometry Based). Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: Diabetes Mellitus is a heterogeneous group of metabolic disorders characterized by chronic hyperglycemia resulting from defects in insulin secretion, action or both. Based on etiopathogenic categories, it is classified as Type 1 and Type 2 diabetes mellitus. In Type 1 there is absolute deficiency of insulin secretion. In Type 2 there is a combination of resistance to insulin action and inadequate compensatory insulin secretory response. Diabetes mellitus is accompanied by wide spread biochemical, morphological and functional abnormalities which may precipitate certain complications that affect the renal, cardio-vascular, neural systems and also skin, liver, collagen and elastic fibres. Thus diabetes is a multisystem disorder that affect many organs of the body. AIM OF THE STUDY: 1. To study the ventilatory function of individuals with type 2 diabetes mellitus by performing spirometry. 2. To record the pulmonary function test in Type-2 diabetes mellitus and control group. 3. To evaluate the impact of Type-2 DM on pulmonary functions by comparing with control groups. 4. To correlate the spirometric values and variables (duration,FBS, PPBS,HbA1c) of diabetes. MATERIALS AND METHODS: A case-control study, descriptive, prospective study of the lung function of diabetics compared with age and sex-matched non-diabetic controls. Sample size: The sample used in this study consisted of 100 subjects – 50 Diabetics, 50 Healthy Non-Diabetics. Sampling procedure: 50 Diabetic individuals were recruited from those attending outpatient departments of Government Rajaji Hospital, Madurai. 50 Healthy Non-Diabetic individuals from the general population were taken as controls. Ethical clearance: Ethical clearance was obtained from Government Rajaji Hospital ethical committee for human research to conduct the study. Inclusion criteria: • Type 2 diabetes mellitus of more than 5 years duration • able to give informed consent. Exclusion criteria: • Smokers • Present or past history of respiratory illness that might affect lung function such as asthms, COPD, tuberculosis, bronchiectasis, interstitial lung disease. • History of occupational exposure to any substance that could affect lung function. • Individuals with current or recent upper respiratory or lower respiratory infection, that could predispose to heightened airway reactivity. • Individuals with unacceptable spirometric technique. An unacceptable spirometry was that in which FEV1 or FVC could not be correctly measured due to Cough, Obstruction of teeth or toungue, Sub-maximal effort, Air escape, Effort sustained for less than 6 seconds duration, Lack of understanding of the procedure, Recent thoracic and abdominal surgery. Materials: Micro medical spirometer, weighing scale, stadiometer, Microsoft excel. Methodology: Diabetics and controls were selected as per the criteria laid down. Their written consent was taken. The screening of diabetic subjects and control group was done for exclusion criteria. The history was elicited. Age, height, weight, BMI were recorded. Each subject was instructed to visit cardio respiratory laboratory with 6 hrs of fasting on a specific date, the blood samples [3ml volume] was drawn for estimation of FBS and glycated hemoglobin. CONCLUSION: The present study was undertaken to resolve conflict between two schools of thought, one expounding impact of Type-2 diabetes mellitus on respiratory system and another non-impact. Pulmonary functions in Type-2 diabetes mellitus and controls were statistically compared to resolve this. The intra diabetic subgroups- FBS wise, PPBS wise, duration wise and HbA1c were correlated to pulmonary functions to find out the impact of Type-2 diabetes mellitus on respiratory system. This study confirms the following features. 1) The pulmonary functions FVC, FEV1, PEF and FEF25%-75% are decreased in Type-2 diabetes mellitus compared to controls. FEV1/FVC% increased in Type-2 diabetes mellitus, which is indicative of restrictive disorder of the lung. 2) There were negative correlation between FBS levels and pulmonary functions FVC, FEV1 and FEV1/FVC. Linear relationship exists between increasing FBS and FEV1/FVC%, which is indicative of restrictive disorder of the lung. 3) Poor glycemic control were reflected in pulmonary functions with the decline of spirometric parameters associated with high PPBS levels. Linear relationship exists between increasing PPBS and FEV1/FVC%, which is indicative of restrictive disorder of the lung. 4) There were negative correlation between duration of diabetes mellitus and pulmonary functions FVC, FEV1, PEF and FEF25%-75%. Linear relationship exists between increasing duration and FEV1/FVC%, which is indicative of restrictive disorder of the lung. 5) Poor glycemic control were also reflected in Pulmonary function test as HbA1c level increases the spirometric values FVC, FEV1, FEV1/FVC, were consistently decreased. The above mentioned effects of Type-2 diabetes mellitus on pulmonary functions are all due to the alterations in pulmonary connective tissue, thickening of basement membrane of capillary and alveolus, modification of surfactant, decreased recoiling tendency of lung and decreased muscle endurance.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Pulmonary Function Tests ; Type 2 Diabetes Mellitus ; Spirometry. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 20 Mar 2018 03:04 |
| Last Modified: | 20 Mar 2018 03:04 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6378 |
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