The relationship between the occurrence of asthma and diabetes.

doi:10.21203/rs.3.rs-5125301/v1

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Research Article

The relationship between the occurrence of asthma and diabetes.

https://doi.org/10.21203/rs.3.rs-5125301/v1

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Introduction: Diabetes is a major public health problem, and there is a continuing increase in the incidence and long-term complications. These complications are mainly sequelae of microvascular destruction in target organs. Many lung injuries occur in the context of diabetes due to the presence of abundant microcirculation and abundance of tissues. Macrophages, raising the possibility that lung tissue is a target organ in patients with diabetes.

Research objectives: This research was designed to study the effect of diabetes, both the duration of infection with this disease, and control of diabetic status on lung function and the incidence of asthma.

Methods and materials: A cross-sectional study, conducted on 100 diabetic patients attending Damascus Hospital in the period between 1/1/20217 and 1/1/2023. It was compared with a control group consisting of 100 healthy individuals without diabetes. It was recorded. Hemoglobin, fasting blood sugar, and a lung function test (spirometry) were measured for all participants in the study, and the following lung measurements were taken: maximum expiratory volume in the first second (FEV1), forced vital capacity (FVC), ratio (FEV1/FVC). Analyze the results using: mean + standard deviation, Pearson's chi-square, Pearson's correlation coefficient, and ANOVA test.

Results: The average percentage of expected FEV1 and expected FVC in people with diabetes is lower compared to healthy non-diabetic controls (p smaller than 0.05), and these values were lower in patients without controlled blood sugar compared to patients with controlled blood sugar, and the values were also lower in patients with diabetes for a longer period of time, these values were lower in patients with type 1 diabetes, and all previous criteria led to the occurrence of asthma.

Conclusion: The findings in this study suggest that the lung is a target organ for diabetes, and that diabetic patients have a decline in lung function and the incidence of asthma compared to non-diabetics in a blockade lesion model. Lung function deteriorates the longer the duration of diabetes and the longer the diabetes is uncontrolled.

Pulmonology

diabetes

lung function

spirometry

maximum expiratory volume in the first second (FEV1)

forced vital capacity (FVC)

ratio (FEV1/FVC)

Asthma is commonly associated with comorbid respiratory and non-respiratory conditions that are more prevalent in patients with severe asthma compared to those with mild to moderate disease or the general population[1]. These comorbidities can affect the clinical course and severity of asthma, consequently increasing the healthcare costs associated with its treatment.

On the other hand, diagnosing and appropriately treating these comorbidities seems to improve asthma outcomes by enhancing treatment and preventing the need for additional doses of medication in asthma patients. Conditions such as gastroesophageal reflux disease, allergic rhinitis, obesity, depression, diabetes, and cardiovascular diseases are quite common, although their prevalence varies greatly across studies. Nonetheless, many comorbidities may remain undiagnosed and are only detected by an experienced and specialized medical team.

Unfortunately, the pathogenic pathways linking asthma with many of these comorbidities remain unknown, which explains why they are often misdiagnosed as conditions associated with asthma treatment. However, asthma and its associated conditions often share common risk factors, and some evidence suggests that they share inflammatory pathways that exacerbate asthma.

It has been shown that inflammation plays a key role in the onset and progression of various comorbidities. On the other hand, the role of systemic inflammation in asthma remains unknown. Understanding the mechanism(s) linking asthma to its comorbidities is crucial for developing an effective treatment strategy.

Although the scheme varies across studies depending on the population and methodology, it is clear that atopy and type 2 inflammation are absent in a large minority of individuals with severe, uncontrolled asthma, highlighting the importance of non-allergic triggers for these individuals [2, 3]. Glucose metabolism disorders (also referred to as dysglycemia, impaired glycemia, and glucose metabolism disorders) may be potential triggers for asthma exacerbations and severe asthma attacks.

These refer to elevated blood sugar levels, arising from clinically silent hyperinsulinemia associated with insulin resistance, which progresses through prediabetes and secondary conditions such as impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), ultimately leading to diabetes.

This article will review the data supporting the detrimental role of these conditions in asthma health and the evidence for treating them as a means to improve asthma, with special attention to emerging evidence from recent studies. Unless otherwise explicitly stated, diabetes in this article refers to both type 1 and type 2 diabetes.

Research Importance

Diabetes mellitus (DM) is a major public health issue with a high incidence rate and long-term complications, which primarily result from microvascular damage to target organs. Given the dense microvascular network and extensive connective tissues in the lungs, the pulmonary tissue may be considered a potential target organ in diabetic patients.

Study Design

This is a retrospective cross-sectional descriptive study aimed at determining the prevalence of asthma among diabetic patients who visited the endocrinology clinic or were admitted to the endocrinology department at Damascus Hospital between January 1, 2023, and January 1, 2024.

Patients

The study included 100 patients diagnosed with diabetes who were admitted to Damascus Hospital.

Methods

A group of patients admitted to Damascus Hospital was studied based on the following inclusion criteria:

All patients were adults over 18 years old.

Patients exhibiting symptoms and signs suggestive of asthma with a high clinical suspicion.

All patients underwent lung function tests between 2023 and 2024.

The exclusion criteria were as follows:

Damaged patient records or those lacking sufficient information relevant to the study.

Patients with respiratory diseases other than asthma (e.g., bronchiectasis, interstitial lung diseases, cystic fibrosis).

The study population was divided into two groups:

Patient group: Included 100 diabetic patients who met the inclusion criteria.

Control group: Included 100 healthy, non-diabetic individuals selected from archived patient records who had undergone lung function tests but were not diabetic.

Data were collected using a research form to ensure adherence to inclusion and exclusion criteria. Detailed clinical history was documented, including age, gender, occupation, residence, type of diabetes, duration of the disease, past medical history, chest symptoms, and habits (alcohol, smoking). A comprehensive clinical examination was performed on all patients.

Laboratory test data were extracted from patient records, including: Complete blood count (CBC), Kidney function tests, Chest X-ray to exclude lung pathology, the glycemic control status was determined by two tests:

Fasting blood sugar: Values ≤ 140 mg/dL indicated good glycemic control, while values > 140 mg/dL indicated poor control. The threshold of 140 mg/dL was based on the American Heart Association (AHA) guidelines.

Glycated hemoglobin (HbA1c): Values ≤ 6.5% indicated good control, while values > 6.5% indicated poor control.

A pulmonary function test was conducted for all patients and individuals participating in the study using a spirometer (COSMED – micro Quark), which is electronically connected to a computer and is self-calibrating, meeting the standard requirements for pulmonary function tests. This device is used in the functional respiratory diseases unit at Damascus Hospital. It is a type of spirometer that detects airflow, designed to be used with the electro-mechanical flow meter located in the mouthpiece, which detects airflow and the electrical circuit converts the initial flow into real volumes and flow rates.The measurement is taken by the patient inhaling to reach total lung capacity (TLC), then exhaling as forcefully and quickly as possible for at least 6 seconds until reaching residual volume (RV). The following measurements were recorded:

Forced Vital Capacity (FVC): The percentage of the predicted value is used, with a percentage equal to or greater than 80% of the predicted value considered normal.

Forced Expiratory Volume in one second (FEV1): The percentage of the predicted value is used, with a percentage equal to or greater than 80% of the predicted value considered normal.

FEV1/FVC ratio: The ratio is considered normal if it is above 80%. The best result from the three tests conducted by the patient (cases) was recorded on the form.

We studied the effect of diabetes on the incidence of asthma and lung function and compared the results with the control group (healthy, non-diabetic individuals). We also studied the effect of the duration of diabetes on asthma incidence and lung function by comparing the results with the control group (healthy, non-diabetic individuals), dividing the cases into patients with diabetes for less than 10 years and those with diabetes for more than 10 years. We also studied the effect of diabetes type in the patient group on lung function and asthma incidence.

We examined the effect of blood sugar control, as determined by glycated hemoglobin (HbA1c), on lung function and asthma incidence. We divided the patient group (Group 1) into two categories: diabetic patients with HbA1c ≤ 6.5%, and diabetic patients with HbA1c > 6.5%. Additionally, we studied the effect of blood sugar control, as determined by fasting blood sugar levels, on asthma incidence and lung function by dividing the patient group into two categories: diabetic patients with fasting blood sugar ≤ 140 mg/dL, and diabetic patients with fasting blood sugar > 140 mg/dL.

Statistical Methods:

The data were entered into an Excel file, and basic statistical analyses were performed. The results were summarized and presented. Descriptive statistics were presented based on percentages and graphical representations, in addition to measures of central tendency (mean and standard deviation).To test statistical relationships between baseline characteristics, we used the following statistical methods: Pearson’s Chi-square test to compare categorical variables with a normal distribution, Pearson’s correlation coefficient to assess the relationship between continuous variables, One-way ANOVA to compare means across multiple groups, T-test to compare means between two groups.We used SPSS version 26 for the statistical analysis, and a p-value of less than 0.05 (p-value < 0.05) was considered statistically significant.

Basic Characteristics of Patients, and the patients with a high clinical suspicion of asthma, based on clinical symptoms and examination, were included in our study. A total of 200 patients, divided into two groups, were studied: the first group consisted of 100 diabetic patients, and the second group included 100 healthy individuals.

The average age of all patients was 48.6 years with a standard deviation of 11.6 years, ranging between 20 and 75 years.

The average age of diabetic patients was 50.1 years with a standard deviation of 11.7 years, ranging between 20 and 75 years.

The number of males in both groups was 144 (72%), and the number of females was 56 (28%).

The number of males in the diabetic group was 67 (67%), while the number of females was 33 (33%).

The percentage of rural residents was (37.5%), while the percentage of urban residents was (62.5%). The percentage of smokers was (44.5%), while the percentage of non-smokers was (55.5%). The percentage of alcohol drinkers was (2%), while the percentage of non-drinkers was (98%).

The average number of cigarette packs smoked by smokers was 1.3 packs with a standard deviation of 0.6 packs. The average amount of alcohol consumed by drinkers was 1 liter with a standard deviation of 0.3 liters. The percentage of retirees, housewives, farmers, and employees was (15%, 13%, 23%, and 49%, respectively).

The average morning blood glucose level in diabetic patients was 197.5 ± 55 mg/dL.

The average morning blood glucose level in the control group was 90 ± 8 mg/dL.

Assessment of Pulmonary Function in Diabetic Patients Compared to Control Cases (Healthy Individuals):

We performed pulmonary function tests (Spirometry) for the group of diabetic patients and the individuals in the control group (healthy individuals). The following measurements were recorded: Forced Vital Capacity (FVC), Forced Expiratory Volume in the First Second (FEV1), Tiffeneau-Pinelli Index (FEV1/FVC ratio).

Comparison between Diabetic Patients and Healthy Individuals Based on FVC

The mean percentage of FVC from the predicted value was calculated for the study groups, and the results were as follows :The mean percentage of FVC from the predicted value in diabetic patients was 70% with a standard deviation of 9.5%. The mean percentage of FVC from the predicted value in healthy individuals was 90.1% with a standard deviation of 3.9%.

It was found that the mean percentage of the predicted FVC in diabetic patients was significantly lower than that in healthy individuals, with a p-value of 0.001, which is less than 0.05, indicating statistical significance.

Comparison between Diabetic Patients and Healthy Individuals Based on FEV1

The mean percentage of FEV1 from the predicted value was calculated for the study groups, and the results were as follows: The mean percentage of FEV1 from the predicted value in diabetic patients was 68% with a standard deviation of 10%. The mean percentage of FEV1 from the predicted value in healthy individuals was 85% with a standard deviation of 4.1%.

It was found that the mean percentage of the predicted FEV1 in diabetic patients was significantly lower than that in healthy individuals, with a p-value of 0.000, which is less than 0.05, indicating strong statistical significance.

Comparison between Diabetic Patients and Healthy Individuals Based on the Tiffeneau Index (FEV1/FVC Ratio)

The mean value of the Tiffeneau Index (FEV1/FVC ratio) was calculated for both diabetic patients and healthy individuals, and the results were as follows: The mean Tiffeneau Index for diabetic patients was 73.3 with a standard deviation of 5.2. The mean Tiffeneau Index for healthy individuals was 93 with a standard deviation of 4.2.

It was found that the mean Tiffeneau Index in diabetic patients was significantly lower than that in healthy individuals, with a p-value of 0.045, indicating statistical significance (p < 0.05).

Study on the Impact of Diabetes on the Incidence of Asthma

The study showed that the prevalence of asthma among diabetic patients was 15%, compared to 9% among non-diabetic individuals. This difference was statistically significant, with a p-value of 0.000, indicating a strong statistical association (p < 0.05).

Study on the Impact of Diabetes Duration on Pulmonary Function:

We divided the patient group based on the duration of diabetes diagnosis into two categories: Patients with diabetes for less than 10 years, totaling 63 patients 63%. Patients with diabetes for more than 10 years, totaling 37 patients 37%.

We recorded the results of pulmonary function tests (Spirometry) for both patient groups and compared the outcomes.

Comparison between Diabetic Patients with Less Than 10 Years and Those with More Than 10 Years of Diabetes Based on FVC

The mean percentage of FVC from the predicted value was calculated for both patient groups, and the results were as follows: The mean percentage of FVC from the predicted value in diabetic patients with less than 10 years of diabetes was 75% with a standard deviation of 6.4%. The mean percentage of FVC from the predicted value in diabetic patients with more than 10 years of diabetes was 65% with a standard deviation of 10.2%.

It was found that the mean percentage of the predicted FVC in patients with more than 10 years of diabetes was significantly lower than that in patients with less than 10 years of diabetes, with a p-value of 0.000, which is less than 0.05, indicating strong statistical significance.

Comparison between Diabetic Patients with Less Than 10 Years and Those with More Than 10 Years of Diabetes Based on FEV1

The mean percentage of FEV1 from the predicted value was calculated for both patient groups, and the results were as follows : The mean percentage of FEV1 from the predicted value in diabetic patients with less than 10 years of diabetes was 71% with a standard deviation of 8.1%. The mean percentage of FEV1 from the predicted value in diabetic patients with more than 10 years of diabetes was 63% with a standard deviation of 9.8%.

It was found that the mean percentage of the predicted FEV1 in patients with more than 10 years of diabetes was significantly lower than that in patients with less than 10 years of diabetes, with a p-value of 0.014, which is less than 0.05.

Comparison between Diabetic Patients with Less Than 10 Years and Those with More Than 10 Years of Diabetes Based on FEV1/FVC Ratio

The mean value of the FEV1/FVC ratio was calculated for diabetic patients with less than 10 years of diabetes and those with more than 10 years. The results showed that the mean FEV1/FVC ratio in patients with less than 10 years of diabetes was 86 with a standard deviation of 5.9, while the mean FEV1/FVC ratio in patients with more than 10 years of diabetes was 75.1 with a standard deviation of 5.3.

It was found that the mean FEV1/FVC ratio in patients with less than 10 years of diabetes was significantly higher than that in patients with more than 10 years of diabetes, with a p-value of 0.026.

Study of the Effect of Diabetes Duration on Asthma Incidence

It was found that there is a statistically significant relationship between the duration of diabetes and the incidence of asthma in patients with diabetes.

Study of the Effect of Diabetes Type on Lung Function

We divided the patient group based on the type of diabetes into two categories: Patients with type 1 diabetes, totaling 50 patients 50%.

Patients with type 2 diabetes, also totaling 50 patients 50%.

We recorded the results of the spirometry tests for both patient categories and compared the results.

The average percentage of FVC (Forced Vital Capacity) from the predicted value was calculated for the study group, and the results were as follows:

The average percentage of FVC from the predicted value in patients with type 2 diabetes was 85%, with a standard deviation of 10.4%.

The average percentage of FVC from the predicted value in patients with type 1 diabetes was 75%, with a standard deviation of 6.6%.

It was found that the average percentage of FVC from the predicted value in patients with type 1 diabetes was lower than that in patients with type 2 diabetes, with a statistically significant difference (p = 0.000), which is less than 0.05.

The average percentage of FEV1 (Forced Expiratory Volume in one second) from the predicted value was calculated for the study group, and the results were as follows:

The average percentage of FEV1 from the predicted value in patients with type 2 diabetes was 77%, with a standard deviation of 9.9%.

The average percentage of FEV1 from the predicted value in patients with type 1 diabetes was 65%, with a standard deviation of 8.8%.

It was found that the average percentage of FEV1 from the predicted value in patients with type 1 diabetes was lower than that in patients with type 2 diabetes, with a statistically significant difference (p = 0.035), which is less than 0.05.

The average value of the Tiffeneau ratio (FEV1/FVC) was calculated for patients with type 1 diabetes and patients with type 2 diabetes. The results showed:

The average Tiffeneau ratio (FEV1/FVC) in patients with type 1 diabetes was 71.6, with a standard deviation of 5.1.

The average Tiffeneau ratio (FEV1/FVC) in patients with type 2 diabetes was 79.6, with a standard deviation of 4.7.

It was found that the average Tiffeneau ratio in patients with type 2 diabetes was higher than that in patients with type 1 diabetes, with a statistical significance of (p = 0.063).

A study on the effect of diabetes type on the incidence of asthma showed a statistically significant relationship between the type of diabetes and the asthma incidence rate among diabetic patients. The incidence of asthma in patients with type 1 diabetes was 20%, which was higher compared to 10% in patients with type 2 diabetes.

A study was conducted to assess the effect of blood glucose control based on fasting blood glucose levels on lung function. The patient group was divided into two categories according to their fasting blood glucose levels:

Patients with fasting blood glucose levels less than 140 mg/dL, with 30 patients (30% of the group).

Patients with fasting blood glucose levels greater than 140 mg/dL, with 70 patients (70% of the group).

Spirometry results were recorded for both groups, and the outcomes were compared between the two.

A study was conducted to assess the effect of blood glucose control, as measured by fasting blood glucose levels, on FVC (Forced Vital Capacity). The results showed the following:

The average percentage of predicted FVC in patients with controlled blood sugar (fasting blood glucose ≤ 140 mg/dL) was 76.5% ± 5.5.

The average percentage of predicted FVC in patients with uncontrolled blood sugar (fasting blood glucose > 140 mg/dL) was 69.9% ± 6.9.

It was found that the average percentage of predicted FVC in patients with fasting blood glucose less than 140 mg/dL was significantly lower than in patients with fasting blood glucose greater than 140 mg/dL (p < 0.05).

A study was conducted to evaluate the effect of blood glucose control, as determined by fasting blood glucose levels, on FEV1 (Forced Expiratory Volume in the first second). The findings were as follows:

The average percentage of predicted FEV1 in patients with controlled blood sugar (fasting blood glucose ≤ 130 mg/dL) was 74.1% ± 7.4.

The average percentage of predicted FEV1 in patients with uncontrolled blood sugar (fasting blood glucose > 130 mg/dL) was 65.3% ± 9.5.

It was observed that the average percentage of predicted FEV1 in patients with fasting blood glucose less than 140 mg/dL was significantly lower than in patients with fasting blood glucose greater than 140 mg/dL (p < 0.05).

A study was conducted to assess the effect of blood glucose control, as determined by fasting blood glucose levels, on the FEV1/FVC ratio (Tiffeneau-Pinelli index). The results were as follows:

The average FEV1/FVC ratio in patients with controlled blood sugar (fasting blood glucose < 140 mg/dL) was 94.5 ± 5.1.

The average FEV1/FVC ratio in patients with uncontrolled blood sugar (fasting blood glucose > 140 mg/dL) was 77.9 ± 5.4.

It was found that the average FEV1/FVC ratio in patients with fasting blood glucose less than 140 mg/dL was higher than in those with fasting blood glucose greater than 140 mg/dL, but the difference was not statistically significant (P = 0.14).

A study was conducted to assess the impact of asthma occurrence in diabetic patients with controlled and uncontrolled blood sugar levels. The results showed a statistically significant relationship between asthma occurrence and blood sugar control. The incidence of asthma was higher among patients with uncontrolled blood sugar levels, with a significance level of (P = 0.036).

A study was conducted to evaluate the effect of glycemic control, determined by glycated hemoglobin (HbA1c), on lung function in diabetic patients. The patients were divided into two groups based on their HbA1c levels:

Patients with HbA1c less than 6.5% (33 patients, representing 33% of the total).

Patients with HbA1c greater than 6.5% (67 patients, representing 67% of the total).

Spirometry tests were conducted for both groups, and the results were compared.

A study was conducted to evaluate the effect of glycemic control, determined by glycated hemoglobin (HbA1c), on FVC (Forced Vital Capacity):

The mean percentage of FVC from the expected value in patients with controlled blood sugar (HbA1c less than 6.5%) was 77.1% ± 6.4%.

The mean percentage of FVC from the expected value in patients with uncontrolled blood sugar (HbA1c greater than 6.5%) was 67.7% ± 9.8%.

The mean percentage of FVC from the expected value in patients with uncontrolled blood sugar was significantly lower than that in patients with controlled blood sugar (P < 0.05).

A study was conducted to evaluate the effect of glycemic control, determined by glycated hemoglobin (HbA1c), on FEV1 (Forced Expiratory Volume in 1 second):

The mean percentage of FEV1 from the expected value in patients with controlled blood sugar (HbA1c less than 6.5%) was 74.5% ± 8.8%.

The mean percentage of FEV1 from the expected value in patients with uncontrolled blood sugar (HbA1c greater than 6.5%) was 62.7% ± 7.7%.

The mean percentage of FEV1 from the expected value in patients with uncontrolled blood sugar was significantly lower than that in patients with controlled blood sugar (P < 0.05).

A study was conducted to assess the effect of glycemic control, determined by glycated hemoglobin (HbA1c), on the FEV1/FVC ratio:

The mean FEV1/FVC ratio in patients with controlled blood sugar (HbA1c less than 6.5%) was 78.8 ± 5.1.

The mean FEV1/FVC ratio in patients with uncontrolled blood sugar (HbA1c greater than 6.5%) was 76.9 ± 4.7.

The mean FEV1/FVC ratio in patients with uncontrolled blood sugar (HbA1c greater than 6.5%) is lower than the mean FEV1/FVC ratio in patients with controlled blood sugar (HbA1c less than 6.5%) (p < 0.05).

A study was conducted to assess the effect of glycemic control, as measured by glycated hemoglobin (HbA1c), on the incidence of asthma. It was found that there is a statistically significant relationship between the occurrence of asthma and uncontrolled blood sugar levels as defined by HbA1c.

Evaluation of Lung Function in Diabetic Patients Compared to Control Cases

After performing spirometry on all participants in the study and recording the results for FVC, FEV1, and the FEV1/FVC ratio, we found that the mean values for diabetic patients were 70%, 68%, and 73.3%, respectively. In contrast, the control group's values were 90.1%, 85%, and 93%, respectively. This indicates a significant decrease in the average values of both FVC, FEV1, and the FEV1/FVC ratio in diabetic patients compared to the control group, with statistical significance less than 0.05 (indicating statistical significance).

In our study, the reduction in the mean values of FVC, FEV1, and the FEV1/FVC ratio suggests the presence of obstructive lung disease in diabetic patients compared to healthy non-diabetics, with statistical significance also less than 0.05. The decrease in the FEV1/FVC ratio is a sensitive indicator of airway obstruction, which is a characteristic feature of asthma. Additionally, we found that the incidence of asthma was higher among diabetic patients, with a statistically significant relationship.

These findings are consistent with the literature, as indicated by several global studies, such as the Egyptian study conducted in 2013, which showed that the values of FVC, FEV1, and the FEV1/FVC ratio were lower in diabetics compared to the control group. Similarly, an American study conducted in 2011 reported comparable results.

Some studies, such as the Indian study [4], indicated the presence of lung injury in diabetic patients; however, the pattern of injury varied between obstructive and restrictive types, as well as a mixed form. In contrast, our study demonstrated only an obstructive pattern of lung injury (asthma).

We conducted a study on the impact of the duration of diabetes on the incidence of asthma and lung function.

In our study, we observed that for patients diagnosed with diabetes for 10 years or more, the average values of FVC, FEV1, and the FEV1/FVC ratio were as follows: 65%, 63%, and 90%, respectively. In contrast, for patients diagnosed with diabetes for less than 10 years, the values were 75%, 70%, and 75.1%, respectively. Spirometry showed a significant decline in the average values of both FVC and FEV1, as well as the FEV1/FVC ratio in patients with longer-duration diabetes compared to those with shorter durations, with a statistical significance level of less than 0.05. Our study indicated that the severity of the condition increased with the duration of the disease, which aligns with findings from Indian and Egyptian studies. Asthma prevalence was higher among patients diagnosed for over 10 years, with a statistically significant relationship.

Study on the Impact of Diabetes Type on Lung Function and Asthma Incidence

We found that for patients with Type 1 diabetes, the average values of FVC, FEV1, and the FEV1/FVC ratio were as follows: 75%, 65%, and 71.6%, respectively. Meanwhile, for patients with Type 2 diabetes, the average values were 85%, 77%, and 79.6%. Spirometry showed a clear decline in the average values of both FVC and FEV1 in Type 1 diabetes patients compared to Type 2, with a statistical significance level of less than 0.05. The pulmonary impairment (asthma) was more severe in Type 1 diabetes patients, consistent with findings from Indian and Egyptian studies, and asthma prevalence was higher in Type 1 patients compared to Type 2, with statistical significance less than 0.05.

Impact of Glycemic Control on Asthma Incidence and Lung Function

We examined the effect of glycemic control on asthma incidence and lung function through two factors: glycated hemoglobin and fasting blood sugar. We found that for patients with controlled blood sugar (glycated hemoglobin less than 6.5%), the average values of FEV1, FVC, and the FEV1/FVC ratio were: 77.1%, 74.5%, and 78.8%, respectively. For patients with uncontrolled blood sugar (glycated hemoglobin greater than 6.5%), the values were: 67.7%, 62.7%, and 76.9%. Spirometry showed a significant decline in the average values of both FVC and FEV1 in patients with uncontrolled blood sugar compared to those with controlled blood sugar, with a p-value less than 0.05, indicating statistical significance. The decline in FEV1 was greater than that in FVC, with the comparison of the FEV1/FVC ratio showing a statistically significant difference.

Thus, poorer glycemic control correlates with greater severity of pulmonary impairment. Many global studies have indicated that diabetic patients with glycated hemoglobin greater than 6.5% experience a greater decline in lung function compared to those with lower levels, including findings from Indian and Egyptian studies.

Our study also demonstrated that for patients with controlled blood sugar (fasting blood sugar less than 140 mg/dL), the average values of FEV1, FVC, and the FEV1/FVC ratio were: 76.5%, 74.1%, and 77.5%, respectively. In contrast, for patients with uncontrolled blood sugar (fasting blood sugar greater than 140 mg/dL), the values were: 69.9%, 65.3%, and 77.9%. Spirometry again showed a significant decline in the average values of FVC and FEV1, as well as the FEV1/FVC ratio in patients with uncontrolled blood sugar compared to those with controlled blood sugar, with a p-value less than 0.05.

Therefore, poorer glycemic control correlates with increased severity of pulmonary impairment, as supported by various global studies linking higher fasting blood sugar levels (greater than 140 mg/dL) to greater declines in lung function compared to those with lower levels. We found a statistically significant relationship between asthma incidence and the presence of uncontrolled diabetes in diabetic patients, with a significance level of less than 0.05.

Ethics approval and consent to participate

The study protocol was approved by the Research Ethics Committee of Al-sham Private University and the relevant ethics committees of Al-sham Private University, and all procedures performed in the studies involving the participant and subjects were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent for publication:

Not applicable.

Convict of interest:

The authors declare that they have no convict of interest.

Funding:

This research received no specific grant from ASPU or any other funding agency in the public, commercial or non-profit sectors.

Acknowledgments:

We are thankful to the management of AL-Sham Private University and Damascus Hospital for their support in the eld of medical training and research.

Availability of data and materials:

All data produced in the present work are contained in the manuscript

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Moore WC, Meyers DA, Wenzel SE et al (2010) Identification of asthma phenotypes using cluster analysis in the Severe Asthma Research Program. Am J Respir Crit Care Med 181:315323
Loza MJ, Djukanovic R, Chung KF et al (2016) Validated and longitudinally stable asthma phenotypes based on cluster analysis of the ADEPT study. Respir Res 17:165
PANPALIA1 NIKHILG, KULKARNI2 (2014) May, SANDHYA, SWATI C. Aundhkar3, To Study the Effects of Diabetes Mellitus on Pulmonary Function Tests, International Journal of Health Sciences & Research, Vol.4; Issue: 5

The authors declare no competing interests.

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The relationship between the occurrence of asthma and diabetes.

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Abstract

Introduction

Methods and materials

Research Importance

Study Design

Patients

Methods

The study population was divided into two groups:

Statistical Methods:

Results

Discussion

Declarations

Convict of interest:

Funding:

Acknowledgments:

Availability of data and materials:

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