Effect of Glucose Improvement on Spirometric Maneuvers in Patients With Type 2 Diabetes: The Sweet Breath Study.

Abstract

Type 2 diabetes exerts a deleterious effect on lung function. However, it is unknown whether an improvement in glycemic control ameliorates pulmonary function. Prospective interventional study with 60 patients with type 2 diabetes and forced expiratory volume in 1 s (FEV1) ≤90% of predicted. Spirometric maneuvers were evaluated at baseline and after a 3-month period in which antidiabetic therapy was intensified. Those with an HbA_1c reduction of ≥0.5% were considered to be good responders (<i>n</i> = 35). Good responders exhibited a significant improvement in spirometric values between baseline and the end of the study (forced vital capacity [FVC]: 78.5 ± 12.6% vs. 83.3 ± 14.7%, <i>P</i> = 0.029]; FEV1: 75.6 ± 15.3% vs. 80.9 ± 15.4%, <i>P</i> = 0.010; and peak expiratory flow [PEF]: 80.4 ± 21.6% vs. 89.2 ± 21.0%, <i>P</i> = 0.007). However, no changes were observed in the group of nonresponders when the same parameters were evaluated (<i>P</i> = 0.586, <i>P</i> = 0.987, and <i>P</i> = 0.413, respectively). Similarly, the initial percentage of patients with a nonobstructive ventilatory defect and with an abnormal FEV1 decreased significantly only among good responders. In addition, the absolute change in HbA_1c inversely correlated to increases in FEV1 (<i>r</i> = -0.370, <i>P</i> = 0.029) and PEF (<i>r</i> = -0.471, <i>P</i> = 0.004) in the responders group. Finally, stepwise multivariate regression analysis showed that the absolute change in HbA_1c independently predicted increased FEV1 (<i>R</i> ² = 0.175) and PEF (<i>R</i> ² = 0.323). In contrast, the known duration of type 2 diabetes, but not the amelioration of HbA_1c, was related to changes in forced expiratory flow between 25% and 75% of the FVC. In type 2 diabetes, spirometric measurements reflecting central airway obstruction and explosive muscle strength exhibit significant amelioration after a short improvement in glycemic control.