Postural Variation In DLCO Identifies Pulmonary Microangiopathy in T2DM patients
Diabetes-related microvascular and macrovascular complications cause a significant increase in morbidity and mortality.
A recent study suggests that postural variation in Diffusion capacity for carbon monoxide (DLCO) is a useful test in identifying pulmonary microangiopathy among patients with Type II diabetes mellitus (T2DM). The study findings were published in the Diabetes & Metabolic Syndrome: Clinical Research & Reviews on December 15, 2021.
Lower Forced Vital capacity (FVC), Forced Expiratory Volume in the first second (FEV1) & DLCO occurs in adults with T2DM compared to non-diabetic individuals. Reduction in lung function correlates with glycemic status and duration of diabetes independent of smoking or obesity. Still, the entity of pulmonary microangiopathy is often under-recognized clinically and its awareness among general practitioners managing diabetes remains low likely due to its subclinical lung function abnormalities. Therefore, Dr Arun K and his team conducted a study assessing the occurrence of pulmonary microangiopathy among T2DM using dynamic DLCO.
In an observational study, the researchers included 120 participants and divided them into 3 groups. Group 1 comprised T2DM with microangiopathy (n = 40), group 2 include T2DM without microangiopathy (n = 40), group 3 were healthy controls (n = 40). Using electronic spirometry, they measured the FEV1, FVC and calculated the FEV1/FVC ratio. They measured the DLCO (%predicted) using the single breath method in the sitting position followed by the supine position and calculated delta DLCO. They further compared the measured DLCO between the three groups.
Key findings of the study:
- Upon analysis, the researchers found that DLCO (median [IQR]) in sitting (78 [70–82.75]) and supine position (70 [62–84]) among group one was significantly decreased when compared to the other two groups.
- They also found that delta DLCO (median, [IQR]) among patients with diabetic microangiopathy (−6 [-8 to −2]) was significant in comparison with group two (4[2,6]) and control group (5[4,6]).
- They noted that the negative delta DLCO reflecting pulmonary microangiopathy was significantly associated with extrapulmonary microangiopathy.
The authors concluded, "Postural variation in DLCO is a useful non-invasive test for identifying pulmonary microangiopathy among T2DM patients. Presence of pulmonary microangiopathy has a significant association with diabetic nephropathy and retinopathy."
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