Breathlessness and Restrictive Lung Disease: An Important Diabetes-Related Feature in Patients with Type 2 Diabetes

Respiration. 2018;96(1):29-40. doi: 10.1159/000488909. Epub 2018 Jun 6.


Background: Diabetes mellitus is a significant comorbidity of interstitial lung disease (ILD).

Objectives: The aim of this study was to investigate the incidence of restrictive lung disease (RLD) and ILD in patients with prediabetes and type 2 diabetes (T2D).

Methods: Forty-eight nondiabetics, 68 patients with prediabetes, 29 newly diagnosed T2D, and 110 patients with long-term T2D were examined for metabolic control, diabetes-related complications, breathlessness, and lung function. Five participants with T2D, breathlessness, and RLD underwent multidetector computed tomography (MDCT) and a Six-Minute Walk Test (6MWT). Lung tissue from 4 patients without diabetes and from 3 patients with T2D was histologically examined for presence of pulmonary fibrosis.

Results: Breathlessness in combination with RLD was significantly increased in patients with prediabetes and T2D (p < 0.01). RLD was found in 9% of patients with prediabetes, in 20% of patients with newly diagnosed T2D, and in 27% of patients with long-term T2D. Thus, patients with long-term T2D had an increased risk of RLD (OR 5.82 [95% CI 1.71-20.5], p < 0.01). RLD was significantly associated with glucose metabolism and albuminuria (p < 0.01); furthermore, presence of nephropathy increased the risk of RLD (OR 8.57 [95% CI 3.4-21.9], p < 0.01) compared to nondiabetics. MDCT revealed ILD in 4 patients, the 6MWT correlated with the extent of ILD, and histological analysis showed fibrosing ILD in patients with T2D.

Conclusions: This study demonstrates increased breathlessness and a high prevalence of RLD in patients with T2D, indicating an association between diabetes and fibrosing ILD.

Keywords: Albuminuria; Diabetes-related complications; Fibrosing interstitial lung disease; Type 2 diabetes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Diabetes Complications / epidemiology
  • Diabetes Mellitus, Type 2 / complications*
  • Dyspnea / epidemiology
  • Dyspnea / etiology*
  • Female
  • Humans
  • Incidence
  • Lung Diseases, Interstitial / diagnosis
  • Lung Diseases, Interstitial / etiology*
  • Male
  • Middle Aged
  • Prediabetic State / complications
  • Respiratory Function Tests
  • Tomography, X-Ray Computed
  • Walk Test