Evaluation of Clinico Radiological Pulmonary Manifestations in Type 2 Diabetes Mellitus and correlation between Pulmonary Function Test and Glycemic Control

BACKGROUND: Diabetes mellitus is increasing in global prevalence with India having more than 50 million diabetic population. Diabetes mellitus causes the lungs to deteriorate quicker than they do normally with age Impaired immune response in diabetes can cause recurrent infections .Higher blood sugar result in diabetic microangiopathy and non enzymatic glycosylation of tissues causing alveolar basement membrane thickening,deposition in collagen of chest wall and bronchial tree causing muscle weakness.This result in decrease gas transfer,diminished lung function and air flow limitation.There are very few data regarding pulmonary function in type 2 diabetes especially in Indian population. AIM OF STUDY : 1. Correlation between pulmonary function in diabetic patients based on PFT values and glycemic control. 2. Various clinical and radiological pulmonary manifestations in diabetes mellitus MATERIALS & METHODS : Prospective study of 150 patients was carried out in Thoracic medicine department, Madras Medical College over 8months. All patients with age more than 30 years with proven Type II diabetes mellitus with or without respiratory symptoms/signs were included.Diabetic status assessed by FBS,PPBS,HbA1C. Chest X ray, Sputum AFB, gram stain,C&S, fungal smear and culture,Mantoux were done.PFT was done in patients and control population.All findings correlated with duration of diabetes and glycemic control. RESULTS : Of the 150 patients in the study group 91 were males and 59 were females.60% of the study group were symptomatic ,of which 37.3% were males & 22.7% were females. Of the symptomatics (n=90),50% had pulmonary tuberculosis,33.3% had other bacterial and fungal infections , 16.6% had no active infection,60% mantoux negative & 40% were mantoux positive. Of the pulmonary TB patients 71.1% were sputum positive & 28.8 % were sputum negative.65.6% of sputum positive were mantoux positive. Radiologically most common finding in pulmonary TB was lower lung field TB. Klebsiella pneumonia was the most common bacterial infection other than TB. Pulmonary function tests were done in 60asymptomatics & 15 symptomatics without active infection and 75 age and sex matched control population. FEV1 and FVC showed statistically significant reduction in diabetics compared to non diabetic controls. Decrease in FEV1 and FVC correlated with duration of diabetes, but not with HbA1C levels