Gas delivery system in patients with type 1 diabetes mellitus

Abstract

The aim of the study was to investigate the effect of diabetes mellitus on the lung diffusing capacity for carbon monoxide (TLCO) and oxygen status of arterial blood in 141 young (of them, 66 female) patients with type 1 diabetes mellitus (IDDM) (mean age, 26.2 ± 6.2 yrs; mean duration of the disease, 12.6 ± 7.3 yrs) in comparison with 36 age-, sex-, weight-, and height-matched healthy controls (C). Diabetic patients were divided into 4 groups: 1) 46 diabetic patients without microvascular complications (DP1); 2) 48 diabetic patients with mild late complications (simple and preproliferative diabetic retinopathy, II to III stage nephropathy (DP2); 3) 34 diabetic patients with advanced late complications (proliferative retinopathy, IV stage nephropathy) (DP3); 4) 13 diabetic patients with end-stage renal failure (V stage nephropathy), not treated with dialysis (DP4). Spirometry with assessment of bronchodilator response, body plethysmography were performed, TLCO and transfer-factor (KCO) were measured in sitting position by the single-breath (TLCOsb) and the steady-state (TLCOss) methods. Gas exchange and lung volumes did not differ between DP1 and C. We found a significant reduction in TLCOsb, TLCOss, KCO in DP2patients compared to controls. Severe diabetic microangiopathy (DP3, DP4) was associated with significant decrease in TLCO and total lung capacity (TLC), progressive fall in arterial pO₂ and total oxygen concentration in arterial blood (ctO2). TLCO, TLC, pO₂ and ctO₂ were particularly low in the group with end-stage renal failure (DP4). Conclusion. Diabetes mellitus alters pulmonary gas exchange and causes reduction in lung volumes. Our data suggest that this abnormalities could be considered as manifestations of late diabetic complications and the lungs are one of the target organs affected by diabetes.