Association of Lung Function Indices with Inflammatory Marker (hsCRP) and Glycemic Control in Type 2 Diabetic Patients of Karachi

Background/Objectives Diabetes Mellitus type 2 is a serious chronic disease with increasing prevalence throughout the world. Almost every system of the body is affected by the disease. Lung function impairment has also appeared to be a complication of diabetes. The aim of this study is to assess the difference in the lung function indices and high sensitive C‐reactive protein (hsCRP) a inflammatory marker in diabetic patients as compared to the non diabetic individuals. Methodology 73 Diabetics and 77 age matched Non Diabetics’ individuals, who were non smokers and had no apparent lung diseases were recruited. All subjects underwent screening with detailed history, anthropometry, high sensitive C‐reactive protein (hsCRP), glycosylated hemoglobin (HbA1c) and spirometric measurements. Results There was a significant reduction in the FVC [mean difference (95% CI) 0.495 L (0.27, 0.72) P < 0.001], FEV1 [mean difference (95% CI) 0.34 L (0.15, 0.53) P < 0.001], FEV1/FVC ratio [mean difference (95% CI) −0.018 (−0.036, −0.0003) P ≤ 0.05] and a significant increase in the hsCRP levels [mean difference (95% CI) 5.52 mg/L (3.1, 7.9) P < 0.001] in the diabetic subjects as compared to the healthy individuals. A statistical model was built using multivariable linear regression analysis to predict FVC. The model equation is as follows. FVC = β0 + β1(X1) + β2(X2) + β3(X3) + β4(X4) + β5(D). Whereas, β0 = −2.78 (constant), X1=gender, X2=height, X3=age, X4=HbA1c, D‐ = duration of disease >10years. R2 value = 0.77 Female gender taken as reference, Duration of disease: ≤5 years (reference), 6 – 10 years (non significant) & > 10 years Conclusion It can be concluded from this study that type 2 diabetic individuals had statistically significant lower FVC and FEV1 and raised hsCRP values as compared to the non diabetics. The effect on the FVC was even more pronounced in diabetics who had inadequate glycemic control and prolonged duration of disease. Therefore, it is suggested that clinicians should assess the diabetic patients on annual follow up for early changes in lung functions through spirometry as this would help in reducing the morbidity and mortality associated with respiratory complications Support or Funding Information The study was approved and funded by Dow University of Health Sciences, Pakistan. Anthropometric measurements of Diabetic and Non DiabeticVariable Non Diabetic (77)Meant ± SD Diabetic (73)Meant ± SDWeight (kg) 67.56 ± 12.54 70.56 ± 11.98 Height (cm) 167.43 ± 9.59 164.10 ± 8.62Waist Circumference (cm) 89.43 ± 10.11 96.85 ± 9.79 Hip Circumference (cm) 96.60 ± 10.55 102.40 ± 10.01BMI(kg/m 2 ) 24.07 ± 3.79 26.19 ± 3.98 WHR 0.92 ± 0.07 0.95 ± 0.06Univariate Linear Regression Analysis of Lung function Indices in liters with diabetic status, age, gender and anthropometric factors.FVC FEV1 FEV1FVCVariables B SE 95%CI R 2 P value B SE 95%CI R 2 P value B SE 95% CI R 2 P value Lower limit Upper limit Lower limit Upper limit Lower limit Upper limitExposure Status a 0.495 0.116 −0.724 −0.266 0.110 <0.001 −0.343 0.095 −0.531 −0.155 0.081 <0.001 0.018 0.009 0.000 0.036 0.025 =0.025Gender b 0.989 0.098 0.795 1.183 0.407 <0.001 0.781 0.080 0.622 0.940 0.389 <0.001 −0.007 0.010 −0.027 0.012 0.004 =0.440Age (years) −0.021 0.006 −0.340 −0.008 0.068 = 0.001 −0.017 0.005 −0.028 −0.007 0.071 =0.001 0.000 0.001 −0.001 0.001 0.002 =0.620Weight (kg) 0.017 0.005 0.007 0.026 0.075 0.001 0.014 0.004 0.006 0.022 0.082 <0.001 0.007 0.000 0.000 0.001 0.000 =0.834Height (cm) 0.059 0.005 −0.050 0.068 0.534 <0.001 0.045 0.004 0.039 0.054 0.499 <0.001 0.000 0.001 −0.002 0.000 0.010 =0.228Waist Circumference (cm) −0.009 −0.006 −0.020 −0.002 −0.017 = 0.111 −0.028 0.005 −0.017 0.001 0.019 =0.095 0.000 0.000 −0.001 0.001 0.001 =0.716Hip Circumference (cm) −0.010 0.006 −0.002 −0.001 0.021 = 0.074 −0.009 0.005 −0.018 0.000 0.024 =0.060 0.000 0.000 0.000 0.001 0.007 = 0.824BMI(kg/m 2 ) −0.040 0.015 −0.069 −0.010 0.045 =0.009 −0.028 0.012 −0.052 −0.004 0.034 =0.023 0.001 0.001 −0.001 0.003 0.007 =0.312WHR 0.426 0.967 −1.480 2.330 0.001 =0.660 0.276 0.781 −1.267 1.819 0.001 =0.724 −0.041 0.073 −0.186 0.104 0.002 =0.577Duration of Disease c (years)= 5 −0.587 0.194 −0.971 −0.204 0.129 = 0.003 −0.435 0.159 −0.750 −0.121 0.101 =0.007 0.017 0.016 −0.014 0.048 0.027 = 0.270 6–10 −0.326 0.149 −0.620 −0.032 = 0.030 −0.203 0.122 −0.444 0.088 =0.098 0.014 0.012 −0.009 0.038 = 0.230> 10 −0.652 0.163 −0.974 −0.331 <0.001 −0.462 .133 −.726 −199 = 0.001 0.023 0.013 −0.003 0.049 = 0.0843 Multivariable Linear Regression Analysis for FVC (L) in Diabetic subjectsVariables B SE 95% CI P Value Lower limit Upper limitGender a 0.436 0.108 0.220 0.652 <0.001Height (cm) 0.043 0.006 0.030 0.056 <0.001 Age (years) −0.026 0.005 −0.035 −0.016 <0.001 HbAlc (%) −0.043 0.018 −0.078 −0.007 = 0.018 Duration of Disease b (years)>10 −0.170 0.081 −0.332 −0.009 =0.039FVC forced vital capacity B Coefficient of regression, SE standard error. CI confidence interval. Sample size 73 diabetic * All variables with insignificant correlation with FVC were excluded by using the stepwise method of multivariable regression analysis. a Female gender taken as reference b Duration of disease: =5 years (reference), 6–10 years (non significant) & > 10 years Significant P Value <0.05 Constant −2.757 R 2 : 0.77 Adjusted R 2 :0.752 Dependent Variable: FVC in liters