A CASE STUDY ON REDUCTION OF LUNG FUNCTIONS IN PATIENTS WITH DIABETES MELLITUS IN ANDHRA PRADESH, INDIA

Bantupalli Suranjan*, Atluri Deekshit, Bala Yaswanth Kumar S, Gutha Bala Teja 

KVSR Siddhartha College of Pharmaceutical Sciences, Vijayawada -520010, Andhra Pradesh, India.

ABSTRACT 

Background and Objectives: The purpose of this study is to evaluate the pulmonary functions in patients with diabetes. Many studies additionally counsel that the respiratory organ as an organ in diabetes and glycemic exposure could also be an effort issue for reduced respiratory organ operate. Systemic inflammation, hypoxemia, oxidative stress, altered gas exchange, and changes in lung tissues were the major impacts on the respiratory system which were induced by hypoglycemia.

Methods: Forty individual patients of both sexes were involved in the study and divided into two groups depending on their conditions. Group A consists of individuals without any complications or any disease conditions and group B consists of diabetic patients excluding smokers and divided into twenty to each group. 

Results: SPSS software was used for the analysis and spirometry was the device used to determine the pulmonary function. Values of Forced Expiratory Volume 1, Forced Vital Capacity, Forced Expiratory Flow, FEV% were only considered in the study and the study results conclude that diabetes shows its effect on the lungs in long term and leads to a decrease in lung function. Conclusion: It was concluded that that monitoring the Pulmonary function tests of the diabetic patients helps the individuals to avoid any complications further ahead and also it helps to ease the flow of the recovery and also prevent further more comorbidity that might arise in the future.

Keywords: Diabetes, fasting blood sugar, forced vital capacity, planning programming budgeting system, pulmonary function. 

 

INTRODUCTION

 

To assess the level of pulmonary function in patients with diabetes by performing pulmonary function tests. Diabetes is a metabolic disorder that was affected by multiple factors. It was characterized by insulin deficiency either a defect in insulin secretion or insulin working mechanism deficit the results in disturbance in protein, fat, and carbohydrate metabolism1. Micro-angiopathy and macroangiopathy were the major complications in diabetes that affect the target organ in diabetes. Reduced lung functions have been observed in patients suffering from both type 1 diabetes mellitus and type 2 diabetes mellitus. The pulmonary functions investigation in diabetes shows that reduction in diffusing capacity of carbon monoxide of the lung, FEV1, and FVC is associated with type 1 and 2 diabetes mellitus2,3. The four primary sources that lead to decreased pulmonary functions in diabetes patients were. Lung elasticity reduction was caused by disrupted glycemic control which also causes non-enzymatic glycosylation end products. Reduced diffusion capacity and pulmonary capillary blood volume due to thickening of the basal lamina of the alveolar epithelium and microvascular changes in the pulmonary capillary beds4,5. The diaphragmatic nerves were affected by an autonomic neuropathy that resulted in decreased muscle tone and control of the diaphragm6. Hyperglycemia increases glucose in the airway surface fluid, which serves as fuel for bacteria, and then increases the frequency of isolated bacterial pathogens in sputum, and also increases inflammation, causing scarring of the lung walls, which causes them to lose elasticity, increasing the Decrease the ability to breathe and exhale, which limits the amount of oxygen released into the bloodstream7,8.

 

SUBJECTS AND METHOD

 

A total no. of 40 patients (20 male and 20 female) was included in the study from patients of Pinnamaneni Siddhartha institute of medical sciences and research foundation, Vijayawada, Andhra Pradesh, India. Patients with type 2 diabetes and a population of normal glycemic control confirmed by normal fasting and postprandial blood sugar9.

Inclusion criteria

Previously diagnosed diabetic patients who are poorly controlled and uncontrolled more than 5 years duration of illness and patients of no history of any lung complications10.

Exclusion criteria

Patients with a history of smoking, acute or chronic respiratory disease, history of occupational exposure and cardiovascular disease, a physical disability that may affect lung functioning, and also obese patients were also excluded from the study11.

Ethics

Request to conduct the study was applied to the ethical committee of Pinnamaneni Siddhartha institute of medical sciences and research foundation, Vijayawada, Andhra Pradesh, India, and was kindly accepted to perform the study. Participants provided informed consent before being included in the study and were notified that they could quit the study at any time12.

Statistical analysis

The data obtained were analyzed by unpaired T-test and ANOVA using the statistical analysis software13.

 

RESULTS

 

The study included 40 volunteered patients categorized into 2 groups.

  1. Group A–controlled group (20).
  2. Group B– diabetes group (20).

Table 1: Glycemic results in two groups.

 

All the values of FVC–forced vital capacity, FEV1– forced vital capacity in the first second, FEV1%, FEF– forced expiratory flow are reduced in the diabetic group compared to the control group. There is a high significance of decline is observed statistically. 

Table 2: Spirometric values comparison in two groups.

 

 

DISCUSSION

 

To demonstrate a decline in less than 10% of Forced Expiratory Volume 1 and Forced Vital Capacity in their study. Measures were decreased at an annual rate of 68 and 71 ml/year for Forced Expiratory Volume 1 and Forced Vital Capacity.  According to the study decreased Spirometric tests cannot assure its detailed pathology, but there have been reports that show histopathological changes in the lungs of diabetic patients. This includes basal lamina thickening and fibrosis14. Many studies also suggest that the lung as a target organ in diabetes and glycemic exposure may be a causation factor for reduced lung function. Systemic inflammation, hypoxemia, oxidative stress, altered gas exchange, and changes in lung tissues were the major impacts on the respiratory system which was induced by hypoglycemic that demonstrates diabetes condition can alter lung function. Where an average of less than 9% of Forced Vital Capacity, Forced Expiratory Volume 1, and Peak Expiratory Flow Rate (PEFR) values were recorded than predicted, also diabetes was independently predictive of reduced lung functions where HBA1C (glycated hemoglobin) is not. 

They explained it by suggesting that HBA1C (glycated hemoglobin) is a short-term marker of glycemic control, a relationship between impaired lung function and glycemia could still be present in diabetes. In this based on the results we obtained and assessed group A (control group) without any complications in their health condition have shown the normal lung function apart from some slight variations in some individuals but not considered as a complication which was only normal values and coming to group B (Diabetic group) shown a large variation in a decline of the lung function which shows that lung was majorly affected in diabetes irrespective of the smoking this suggests us to monitor the lung functions in long term diabetic condition patients.

 

CONCLUSION

 

It was found that Forced Expiratory Volume 1 and Forced Vital Capacity are significantly decreased in diabetic patients compared to the control group. We cannot confirm specific reasons for the decline due to a huge number of parameters that are too considered. Hence it was suggested that monitoring the Pulmonary function tests of the diabetic patients helps the individuals to avoid any complications further ahead and also it helps to ease the flow of the recovery and also prevent further more comorbidities that might arise in the future. A strict diet and glycemic control and regular exercise that improve the strength of respiratory muscles help in increasing lung functions in diabetes patients.

 

ACKNOWLEDGEMENT

 

Authors expresses their gratitude towards the staff of the pulmonary ward in Pinnamaneni Siddhartha College of medical sciences and research foundation; chinnavutupalli, who provide us with their facilities and their diagnostic equipment to attain the results and supported us through the volunteer recruiting process.  

 

CONFLICT OF INTEREST

 

The authors attest that they have no conflict of interest in this study.

 

AUTHOR’S CONTRIBUTION 

 

Authors declare that the work done by the names mentioned in the article and all the liabilities and claims related to the content of the article will be borne by the authors. 

 

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