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Spirometry and diabetes: implications of reduced lung function.

The association of reduced lung function and diabetes has been described for many years (1). Although the clinical significance of this association is not known, it is intriguing to think of the lung as another end organ adversely affected by diabetes. It is also interesting to consider that reduced lung function may be present before the clinical recognition of diabetes (2) or insulin resistance (3,4), suggesting that the lung may be involved in the pathogenesis of diabetes.

The issue of lung function and diabetes is addressed in the current study by Davis et al. (5). Taking advantage of an extensive population database in western Australia, this group has conducted the largest prospective longitudinal survey to date of the pulmonary function of a cohort of patients with type 2 diabetes who had no history of lung disease. A total of 125 patients had spirometry measured at baseline and then again 7 years later. The key finding was that the average rate of decline of lung function as measured by forced expiratory volume in 1 s (FEV1) was 71 ml/year compared with an expected decline in healthy nonsmokers of 25–30 ml/year. This change in lung function was similar whether or not smokers were included in the analysis, indicating its independence from smoking status. Although the follow-up group clearly represented healthy survivors, their lung function decline was still greater than expected, which would likely only underestimate the true rate of decline …