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Li M, Wan Y, Zhu Z, Luo P, Yu H, Su J, Hang D, Lu Y, Tao R, Wu M, Zhou J, Fan X. Association between glycated haemoglobin and the risk of chronic obstructive pulmonary disease: A prospective cohort study in UK biobank. Diabetes Obes Metab 2023; 25:3599-3610. [PMID: 37643990 DOI: 10.1111/dom.15255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023]
Abstract
AIMS To investigate the association between glycated haemoglobin (HbA1c) levels and chronic obstructive pulmonary disease (COPD) incidents in the general population, and the association between HbA1c levels and mortality in patients with COPD. MATERIALS AND METHODS We investigated the association of HbA1c levels with COPD risk in the general population in the UK Biobank, using data from 420 065 participants. Survival analysis was conducted for 18 854 patients with COPD. We used restricted cubic spline analysis to assess the dose-response relationship between HbA1c levels and COPD risk and survival. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS During a median follow-up of 12.3 years, 11 556 COPD cases were recorded. HbA1c had a non-linear relationship with COPD risk (p for non-linearity < .05). Compared with the quintile 2 (32.2-<34.3 mmol/mol), those with HbA1c levels above 38.7 mmol/mol (quintile 5) had a 22% (HR, 1.22, 95% CI: 1.15-1.30) higher risk of COPD. Compared with the HbA1c decile 2 (30.5-<32.2 mmol/mol), the HRs (95% CI) of COPD risk were 1.16 (1.03-1.30) and 1.36 (1.24-1.50) in the lowest HbA1c decile (<30.5 mmol/mol) and highest decile (≥41.0 mmol/mol), respectively. The increased COPD risk associated with HbA1c was more pronounced in younger, current smokers, passive smokers, and participants with a higher Townsend deprivation index (all p for interaction < .05). Among patients with COPD, 4569 COPD cases died (488 because of COPD) during a median follow-up of 5.4 years. Regarding COPD survival, HbA1c had a non-linear relationship with all-cause death (p for non-linearity < .05). Those with HbA1c quintile 5 (≥38.7 mmol/mol) had a 23% (HR, 1.23, 95% CI: 1.10-1.37) higher risk of all-cause death compared with the quintile 2 (32.2-<34.3 mmol/mol). Compared with the HbA1c decile 4 (33.3-<34.3 mmol/mol), those in the lowest HbA1c decile (<30.5 mmol/mol) and highest HbA1c decile (≥41.0 mmol/mol) had 22% (HR, 1.22; 95% CI: 1.01-1.47) and 28% (HR, 1.28; 95% CI: 1.11-1.48) higher risk for overall death. However, no significant association was observed between HbA1c levels and the risk of COPD-specific death. CONCLUSIONS Our findings indicated that lower and higher HbA1c levels were associated with a higher risk of COPD. In COPD cases, lower and higher HbA1c levels were associated with a higher COPD all-cause death risk.
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Affiliation(s)
- Mengyao Li
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yanan Wan
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Zheng Zhu
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Pengfei Luo
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Hao Yu
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Jian Su
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Dong Hang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yan Lu
- Department of Chronic Disease Prevention and Control, Suzhou City Centre for Disease Control and Prevention, Suzhou, China
| | - Ran Tao
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Ming Wu
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Jinyi Zhou
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Xikang Fan
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
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Motamed B, Alavi Foumani A, Tangestaninezhad A, Almasi M, Faraji N, Jafarinezhad A. The relationship between glycated hemoglobin A1c levels and exacerbation status in the patients with chronic obstructive pulmonary disease. BMC Res Notes 2022; 15:326. [PMID: 36243756 PMCID: PMC9571465 DOI: 10.1186/s13104-022-06217-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study was performed in Razi Hospital, Rasht, Iran, between March 2016 and August 2018 on a population of chronic obstructive pulmonary disease (COPD) patients (56 as COPD exacerbation group and 56 as COPD stable group). Study variables include age, sex, occupation, body mass index (BMI), cigarette consumption, duration of COPD, annual hospitalization, dyspnea, glycated hemoglobin (HbA1c), FEV1, and FEV1/FVC indices. RESULT The mean age of the participants was 63.92 ± 10.75 years. There was a significant difference in the hospitalization between the patients with both exacerbation and normal state of COPD (P ≤ 0.001). HbA1c in the patients with exacerbation of COPD was significantly higher than stable status (P = 0.001). Logistic regression showed that HbA1c levels and hospitalization were predictors of exacerbation of COPD. HbA1c levels were statistically significant in terms of hospitalization in patients with COPD exacerbation. There was a significant difference between the HbA1c levels and MMRC in patients with COPD. The percentage of HbA1c was associated with exacerbation of COPD and HbA1c is a good predictor of disease severity in patients with COPD. It also shows that patients with COPD exacerbation and severe COPD are at the higher risk of hyperglycemia.
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Affiliation(s)
- Behrang Motamed
- grid.411874.f0000 0004 0571 1549Inflammatory Lung Diseases Research Center, Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Alavi Foumani
- grid.411874.f0000 0004 0571 1549Inflammatory Lung Diseases Research Center, Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Azita Tangestaninezhad
- grid.411874.f0000 0004 0571 1549Inflammatory Lung Diseases Research Center, Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Almasi
- grid.411874.f0000 0004 0571 1549Inflammatory Lung Diseases Research Center, Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Niloofar Faraji
- grid.411874.f0000 0004 0571 1549Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Alireza Jafarinezhad
- grid.411874.f0000 0004 0571 1549Inflammatory Lung Diseases Research Center, Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
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Covantsev S, Corlateanu O, Volkov SI, Uzdenov R, Botnaru V, Corlateanu A. COPD and diabetes mellitus: down the rabbit hole. CURRENT RESPIRATORY MEDICINE REVIEWS 2022. [DOI: 10.2174/1573398x18666220411123508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract:
: One of the important comorbidities that has a longstanding research history in COPD is diabetes. Although there are multiple studies on COPD and diabetes the exact links between these two conditions is still controversial. The exact prevalence of diabetes in COPD varies between 2 and 37 %. The true nature of this relationship is complex and may be partially related to the traditional risk factors for diabetes such as smoking, cardiovascular disease and use of steroids. However, COPD is a disease that has multiple phenotypes and is no longer regarded as a homogeneous condition. It seems that some COPD patients who have overlap with asthma or the obese phenotype at a particular risk for T2DM. The aim of this review is to analyze the prevalence, risk factors and possible interactions between COPD and diabetes mellitus.
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Affiliation(s)
- Serghei Covantsev
- S.P. Botkin State Clinical Hospital, Moscow, Department of General Oncology, Moscow, Russian Federation
| | - Olga Corlateanu
- Nicolae Testemițanu State University of Medicine and Pharmacy, Department of Internal Medicine, Division of Pneumology and Allergology, Chisinau, Republic of Moldova
| | - Stanislav I. Volkov
- Russian Medical Academy of Continuous Postgraduate Education, Department of Endocrinology, Moscow, Russian Federation
| | - Rasul Uzdenov
- North-Caucasus Federal University, Department of Hospital Surgery with the Course of Anesthesiology and Intensive Care, Stavropol, Russian Federation
| | - Victor Botnaru
- Nicolae Testemițanu State University of Medicine and Pharmacy, Department of Internal Medicine, Division of Pneumology and Allergology, Chisinau, Republic of Moldova
| | - Alexandru Corlateanu
- Nicolae Testemițanu State University of Medicine and Pharmacy, Department of Internal Medicine, Division of Pneumology and Allergology, Chisinau, Republic of Moldova
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Zuberi FF, Bader N, Rasheed T, Zuberi BF. Association between insulin resistance and BMI with FEV 1 in non-hypoxemic COPD out-patients. CLINICAL RESPIRATORY JOURNAL 2021; 15:513-521. [PMID: 33497542 DOI: 10.1111/crj.13336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/26/2020] [Accepted: 01/21/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study was conducted to determine the impact of insulin resistance using Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) score and BMI in non-hypoxemic out-patients with COPD on FEV1 using linear and polynomial regressions and to determine their correlation. METHODS COPD patients of both genders were included after informed consent. Fasting blood sugar and serum insulin were done to calculate HOMA-IR, which were segregated into two groups of ≥ 3 and < 3 labeled insulin resistance present and absent, these were compared with BMI. Patients were segregated into GOLD Grade 1-4 per GOLD Guidelines and compared with HOMA-IR and BMI. Curve and linear regressions, multivariate and univariate analysis of HOMA-IR with BMI, FVC, and FEV1 were done. RESULTS A total of 273 subjects were inducted after informed consent. There was a linear correlation between HOMA-IR and BMI (r2 0.498, P < 0.001) and nonlinear correlation between HOMA-IR and FEV1 (r2 0. 617, P < 0.001) which showed little evidence of association above FEV1 > 60 predicted, but a clear negative association below that. Significant increase in HOMA-IR was seen from GOLD-2 to 3 and from GOLD-3 to 4 classes. The impact of HOMA-IR on FEV1 was 49.9% (P < 0.001) on FVC was 43.7%. CONCLUSIONS The results indicate that there is a high prevalence of IR in non-hypoxemic COPD. A nonlinear association is present between FEV1 and HOMA-IR which is most evident with FEV1 <60% predicted.
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Affiliation(s)
- Faisal Faiyaz Zuberi
- Department of Pulmonology, Ojha Institute of Chest Disease, Dow University of Health Sciences, Karachi, Pakistan
| | - Nimrah Bader
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Tazeen Rasheed
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Bader Faiyaz Zuberi
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
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Del Pino-Sedeño T, González de León B, Pérez Martín EF, Martín Gandolfo AM, Estupiñán Ramírez M, Redondo M, Ramallo-Fariña Y, Trujillo-Martín MM. Relationship between glycemic control and chronic obstructive pulmonary disease in patients with type 2 diabetes: A nested case-control study. Prim Care Diabetes 2020; 14:729-735. [PMID: 32535089 DOI: 10.1016/j.pcd.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/17/2020] [Accepted: 05/17/2020] [Indexed: 01/26/2023]
Abstract
AIMS To evaluate the relationship between glycemic control and plasma glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes mellitus (T2D) and the risk of chronic obstructive pulmonary disease (COPD). METHODS We conducted a population-based, retrospective, nested, case-control study involving 124,876 patients with DM2 from the Canary Islands, Spain. From the cohort, we selected all COPD cases and, for each case, five control subjects who were COPD free. We analyzed the association between glycemic control, HbA1c level and incident COPD. RESULTS A total of 1320 incidence cases of COPD (1.06%) were identified and matched individually with 6600 controls according to age and sex. After multivariate adjustment, the COPD risk increased among patients with poor glycemic control compared to patients with good glycemic control [HbA1c levels <7% (53 mmol/mol)] (OR 1.18; 95% CI: 1.03-1.36). In comparison with patients exhibiting HbA1c levels <7% (53 mmol/mol), the risk of COPD was higher among people with HbA1c levels of 7-8% (53-64 mmol/mol) (OR 1.24; 95% CI: 1.05-1.47) and 8-9% (64-75 mmol/mol) (OR 1.31; 95% CI: 1.04-1.66). CONCLUSIONS Poor glycemic control reveals a weak association with increased risk of COPD in T2D patients.
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Affiliation(s)
- Tasmania Del Pino-Sedeño
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Spain
| | - Beatriz González de León
- Unidad Docente de Atención Familiar y Comunitaria "La Laguna-Tenerife Norte", Servicio Canario de Salud, Santa Cruz de Tenerife, Spain
| | - Elías Fernando Pérez Martín
- Unidad Docente de Atención Familiar y Comunitaria "La Laguna-Tenerife Norte", Servicio Canario de Salud, Santa Cruz de Tenerife, Spain
| | - Anna María Martín Gandolfo
- Unidad Docente de Atención Familiar y Comunitaria "La Laguna-Tenerife Norte", Servicio Canario de Salud, Santa Cruz de Tenerife, Spain
| | - Marcos Estupiñán Ramírez
- Servicio de Atención Primaria, Dirección General de Programas Asistenciales, Servicio Canario de la Salud, Las Palmas de Gran Canaria, Spain
| | - Maximino Redondo
- Unidad de Investigación, Hospital Costa del Sol Marbella, Universidad de Málaga, IBIMA (Instituto de Investigación Biomédica de Málaga), Málaga, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Yolanda Ramallo-Fariña
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain; Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain
| | - María M Trujillo-Martín
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain; Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain.
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Yang G, Han YY, Forno E, Yan Q, Rosser F, Chen W, Celedón JC. Glycated Hemoglobin A 1c, Lung Function, and Hospitalizations Among Adults with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3409-3415.e1. [PMID: 32569755 DOI: 10.1016/j.jaip.2020.06.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/16/2020] [Accepted: 06/05/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Insulin resistance and metabolic dysfunction have been associated with asthma risk and asthma severity. OBJECTIVE To examine the association between glycated hemoglobin A1c (HbA1c), asthma-related hospitalizations, and lung function measures among adults in the United Kingdom. METHODS A cross-sectional study was conducted of 47,606 adults aged 40 to 69 years who participated in the UK Biobank and had asthma but no diagnosis of diabetes mellitus. HbA1c level was analyzed as a continuous measure and also categorized as normal (<42 mmol/mol) or as consistent with prediabetes/diabetes (≥42 mmol/mol). An asthma-related hospitalization was defined as ever having had a hospitalization with an International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification code of a main diagnosis compatible with asthma (International Classification of Diseases, Ninth Revision, Clinical Modification code 493.x or International Classification of Diseases, Tenth Revision, Clinical Modification codes J45.x and J46.x). Logistic or linear regression was used for the multivariable analysis of asthma hospitalizations and lung function measures (FEV1, forced vital capacity [FVC], and FEV1/FVC). All models were adjusted for age, sex, ethnic background, body mass index, average annual household income, current smoking status, pack-years of smoking, fasting time, and C-reactive protein level. RESULTS Both HbA1c level (odds ratio, 1.03; 95% CI, 1.01-1.04) and an HbA1c level in the prediabetes/diabetes range (odds ratio, 1.68; 95% CI, 1.18-2.41) were associated with 1 or more asthma hospitalizations. Moreover, both HbA1c level and an HbA1c level in the prediabetes/diabetes range were significantly and inversely associated with FEV1 and FVC. CONCLUSIONS HbA1c is linked to asthma-related hospitalizations and small decrements in FEV1 and FVC among British adults with asthma but no diagnosis of diabetes mellitus.
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Affiliation(s)
- Ge Yang
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa; Department of Neonatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yueh-Ying Han
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Erick Forno
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Qi Yan
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Franziska Rosser
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Wei Chen
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa.
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Khalil MM, Mohammed RM, Hassan OHS. A study of the relationship between pulmonary function tests and both fasting plasma glucose and glycated hemoglobin levels among asymptomatic cigarette smokers. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_36_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Muro S. Diabetes mellitus and metabolic syndrome in patients with airflow limitation in Japan. Respir Investig 2018; 56:203-204. [PMID: 29773289 DOI: 10.1016/j.resinv.2018.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan.
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Machida H, Shibata Y, Inoue S, Igarashi A, Tokairin Y, Yamauchi K, Kimura T, Sato K, Nakano H, Nishiwaki M, Kobayashi M, Yang S, Minegishi Y, Furuyama K, Yamamoto T, Watanabe T, Konta T, Ueno Y, Kato T, Kayama T, Kubota I. Prevalence of diabetes mellitus in individuals with airflow obstruction in a Japanese general population: The Yamagata-Takahata Study. Respir Investig 2017; 56:34-39. [PMID: 29325679 DOI: 10.1016/j.resinv.2017.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 10/24/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Diabetes has been reported as a comorbidity of chronic obstructive pulmonary disease (COPD) in Western countries, but it has not been demonstrated in epidemiological reports in Japan. The purpose of this study was to clarify whether the relationship between airflow obstruction and diabetes can be confirmed in a Japanese general population. METHODS From 2004 to 2006, blood sampling and pulmonary function tests were performed on 3045 people over the age of 40 years in annual health check-ups held in Takahata, Yamagata Prefecture, Japan. Pulmonary function was re-evaluated in 2009 and 2011. RESULTS The prevalence of diabetes did not differ between subjects with and without airflow obstruction. Furthermore, although body mass index decreased, no increase in the prevalence of diabetes was observed with the progression of airflow obstruction. The annual changes in forced expiration volume in 1s (FEV1) did not differ depending on the presence or absence of diabetes in the study population. CONCLUSION There was no difference in the prevalence of diabetes between subjects with airflow obstruction and those without. As patients with COPD in Japan are thinner than in the West, diabetes may not be a common comorbidity in Japanese patients with COPD.
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Affiliation(s)
- Hiroyoshi Machida
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Yoko Shibata
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Sumito Inoue
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Akira Igarashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Yoshikane Tokairin
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Keiko Yamauchi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Tomomi Kimura
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Kento Sato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Hiroshi Nakano
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Michiko Nishiwaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Maki Kobayashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Sujeong Yang
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Yukihiro Minegishi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Kodai Furuyama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Tomoka Yamamoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Tsuneo Konta
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Yoshiyuki Ueno
- Global Center of Excellence Program Study Group, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Takeo Kato
- Global Center of Excellence Program Study Group, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Takamasa Kayama
- Global Center of Excellence Program Study Group, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Isao Kubota
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
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