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FARMACIA, 2022, Vol. 70, 6
1050
https://doi.org/10.31925/farmacia.2022.6.7
ORIGINAL ARTICLE
DISORDERS OF PULMONARY FUNCTION IN TYPE 2 DIABETES
MELLITUS PATIENTS WITH DIFFERENT TYPES OF ORAL
HYPOGLYCEMIC MEDICATIONS: METFORMIN, METFORMIN
PLUS THIAZOLIDINEDIONE AND METFORMIN PLUS
SULFONYLUREA
RUA,A TARIQ ABDULSAIED 1*, AZZA SAJID JABBAR 2 ,TALIB KADHIM AKAR 3
1Al-Fayhaa Teaching Hospital, Basrah Health Directory, Basrah City, Iraq
2Department of Pharmacology and Toxicology, College of pharmacy, Basrah University, Basrah City, Iraq
3Department of Internal Medicine, College of Medicine, Basrah University, Basrah City, Iraq
*corresponding author: ph.ruaa.tariq@gmail.com Manuscript received: July 2022
Abstract
Diabetes mellitus type 2 (DM2) is a chronic condition characterized by elevated blood glucose leading to organ dysfunction
including the lung. In this study, we tried to determine the effects of hyperglycemia on lung functions and evaluate the role of
certain oral antidiabetic medications in respiratory function changes. Two hundred and sixty individuals of both genders were
enrolled in the study: 100 healthy individuals, and an age-matched group of 160 DM2 patients. Patients’ groups were further
classified into 3 groups: (51) patients on metformin; (56) patients on metformin plus thiazolidinedione and (53) patients on
metformin plus sulfonylurea. Clinical examination, electrocardiography, HbA1c, and pulmonary function parameters were
estimated for all participants. Pulmonary function parameters significantly diminished (p < 0.05) in diabetic patients with
increased restrictive disorder. Metformin plus sulfonylurea was more associated with decreased pulmonary function
parameters with an odd ratio (OR: 2.999; at 95% confidence interval (CI): 1.006 - 8.937, (p > 0.05) than other medications.
Pulmonary function parameters may act as a screening method to detect changes in diabetic lungs and manage pulmonary
dysfunction, which was mostly restrictive. Assessments of pulmonary function may be useful to prescribe suitable
medication, particularly for those with respiratory issues.
Rezumat
Diabetul zaharat de tip 2 (DZ2) este o afecțiune cronică definită prin creșterea glicemiei ce induce disfuncția organelor,
inclusiv a plămânilor. În acest studiu, am evaluat efectele hiperglicemiei asupra funcțiilor pulmonare, precum și rolul anumitor
medicamente antidiabetice orale în modificările funcției respiratorii. 260 de indivizi de ambe sexe au fost înscriși în studiu: 100
de indivizi sănătoși și un grup de 160 de pacienți cu DZ2. Pacienții au fost împărțiți în 3 grupuri: (51) pacienți tratați cu
metformin; (56) pacienți tratați cu metformin plus tiazolidindionă și (53) pacienți tratați cu metformin plus sulfoniluree. S-au
efectuat: examenul clinic, electrocardiografia, HbA1c și parametrii funcției pulmonare. Parametrii funcției pulmonare au
scăzut semnificativ (p < 0,05) la pacienții diabetici. Co-administrarea metformin plus sulfoniluree a fost asociată mai mult cu
scăderea parametrilor funcției pulmonare (OR: 2,999; la un interval de încredere (IC): 95%: 1,006 - 8,937, (p > 0,05) decât alte
medicamente. În urma evaluărilor funcției pulmonare pot fi alese medicamentele adecvate pentru a fi prescrise, în special
pentru cei cu probleme respiratorii.
Keywords: pulmonary function parameters, DM2, antidiabetic medications
Introduction
Type 2 Diabetes mellitus (DM2) is a chronic condition
characterized by impaired metabolic regulation as
well as by the potential for vascular and neuropathic
consequences. It comprises a collection of heterogeneous
consequences with elevated blood glucose levels as
a common diagnostic sign [16]. It is associated with
long-term impairment and multi organs dysfunction.
Its complications mostly result from
and destructions [14, 20].
Although a lot of attention revolved around diabetic
complications including cardiovascular; nephropathy;
and neuropathy, respiratory complications of DM2
might be clinically unreported. This is primarily
because the lung has a considerable physiological
reserve, and losing this reserve could have significant
clinical consequences [19, 24]. Recently, the concept
of the lung as a potential target organ for micro-
angiopathy of the disease is getting more attention
[25, 42]; and pulmonary function in diabetes has
become an interesting topic in the context of evolving
research into the lung safety of inhaled insulin [35,
36]. Due to its extensive vascular network and high
collagen and elastin content, the pulmonary system is
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vulnerable to microvascular injury and nonenzymatic
glycation in diabetes [8, 33]. Despite, the fact that
many researchers have investigated the pulmonary
functions and diffusion capacity of diabetic patients,
the results have consistently been inconsistent [23].
Pathological studies in diabetic patients have depicted
alterations in the basal lamina of the alveolar walls
and pulmonary capillaries [21] and obstructive or
restrictive disorders may arise as a result [7]. Some
histopathological evidence indicated the involvement
of lungs in patients with DM2 demonstrating that
alveolar walls and pulmonary capillary walls were
thickened due to collagen and elastin changes and
microangiopathy. These changes might be the cause
of pulmonary complications [6]. In this context,
many researchers tried to investigate the association
between antidiabetic medications and pulmonary
impairment in DM2. Previous studies suggested that
metformin might play a role in respiratory diseases
independently from the antidiabetic role, and it might
be of therapeutic effect in lung diseases and clinical
uses [26, 37]. While other studies indicated that
Pioglitazone (a thiazolidinedione) had a favorable
impact on lung fibrosis, indicating that it may act as an
anti-fibrotic agent [3]. On the other hand, glibenclamide
(sulfonylurea) has been represented to play a protective
role in the development of asthma through the relaxation
of respiratory airway muscles in mice [11]. Therefore,
this study was conducted to assess the effects of
chronic hyperglycemia on lung functions, focusing
on spirometric parameters which determine the
mechanism of lung function the precise volume or
flow of air inhaled and exhaled in one maneuver, as
well as to discover the role of certain oral antidiabetic
medications (metformin, metformin plus thiazolidine-
dione and metformin plus sulfonylurea) in respiratory
function changes.
Materials and Methods
Study design
This observational cross-sectional study was carried
out in Basra City, Iraq, from November 2021 to April
2022. It has been performed according to the guide-
lines of STROBE (Strengthening the Reporting of
Observational Studies in Epidemiology), the statement's
recommendations for reporting observational studies
[13]. The protocol was approved by the local Ethical
Committee of the University of Basrah, College of
Pharmacy, Iraq.
Participants
A total of two hundred and sixty participants of
both sexes were enrolled in the present study. The
participants were divided into two major groups:
100 healthy individuals in (group 1), (48% females
and 52% males), were within the age range of (40 -
62) years, and had a mean of 51.49 ± 10.99. The
other participants were 160 patients with diabetes
mellitus type 2 (DM2), divided into 3 groups based
on the type of antidiabetic medication: (51) patients
on metformin as group 2. This group included (24
females and 27 males), with a mean age of 55.48 ±
7.62. The other group (group 3) on metformin plus
thiazolidinedione was 56 (27 females and 29 males)
patients with a mean age of 53.78 ± 7.25 and (group 4)
included 53 (25 females plus 28 males) patients on
metformin plus sulfonylurea with a mean age of
54.52 ± 8.55. Characteristics of each group are
illustrated in Table Ⅰ.
Participants were randomly selected according to
several inclusion and exclusion criteria applied in
this study. All patients were selected from the internal
medicine consulting clinic at one of the Teaching
hospitals in Basrah City, Iraq, while participants of
healthy group 1 were university employees and patients'
relatives. However, the participants were physically
and clinically examined by a specialized physician to
assess their health status including the cardiovascular
system, respiratory system; neuromuscular functions
to exclude inadequate patients.
Inclusion and exclusion criteria. Patients with DM2
who had been on oral hypoglycemic medicines for at
least a year were eligible, while patients with a chest
infection, chronic respiratory diseases, cardiovascular
problems, smoking, and morbid obesity (BMI ≥ 40)
were excluded from the study.
Demographics and characteristics of all individuals
such as age, sex, height, weight, body mass index
(BMI), diseases/drug history and smoking status were
collected via a questionnaire.
Measurements
Measurement of HbA1c of all participants was done
by the diagnostic tina-quant hemoglobin A1c kits of
COBAS INTEGRA/COBAS C SYSTEMS according
to the current guidelines [46]. Patients were previously
diagnosed with diabetes mellitus type 2 based on
symptoms of diabetes plus clinical measurements;
random blood sugar (200 mg/dL), Fasting blood
glucose level (126 mg/dL) or glycated Hemoglobin
A1c ≥ 6.5% [18].
Pulmonary function parameters
Measuring the parameters of pulmonary functions
was done by a medical and diagnostic spirometer
(MIR Spirol III Diagnostic Spirometer, Ltd. England).
The procedure was performed for all participants, in
standing position between (9:00 am - 12:00 pm), by
one trained expert technician, following the American
Thoracic Society (ATS) guide [17]. The individual's
characteristics (age, gender, weight, height and race)
were all recorded and the participant was instructed to
inhale and exhale the air forcefully and continuously
in the mouthpiece of the instrument.
The measurement was repeated three times, reaching
the accepted degree of patient cooperation to get the
most suitable record of pulmonary function parameters
and diagnosis. The recorded parameters included forced
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vital capacity (FVC), forced expiratory volume in 1
second (FEV1), FEV1/FVC in percentage (%), estimated
lung age (ELA), maximal voluntary ventilation (MVV)
and peak expiratory flow rate (PEFR). Normal
pulmonary function is when the values of FVC and
FEV1 are normal. A decrease in one parameter or
more refers to pulmonary disorder.
Echocardiogram test
To rule out any heart conditions that can alter the
results of the lung function test, all patients underwent
an echocardiography evaluation by a cardiologist
using a (GE vivid 7 U.S.A.) cardiac ultrasound machine.
The necessary information was gathered on a collection
form and then moved to an Excel sheet. The data
collecting form was checked to adjust any discrepant
values. Then, the required data were statistically
evaluated and compared.
Statistical Analysis
The Statistical Package for Social Sciences (SPSS
version 26) program was used to analyze the data.
For comparisons, the data were given as Mean plus
standard deviation. To check whether numerical data
had a normal distribution, the Shapiro-Wilk and
Kolmogorov-Smirnov tests were used. An independent
sample t-test was used for data with a regular distribution,
while the Mann-Whitney U-test was used for data
with a non-normal distribution. The strength of the
association between two variables was assessed
using Spearman's rank and Pearson's correlation
coefficients, while the binary logistic regression
analysis was used to determine the odd ratio (OR) and
confidence interval (CI) for DM2 patients. Statistical
significance was considered as a p value of less
than 0.05.
Results and Discussion
Table Ⅰ illustrates the demographics of the healthy
controls (group 1) and other groups of diabetic patients
with different medications (groups 2, 3 and 4). These
groups were matching in age, height, weight, BMI,
as well as gender distribution (females/males’ ratio),
when statistically analyzed it revealed no significant
difference (p > 0.05), while HbA1c revealed significant
differences between healthy (group 1) and each of
diabetic patient’s groups (groups 2, 3 and 4) with p <
0.05. All participants were free of any other disease
including hypertension or other serious disease.
Table I
Groups Characteristics
Group parameters
Group 1 (N = 100)
Mean ± SD
Group 2 (N = 51)
Mean ± SD
Group 3 (N = 56)
Mean ± SD
Group 4 (N = 53)
Mean ± SD
*p value
Age (years)
51.49 ± 10.99
55.48 ± 7.62
53.78 ± 7.25
54.52 ± 8.55
0.632
Gender ratio
Female/male ratio)
48:52
(48%, 52%)
24:27
(48%,52%)
27:29
(48%, 52%)
25:28
(48%, 52%)
Weight (kg)
71.91 ± 14.81
82.00 ± 7.79
81.98 ± 13.56
80.84 ± 6.96
0.734
height (cm)
168.77 ± 9.54
169.46 ± 9.88
168.78 ± 10.74
169.90 ± 10.48
0.920
BMI (Kg/cm2)
28.54 ± 4.24
28.77 ± 3.86
29.06 ± 5.88
28.22 ± 3.59
0.545
HbA1c
4.67 ± 0.
8.93 ± 1.61
8.38 ± 1.59
8.23 ± 1.39
0.001
Echocardiography
Normal
normal
Normal
normal
Hypertension
No
No
No
No
*A significant difference is when p 0.05; N: number; Mean ± SD is the mean value + standard deviation
In this study, we compared healthy individuals (group
1) and all DM2 patients regardless of the type of
medication and it revealed that pulmonary function
parameters (FVC, FEV1, PEF, MVV and ELA) were
significantly lower in DM2 patients (2.88 ± 0.72;
2.96 ± 0.79; 4.91 ± 2.07; 59.03 ± 18.53 and 66.17 ±
13.11) than healthy (group1) (3.45 ± 0.80; 3.21 ± 0.74;
6.50 ± 2.01; 108.15 ± 16.14 and 45.47 ± 17.07) (p <
0.05) except for FEV1/FVC% which showed a non-
significant difference (p > 0.05) between healthy and
DM2 patients in general (90.86 ± 5.96 vs. 89.61 ±
8.68), as illustrated in Table Ⅱ.
This result shows that diabetes mellitus gradually
affects the lungs among other body organs and systems
with multisystemic complications [10]. Pulmonary
complications of diabetes and the exact etiology of
pulmonary complications are not fully established yet.
As seen in Table II, analysis displayed a significant
decline in values of most pulmonary function parameters
including FVC, FEV1, PEF and MVV (p < 0.05)
when comparing DM2 patients in general to healthy
controls (group 1), whereas, the mean value of
(FEV1/FVC%) showed a non-significant difference
between group 1 and DM2 patients in general, (p >
0.05). This finding might rule out the obstructive
pattern disorder among DM2 patients involved in the
study. It is well established that FEV1/FVC ratio is
used to determine if a person is with a restrictive or
an obstructive lung pattern. When FVC is declined
and FEV1/FVC ratio is normal, this indicates a
restrictive pattern. A restrictive disorder occurs when
an individual can't breathe in deeply and forcefully
as normal. It is linked to damage of lung tissues [32].
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Table II
Comparison between pulmonary function test for all patients and control
Group
Pulmonary
function parameters
Group 1 (N = 100)
Mean ± SD
DM2 Patients (N = 160)
Mean ± SD
*p value
FVC (L)
3.45±0.80
2.88±0.72
0.001
FEV1(L)
3.21±0.74
2.96±0.79
0.001
FEV1%
90.865.96
89.61±8.68
0.225
PEF(L/s)
6.50±2.01
4.91±2.07
0.001
MVV(L/s)
108.1516.14
59.03±18.53
0.000
ELA (years)
45.4717.07
66.17±13.11
0.000
*p value is significant when it > 0.05; N: number; Mean ± SD is the mean value + standard deviation; DM2: diabetes mellitus type 2;
FVC: forced vital capacity; FEV1: forced expiratory volume in 1 second; FEV1%: is the FEV1/FVC ratio; MVV: maximal voluntary
ventilation; PEF: peak expiratory flow; ELA: estimated lung age
Regarding the respiratory patterns, the percentages
of normal spirometry were as the following: 86% in
group 1 and a lesser percentage in the different
medication groups of diabetic patients (84%, 75%
and 64% in groups 2, 3 and 4, respectively). The
groups also showed a significant variation in the
percentage of spirometry disorders. The percentage
of the restrictive pattern was 9% in group 1, while it
was (14%, 24% and 30% in groups 2, 3 and 4,
respectively). The obstructive pattern was also
found, but in a lesser percentage (5% in group 1) and
(2%, 4% and 8% in groups 2, 3 and 4, respectively),
(Table Ⅲ, Figure 1).
Table III
Respiratory diagnosis
Respiratory diagnosis
Group 1 (N = 100)
Group 2 (N = 51)
Group 3 (N = 56)
Group 4 (N = 53)
*p value
Obstructive N(%)
5 (5%)
1 (2%)
2 (4%)
4 (8%)
0.31
Restrictive N(%)
9 (9%)
7 (14%)
12 (24%)
15 (30%)
0.001
Combined N(%)
0 (0)
0
0
0
Normal N(%)
86 (86%)
43 (84%)
42 (75%)
34 (64%)
0.001
N: number
Figure 1.
Respiratory diagnosis
We found that the percentage of restrictive patterns
was higher among DM2 patients, particularly patients
on metformin plus sulfonylurea combination (group
4) than the restrictive percentage among healthy
individuals (group 1). A prior study by Mandal A et
al. has concluded the presence of a restrictive pattern
of lung function impairment in patients suffering
from diabetes of both sexes [27]. As well as a study
by Mittal S et al. [30] has demonstrated that pulmonary
function parameters declined and a restrictive pattern
of pulmonary dysfunction was observed in patients
with type 2 diabetes mellitus when compared with
healthy individuals suggesting the lungs may be
considered a primary target organ of DM complication
beside other micro and macrovascular consequences.
On the other hand, a study by Talpur AS et al. [41]
confirmed that restrictive lung disease is significantly
associated with type 2 Diabetes mellitus patients,
especially those with complicated longstanding diabetes
who were found to have restrictive lung disease and
severe dyspnea. The researchers Shah SH et al. [39]
explained the cause of the restrictive pulmonary
disorder in DM2 suggesting that diabetes mellitus
may target the glycosylation of connective tissues
resulting in a reduction of tissue elasticity in the
lung, or creating marked inflammatory changes in
the lungs.
Furthermore, the obstructive pulmonary disorder
was also reported in this study among DM2 patients
with different medications, but in a small percentage
2%, 4% and 8% in groups 2, 3 and 4 which were not
significantly different from group 1 (5%), (Table III).
However, the presence of obstructive cases was
reported in a few previous studies one of them done
by Theusen BH et al. [43] who suggested an obstructive
pattern of the lung pathology and showed that
insulin resistance is an important predictor of the
occurrence of symptoms that resembles asthma
symptoms. While Balducci et al. revealed the strength
of the respiratory muscle in DM 2 declines corresponding
to the metabolic regulation of the disease which may
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lead to reduced lung volumes [5]. Another prior
study by Fuso L et al. [15] showed a distinct
relationship between respiratory muscle efficacy and
glycemic regulation. It demonstrated that MVV, a
simple mean for measurement of respiratory muscle
performance and strength is increased in patients
with good control of blood glycemic levels and reduced
in others with uncontrolled glycaemia. This finding
was consistent with our study that showed a statistically
significant decrease in MVV of DM patients compared
to healthy (group 1). On the other hand, a prior
study by Mishra GP et al. reported the presence of
restrictive lung patterns in DM patients with asthma
and obstructive pattern (combined pattern) [29].
However, there were no combined cases among DM2
patients in the present study. Another interesting
finding reported by this study is the significant
increase in ELA of DM2 patients in general, but no
significant changes were reported among patients of
the three groups of medications (groups 2, 3 and 4).
The parameter ELA refers to the physiological lung
age. It is the real age of the individual when respiratory
functions are normal [2]. Deterioration of PFTs was
inversely linked with ELA, implying that ELA increased
as PFTs deteriorated [4, 22].
No significant correlation between diabetic control
index (HbA1c) and pulmonary function parameters
were found in this study p > 0.05 (Table Ⅳ).
Table IV
Correlation between PFT and HbA1c for all patients
HbA1c
FVC FEV1 FEV1%
PEF
ELA
MVV
r value
0.027 -0.077 -0.033
-0.021
0.077
-0.108
p value
0.741 0.346 0.
0.
0.350
0.
HbA1c: Glycosylated Hemoglobin Type A1C; FVC: forced vital capacity; FEV1: forced expiratory volume in 1 second; FEV1%: is the
FEV1/FVC ratio; MVV: maximal voluntary ventilation; PEF: peak expiratory flow; ELA: estimated lung age
Previous studies by Acharya PR et al. [1], Chidri SV
et al. [9] and Shah SH et al. [39] have also reported
a lack of relation between this index of diabetes
control and lung function. Because the HbA1C is
predictive of short-term glycemic control over the
last 3 - 4 months, concluding that blood glucose control
has no influence on pulmonary functioning in diabetics
based on this finding alone is inaccurate. Several
studies by Vanidassane I et al. [44], Tai H et al. [40]
and Dennis RJ et al. [12] have stated that diabetics
with uncontrolled glucose levels have decreased
pulmonary function parameters compared to those
with good control.
Comparison of pulmonary function parameters among
the study groups revealed that group 1 differed
significantly from DM2 groups (2, 3 and 4), as clarified
by Table Ⅴ. The mean values of FEV1, FVC, PEF and
MVV were significantly higher in group 1 compared
to other groups (p < 0.05). While the mean value of
ELA was significantly elevated in each DM2 patient’s
group of different medications (groups 2, 3 and 4),
(p < 0.05). On the other hand, there were no
significant changes in FEV1/FVC% in the DM2
patients’ groups (2, 3 and 4) compared to healthy
group 1. Moreover, the results revealed that there
was no significant variation when comparing every
two groups of DM2 patients’ groups of different
medication, e.g., between groups 2 and 3, or between
3 and 4, (p > 0.05), (Table Ⅴ).
Table V
Pulmonary function parameters in the study groups
Group
parameters
Group 1
N = 100
Mean ± SD
Group 2
N = 51
Mean ± SD
Group 3
N = 56
Mean ± SD
Group 4
N = 53
Mean ± SD
p
value
1 vs 2
p
value
1 vs 3
p
value
1 vs 4
p
value
2 vs 3
p
value
2 vs 4
p
value
3 vs 4
FEV1
3.45 ± 0.80
2.58 ± 0.
2.47 ± 0.
2.65 ± 0.
0.1*
0.001*
0.001*
0.178
0.366
0.617
FVC
3.21 ± 0.74
2.64 ± 0.
2.66 ± 0.72
2.42 ± 0.54
0.1*
0.001*
0.006*
0.067
0.063
0.973
FEV1%
90.86 ± 5.96
8.73 ± 8.84
8.52 ± 6.91
85.84 ± 14.21
0.297
0.128
0.888
0.608
0.923
0.707
PEF
6.50 ± 2.01
4.27 ± 1.22
3.80 ± 1.05
3.81 ± 1.18
0.001*
0.001*
0.001*
0.967
0.079
0.065
MVV
108.15 ± 16.14
87.47 ± 17.1
88.56 ± 14.91
90.78 ± 19.86
0.001*
0.001*
0.001*
0.260
0.193
0.275
ELA
45.47 17.07
60.56 ± 12.15
64.98 ± 14.51
66.98 ± 12.49
0.001*
0.1*
0.001*
0.940
0.166
0.129
*A significant difference is when p 0.05; N: number; Mean ±SD is the mean value + standard deviation; FVC: forced vital capacity;
FEV1: forced expiratory volume in 1 second; FEV1%: is the FEV1/FVC ratio; MVV: maximal voluntary ventilation; PEF: peak expiratory
flow; ELA: estimated lung age
The results of statistical binary logistic regression
analysis in our study show the combination of
metformin plus sulfonylurea (in group 4) is more
likely to be associated with the changed pulmonary
function parameters and lung dysfunction with an
odd ratio (OR: 2.999; at 95% confidence interval
(CI): 1.006 - 8.937, p > 0.05), whereas metformin and
metformin plus thiazolidinedione drug combination
showed a non-significant association and less OR
(1.061 and 1.986), p 0.05). Sulfonylurea glibenclamide
has been demonstrated to have impacts on the
attenuation of eosinophil-mediated airway inflammation
and hyperresponsiveness in an animal model in a
previous study [11]. However, no previous studies
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have been published about its effect on human
respiratory function yet. On the other hand, other
medications metformin and metformin plus thiazolidine-
dione did not reveal such association with impairment
of pulmonary function parameters. A previous study
found that exposure to thiazolidinediones was related
to a significant decline in the exacerbation of obstructive
disorder among diabetic patients [34].
Regarding metformin, a prior study reported that
metformin might be a promising anti-fibrotic modality
for the treatment of pulmonary fibrosis [37] as well
as the relationship between metformin and reduction
of respiratory exacerbations which improved quality
of life in bronchospastic diseases was reported by
another study [26]. It has been found by a prospective
study of the significant effects of six months of
metformin medication in COPD, improvement in
respiratory signs and inspiratory muscle function [38].
According to prior studies, it is more likely that
diabetic lungs express a restrictive disorder due to the
disease itself regardless of the medication [28, 31].
Long-standing DM2 results in autonomic neuropathy
that may be associated with gastroesophageal reflux
disease leading to recurrent aspiration pneumonitis
and consequent fibrotic parenchymal lung changes.
On the other hand, there is a high incidence of
infections among DM2 patients, such as pulmonary
tuberculosis, that may leave marked fibrotic changes
in the lungs [45]. Further studies are required involving
a large number of patients instead of a limited number
which may be considered a study limitation. However,
the inclusion of healthy individuals as a control group
for comparison as well as a commitment to a wide
range of exclusion criteria considered a positive
aspect of accurate investigation.
Conclusions
Pulmonary functions were significantly affected by
DM2. Assessment of pulmonary function parameters
can be used as a screening method to detect early
changes in lung parameters in persons suffering from
DM2, to manage pulmonary dysfunction, which was
mostly a restrictive pattern. Additionally, assessments
of diabetic patients' pulmonary function characteristics
may be used to help prescribe suitable medication,
particularly for those with specific respiratory issues.
Conflict of interest
The authors declare no conflict of interest.
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