A study of pulmonary function test in type II diabetes mellitus: spirometry based

Suguna, S (2013) A study of pulmonary function test in type II diabetes mellitus: spirometry based. Masters thesis, Thanjavur Medical College, Thanjavur.


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INTRODUCTION: Diabetes mellitus is one of the most common chronic diseases in nearly all countries, and continues to increase in numbers and significance, as changing lifestyles lead to reduced physical activity, and increased obesity. According to WHO survey, India will be the world diabetic capital in 2025. As the prevalence of diabetes is increasing, with type II diabetes accounting for 90 – 95% of all cases. It is often asymptomatic in its early stages and can remain undiagnosed for many years. The etiogenesis of type II diabetes reflects the heterogeneous genetic, pathologic, environmental and metabolic abnormalities that can exist in different patients and all lead to a final common pathway of hyperglycemia. Chronic hyperglycemia is associated with continuing damage, dysfunction and failure of various organs, especially the eyes, kidneys, nerves, heart, lungs and blood vessels. The pathogenesis is thought to involve both a microangiopathic process and non enzymatic glycosylation of tissue proteins. This process results in impaired collagen and elastin cross-linkage with a reduction in strength and elasticity of connective tissue. Due to the presence of an abundant connective tissue and an extensive microvascular circulation raises the possibility that lung may be a target organ in diabetic patients. It has been demonstrated that pulmonary complications in diabetes are due to thickening of walls of alveoli, alveolar capillaries and pulmonary arterioles and these changes cause pulmonary dysfunction. These microvascular complications appear early within 5 to 10 yrs and macrovascular complications appear within 15 to 20 yrs from the onset of diabetes. In type I diabetes lung function has been investigated in several clinical studies and evidenced reduced lung volume, reduced elastic recoil, diminished respiratory muscle performance, decrease in pulmonary diffusion capacity for carbon monoxide. As the prevalence of type II DM is increasing, particularly in developing countries like India, and since these changes can potentially incapacitate the patients, it is of utmost importance to define these changes. It is also important to find ways of retarding the progression of disease so that they do not become irreversible thus allowing millions of patients to be economically productive). It has been suggested that pulmonary dysfunction may be one of the earliest measurable non metabolic alteration in diabetes. So it is important to determine whether these lung function changes also occur in type II diabetes. Thus, this study was under taken to correlate the lung function in type II diabetes with duration of diabetes and to find out whether it is obstructive or restrictive pattern. AIMS & OBJECTIVES: 1. To study lung function in type II diabetic patients. 2. To correlate pulmonary function test with duration of diabetes mellitus. 3. To find out whether it is obstructive or restrictive. MATERIALS AND METHODS: 40 healthy volunteers were randomly recruited from the general population residing around Thanjavur Medical College. 40 type II diabetic patients were selected from the diabetic outpatient department of age group 35 – 55yrs with duration of diabetes more than 2 yrs. This was a case-control type of study done in the period may 2011-2012. The study group was divided into two groups based on the duration of diabetes as 2-5yrs and 6-10yrs. Group I - 40 healthy controls. Group II - type II diabetic patients having diabetes for 2-5 years. Group III - type II diabetic patients having diabetes for 6-10 years. An informed written consent was obtained from all the participants prior to their participation in the study. The study protocol was approved by the Institutional ethical committee of Thanjavur Medical College. Anthropometric measurements like height, weight were measured and BMI was calculated. Glycemic status for the participants was measured by doing fasting & post prandial blood sugar. HbA1c was determined by turbidimetric immunoassay and its value less than 7 % was taken for study. Detailed history and thorough clinical examination was carried out. Inclusion criteria: Apparently healthy individuals with type II diabetic patients on oral hypoglycemic drugs and having diabetes for more than 2 years duration of age group 35 – 55years. Thorough clinical examination and history was obtained from the subjects in order to determine the health status of the individual. Exclusion criteria: • Smokers. • Patients with history of cardiac/respiratory disease (hypertension, myocardial infarction, bronchial asthma, bronchitis, tuberculosis). • History of recent surgery. • History of recent respiratory tract infection. • History of occupational exposure. Pulmonary function tests were done using computerized spirometer which was standardized according to American Thoracic Society performance criteria [Spiro Excel – Digital Spirometer – Medicaid systems]. RESULTS: Totally 80 subjects were participated in the study. Out of 80 participants, 40 were type II diabetes forming the study group and the remaining 40 were normal subjects forming the control group. The study group was divided into 2 subgroups based on the duration of diabetes as 2-5 years and 6-10 years. The anthropometric, biochemical and the lung function parameters were analyzed by arithmetic mean and standard deviation. The mean values of pulmonary function parameters of the diabetics were compared with healthy controls using Independent Student’s t test. The pulmonary function parameters were correlated with duration of diabetes by using Pearson’s correlation coefficient test. CONCLUSION: The result of the present study shows that there is a decrease in the pulmonary function in type II diabetics when compared with healthy controls. In this study there is a restrictive type of pulmonary impairment in type II diabetics and as the duration of diabetes increases the restrictive lung impairment becomes more prominent. Pulmonary function parameters are negatively correlated with the duration of diabetes. These findings are of importance in that they demonstrate the need for prevention of lung damage. The pulmonary dysfunction may be one of the earliest and easily measurable non-metabolic alterations in diabetes. Therefore the patients with diabetes are suggested to undergo pulmonary function testing periodically. As spirometry is much more reliable, valid and simple test, it is time to include the spirometer as a tool for monitoring diabetes. Strict glycemic control and regular breathing exercises to strengthen respiratory muscles is necessary to improve the pulmonary function in type II diabetics.

Item Type: Thesis (Masters)
Uncontrolled Keywords: pulmonary function test ; type II diabetes mellitus ; spirometry based.
Subjects: MEDICAL > Physiology
Depositing User: Punitha K
Date Deposited: 16 Jun 2018 02:09
Last Modified: 17 Jun 2018 03:37
URI: http://repository-tnmgrmu.ac.in/id/eprint/8510

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