TY - JOUR
T1 - Associations between spirometric impairments and microvascular complications in type 2 diabetes
T2 - a cross-sectional study
AU - Hayfron-Benjamin, Charles F.
AU - Agyemang, Charles
AU - van den Born, Bert-Jan H.
AU - Amoah, Albert G. B.
AU - Amissah-Arthur, Kwesi Nyan
AU - Musah, Latif
AU - Abaidoo, Benjamin
AU - Awula, Pelagia
AU - Awuviri, Henry Wedoi
AU - Abbey, Joseph Agyapong
AU - Fummey, Deladem A.
AU - Ackam, Joana N.
AU - Asante, Gloria Odom
AU - Hashimoto, Simone
AU - Maitland-van der Zee, Anke H.
N1 - Funding Information: We are very grateful to the study participants for taking part in the study. Patience Vormatu deserves special commendation for coordinating the recruitment and study procedures. We thank the research assistants (Abraham Ablor, Alexander Danquah, Maame Boatemaa Ansong, Michael Adjei and Nii Adjetey Kwaw Wills) for assisting with interviews and anthropometric measurements. We also thank Edem Ahiabor for assisting with the retinal photography. We gratefully acknowledge the leadership and staff of the NDMRC for helping with various aspects of the study. We also acknowledge Elikem Jasper Butsey, Faustina Aba Amoah, Odelia Tamakloe and Seth Agyemang, and the staff of the National Cardiothoracic Centre Laboratory and the KBTH Accident and Emergency Laboratory for running the biochemical tests. We are grateful to Dr Charles Antwi-Boasiako, Dr Yvonne Dei-Adomako and Enoch Mensah for their support in biobank management and the high-quality storage of collected samples. were responsible for statistical analysis. CH-B, B-JHvdB, AHM, AGBA, SH, KNA-A, JAA, PA, HWA, LM, GOA, JNA and BA were responsible for data interpretation. All authors were involved in reporting of the work/writing the manuscript. Each author contributed important intellectual content during article drafting or revision and accepts accountability for the overall work by ensuring that questions about the accuracy or integrity of any portion of the work are appropriately investigated and resolved. CH-B takes responsibility for the fact that this study has been reported honestly, accurately, and transparently, that no important aspects of the study have been omitted, and that any discrepancies from the study as planned have been explained. CH-B is the author acting as guarantor. This work was funded by the Faculty Development Grant of the University of Ghana College of Health Science (Grant Number: N/A). Funding Information: This work was funded by the Faculty Development Grant of the University of Ghana College of Health Science (Grant Number: N/A). Publisher Copyright: © Author(s) (or their employer(s)) 2023.
PY - 2023/10/30
Y1 - 2023/10/30
N2 - OBJECTIVE: Evidence shows that the conventional cardiometabolic risk factors do not fully explain the burden of microvascular complications in type 2 diabetes (T2D). One potential factor is the impact of pulmonary dysfunction on systemic microvascular injury. We assessed the associations between spirometric impairments and systemic microvascular complications in T2D. DESIGN: Cross-sectional study. SETTING: National Diabetes Management and Research Centre in Ghana. PARTICIPANTS: The study included 464 Ghanaians aged ≥35 years with established diagnosis of T2D without primary myocardial disease or previous/current heart failure. Participants were excluded if they had primary lung disease including asthma or chronic obstructive pulmonary disease. PRIMARY AND SECONDARY OUTCOME MEASURES: The associations of spirometric measures (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio) with microvascular complications (nephropathy (albumin-creatinine ratio ≥3 mg/g), neuropathy (vibration perception threshold ≥25 V and/or Diabetic Neuropathy Symptom score >1) and retinopathy (based on retinal photography)) were assessed using multivariable logistic regression models with adjustments for age, sex, diabetes duration, glycated haemoglobin concentration, suboptimal blood pressure control, smoking pack years and body mass index. RESULTS: In age and sex-adjusted models, lower Z-score FEV1 was associated with higher odds of nephropathy (OR 1.55, 95% CI 1.19-2.02, p=0.001) and neuropathy (1.27 (1.01-1.65), 0.038) but not retinopathy (1.22 (0.87-1.70), 0.246). Similar observations were made for the associations of lower Z-score FVC with nephropathy (1.54 (1.19-2.01), 0.001), neuropathy (1.25 (1.01-1.54), 0.037) and retinopathy (1.19 (0.85-1.68), 0.318). In the fully adjusted model, the associations remained significant for only lower Z-score FEV1 with nephropathy (1.43 (1.09-1.87), 0.011) and neuropathy (1.34 (1.04-1.73), 0.024) and for lower Z-score FVC with nephropathy (1.45 (1.11-1.91), 0.007) and neuropathy (1.32 (1.03-1.69), 0.029). Lower Z-score FEV1/FVC ratio was not significantly associated with microvascular complications in age and sex and fully adjusted models. CONCLUSION: Our study shows positive but varying strengths of associations between pulmonary dysfunction and microvascular complications in different circulations. Future studies could explore the mechanisms linking pulmonary dysfunction to microvascular complications in T2D.
AB - OBJECTIVE: Evidence shows that the conventional cardiometabolic risk factors do not fully explain the burden of microvascular complications in type 2 diabetes (T2D). One potential factor is the impact of pulmonary dysfunction on systemic microvascular injury. We assessed the associations between spirometric impairments and systemic microvascular complications in T2D. DESIGN: Cross-sectional study. SETTING: National Diabetes Management and Research Centre in Ghana. PARTICIPANTS: The study included 464 Ghanaians aged ≥35 years with established diagnosis of T2D without primary myocardial disease or previous/current heart failure. Participants were excluded if they had primary lung disease including asthma or chronic obstructive pulmonary disease. PRIMARY AND SECONDARY OUTCOME MEASURES: The associations of spirometric measures (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio) with microvascular complications (nephropathy (albumin-creatinine ratio ≥3 mg/g), neuropathy (vibration perception threshold ≥25 V and/or Diabetic Neuropathy Symptom score >1) and retinopathy (based on retinal photography)) were assessed using multivariable logistic regression models with adjustments for age, sex, diabetes duration, glycated haemoglobin concentration, suboptimal blood pressure control, smoking pack years and body mass index. RESULTS: In age and sex-adjusted models, lower Z-score FEV1 was associated with higher odds of nephropathy (OR 1.55, 95% CI 1.19-2.02, p=0.001) and neuropathy (1.27 (1.01-1.65), 0.038) but not retinopathy (1.22 (0.87-1.70), 0.246). Similar observations were made for the associations of lower Z-score FVC with nephropathy (1.54 (1.19-2.01), 0.001), neuropathy (1.25 (1.01-1.54), 0.037) and retinopathy (1.19 (0.85-1.68), 0.318). In the fully adjusted model, the associations remained significant for only lower Z-score FEV1 with nephropathy (1.43 (1.09-1.87), 0.011) and neuropathy (1.34 (1.04-1.73), 0.024) and for lower Z-score FVC with nephropathy (1.45 (1.11-1.91), 0.007) and neuropathy (1.32 (1.03-1.69), 0.029). Lower Z-score FEV1/FVC ratio was not significantly associated with microvascular complications in age and sex and fully adjusted models. CONCLUSION: Our study shows positive but varying strengths of associations between pulmonary dysfunction and microvascular complications in different circulations. Future studies could explore the mechanisms linking pulmonary dysfunction to microvascular complications in T2D.
KW - diabetic nephropathy & vascular disease
KW - diabetic neuropathy
KW - diabetic retinopathy
KW - pulmonary disease, chronic obstructive
UR - http://www.scopus.com/inward/record.url?scp=85175660489&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/bmjopen-2023-075209
DO - https://doi.org/10.1136/bmjopen-2023-075209
M3 - Article
C2 - 37903605
SN - 2044-6055
VL - 13
SP - e075209
JO - BMJ Open
JF - BMJ Open
IS - 10
M1 - e075209
ER -