Non-linear association between diabetes mellitus and pulmonary function: a population-based study

dc.contributor.authorZhang, Rui‑Heng
dc.contributor.authorZhou, Jian‑Bo
dc.contributor.authorCai, Yao‑Hua
dc.contributor.authorShu, Lin‑Ping
dc.contributor.authorSimó, Rafael
dc.contributor.authorLecube Torelló, Albert
dc.description.abstractBackground: There is increasing evidence that the lung is a target organ of diabetes. This study aimed to examine in detail the association between diabetes mellitus and pulmonary function using a national cohort. We also aimed to explore the non-linear association between pulmonary function and blood glucose, insulin resistance, and C-reactive protein (CRP). Methods: A total of 30,442 participants from the National Health and Nutrition Examination Survey from the period between 2007 and 2012 were included. The cross-sectional association between diabetes mellitus and pulmonary function was assessed using multiple linear regression. Where there was evidence of non-linearity, we applied a restricted cubic spline with three knots to explore the non-linear association. Partial mediation analysis was performed to evaluate the underlying mechanism. All analyses were weighted to represent the US population and to account for the intricate survey design. Results: A total of 8584 people were included in the fnal study population. We found that diabetes was signifcantly associated with reduced forced expiratory volume in one second (FEV1) and forced vital capacity. We further found L-shaped associations between hemoglobin A1c (HbA1c) and pulmonary function. There was a negative association between HbA1c and FEV1 in diabetes participants with good glucose control (HbA1c<7.0%), but not in patients with poor glucose control. A non-linear association was also found with fasting plasma glucose, 2 h-plasma glucose after oral glucose tolerance test, insulin resistance, and CRP. Finally, we found that diabetes duration did not afect pulmo‑nary function, and the deleterious efect of diabetes on pulmonary function was mediated by hyperglycemia, insulin resistance, low-grade chronic infammation (CRP), and obesity. Conclusions: Diabetes mellitus is non-linearly associated with pulmonary function. Our fnding of a negative associa‑ tion between HbA1c and FEV1 in diabetes patients with good glucose control but not in patients with poor glucose control indicates that a stricter glycemic target should be applied to diabetic patients to improve pulmonary function. Given, the cross-sectional nature of this research, a longitudinal study is still needed to validate our fndings.ca_ES
dc.description.sponsorshipThis work was supported by (i) the National Natural Science Foundation of China (No. 82070851, 81870556, 81670738), Beijing Municipal Administration of Hospital`s Youth Program (QML20170204), Excellent Talents in Dongcheng District of Beijing and (ii) the Instituto de Salud Carlos III (Fondo de Investi‑ gación Sanitaria, PI 12/00803 and PI 15/00260), European Union, European Regional Development Fund (Fondo Europeo de Desarrollo Regional, FEDER, “Una manera de hacer Europa”). CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) are initiatives of the Instituto Carlos III. The European Foundation for the Study of Diabetes (EFSD/Lilly-Mental Health and Diabetes Programme) and Laboratorios Menarini.ca_ES
dc.identifier.issn1465-9921 (paper)
dc.identifier.issn1465-993X (electrònic)
dc.relation.isformatofReproducció del document publicat a
dc.relation.ispartofRespiratory Research, 2020, vol. 21, núm. 1, Article number: 292ca_ES
dc.rightscc-by (c) The Author(s), 2020ca_ES
dc.subjectDiabetes mellitusca_ES
dc.subjectPulmonary functionca_ES
dc.titleNon-linear association between diabetes mellitus and pulmonary function: a population-based studyca_ES
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