The Effects of Diabetes on Gas Transfer Capacity, Lung Volumes, Muscle Strength, and Cardio-pulmonary Responses During Exercise

IF 4.6 2区 医学 Q1 RESPIRATORY SYSTEM
Lung Pub Date : 2024-09-13 DOI:10.1007/s00408-024-00744-9
Eldar Priel, Emir Ali, Danica Brister, Nermin Diab, Andy Freitag, Paul M. O’Byrne, Hertzel Gerstein, Kieran J. Killian, Imran Satia
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Abstract

Background

Diabetes is a risk factor for the development of vascular disease, chronic kidney disease, retinopathy, and neuropathy. Diabetes is a co-morbid condition commonly present in patients with respiratory disorders but the extent to which it influences ventilatory capacity, gas exchange, and functional capacity is not well known.

Research question

Does the presence of diabetes contribute to impairment in spirometry, gas transfer, and exercise capacity?

Methods

Retrospective analysis of all subjects who performed incremental cardio-pulmonary exercise testing (CPET) between 1988 and 2012 at McMaster University Medical Centre. The impact of diabetes on physiological outcomes and maximum power output (MPO) was assessed using stepwise multiple additive linear regression models including age, height, weight, sex, muscle strength, and previous myocardial infarct as co-variates, and was also stratified based on BMI categories.

Results

40,776 subjects were included in the analysis; 1938 (5%, 66% male) had diabetes. Diabetics were older (59 vs. 53 years), heavier (88.3 vs.78.0 kg), and had a higher BMI (31 vs. 27 kg/m2). The presence of diabetes was independently associated with a reduction in FEV1 (− 130 ml), FVC (− 220 ml), DLCO (− 1.52 ml/min/mmHg), and VA (− 340ml) but not KCO. Patients with diabetes achieved a lower % predicted MPO[diabetic subjects 70% predicted (670 kpm/min ± 95% CI 284) vs. 80% in non-diabetics (786 kpm/min ± 342), p < 0.001]. With the exception of KCO, these differences persisted across BMI categories and after adjusting for MI.

Conclusion

The presence of diabetes is independently associated with weaker muscles, lower ventilatory and gas transfer capacity and translates to a lower exercise capacity. These differences are independent of age, height, weight, sex, and previous MI.

Abstract Image

糖尿病对运动时气体传输能力、肺容积、肌肉力量和心肺反应的影响
背景糖尿病是导致血管疾病、慢性肾病、视网膜病变和神经病变的危险因素。糖尿病是呼吸系统疾病患者的常见并发症,但它对通气能力、气体交换和功能能力的影响程度尚不清楚。研究问题糖尿病是否会导致肺活量、气体转移和运动能力受损?采用逐步多元加和线性回归模型评估糖尿病对生理结果和最大功率输出(MPO)的影响,将年龄、身高、体重、性别、肌肉力量和既往心肌梗死作为共变因素,并根据体重指数进行分层。糖尿病患者年龄较大(59 岁对 53 岁),体重较重(88.3 公斤对 78.0 公斤),体重指数较高(31 公斤对 27 公斤/平方米)。糖尿病与 FEV1(- 130 毫升)、FVC(- 220 毫升)、DLCO(- 1.52 毫升/分钟/毫米汞柱)和 VA(- 340 毫升)的降低有关,但与 KCO 无关。糖尿病患者的 MPO 预测百分比较低[糖尿病患者为 70% 预测百分比(670 kpm/min ± 95% CI 284),非糖尿病患者为 80% 预测百分比(786 kpm/min ± 342),p < 0.001]。除 KCO 外,这些差异在 BMI 类别和调整 MI 后仍然存在。这些差异与年龄、身高、体重、性别和既往的心肌梗死无关。
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来源期刊
Lung
Lung 医学-呼吸系统
CiteScore
9.10
自引率
10.00%
发文量
95
审稿时长
6-12 weeks
期刊介绍: Lung publishes original articles, reviews and editorials on all aspects of the healthy and diseased lungs, of the airways, and of breathing. Epidemiological, clinical, pathophysiological, biochemical, and pharmacological studies fall within the scope of the journal. Case reports, short communications and technical notes can be accepted if they are of particular interest.
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