Evaluation of Clinical and Instrumental Results of Lung Examination in Patients with Diabetes Mellitus, Coronary Artery Disease, and Obesity

Saule Zhautikova; Khamida Abdikadirova; Fatima Abikenova; Kymbat Zhienbayeva; B. M. Suleimenova; Asima Karipova; Irina Baryshnikova; Murat Zhalmakhanov; Irina Medvedeva; Dana Aubakirova; Lubov Piven; Sergey Zhuravlev

doi:10.3889/oamjms.2022.9182

Authors

Saule Zhautikova Department of Pathology, Non-Profit Joint-Stock Company, Karaganda Medical University, Karaganda, Kazakhstan
Khamida Abdikadirova Department of Pathology, Non-Profit Joint-Stock Company, Karaganda Medical University, Karaganda, Kazakhstan https://orcid.org/0000-0003-0413-2396
Fatima Abikenova Department of Pathology, Non-Profit Joint-Stock Company, Karaganda Medical University, Karaganda, Kazakhstan
Kymbat Zhienbayeva Department of Pathology, Non-Profit Joint-Stock Company, Karaganda Medical University, Karaganda, Kazakhstan
B. M. Suleimenova Department of Pathology, Non-Profit Joint-Stock Company, Karaganda Medical University, Karaganda, Kazakhstan
Asima Karipova Department of Pathology, Non-Profit Joint-Stock Company, Karaganda Medical University, Karaganda, Kazakhstan
Irina Baryshnikova Department of Pathology, Non-Profit Joint-Stock Company, Karaganda Medical University, Karaganda, Kazakhstan
Murat Zhalmakhanov Department of Pathology, Non-Profit Joint-Stock Company, Karaganda Medical University, Karaganda, Kazakhstan
Irina Medvedeva Department of Pathology, Non-Profit Joint-Stock Company, Karaganda Medical University, Karaganda, Kazakhstan
Dana Aubakirova Department of Pharmacology Non-Profit Joint-Stock Company, Karaganda Medical University, Karaganda, Kazakhstan
Lubov Piven Department of Pharmacology Non-Profit Joint-Stock Company, Karaganda Medical University, Karaganda, Kazakhstan https://orcid.org/0000-0002-3553-4251
Sergey Zhuravlev Department of Pathology, Non-Profit Joint-Stock Company, Karaganda Medical University, Karaganda, Kazakhstan https://orcid.org/0000-0002-3494-8612

DOI:

https://doi.org/10.3889/oamjms.2022.9182

Keywords:

Type 1 and 2 diabetes mellitus, Ischemic heart disease, Obesity, Functions of the bronchi and lungs, External respiration, Spirography, Biochemical disorders, Morphology

Abstract

BACKGROUND: There are a large number of works devoted to the study of the state of the bronchopulmonary system in diabetes mellitus in the literature in the last 20 years. However, these studies are often conflicting. Some researchers identify a deterioration in the function of external respiration and a connection with metabolic changes and complications of the disease, others associate it with vascular pathology. There are a number of reports of increased pulmonary ventilation in diabetes.

AIM: To assess the structural and functional state of the lungs in patients with diabetes mellitus and in combination with coronary heart disease and obesity.

METHODS: 395 patients with type 1 and type 2 diabetes mellitus were under observation. The diagnosis of diabetes mellitus was verified in accordance with International Programs and was based on WHO criteria. The glycemic level of patients was determined using a One Touch® basic glucometer (Johnson&Johnson, USA). The degree of carbohydrate metabolism compensation was assessed by the level of glycated hemoglobin (Hb_A1c), determined using a laboratory analyzer DCA-2000 MT (BAYER, Germany). The concentration of C-peptide in the blood serum was determined by the method of immunoluminometric analysis "Immunotech" (Czech Republic). Caro and HOMA-IR indices were calculated to identify and assess the insulin resistance (IR). The indices of hormone metabolism were determined by ELISA using DSL kits (USA) with subsequent measurement of optical density on a Spectra Classic reader from Tecan (Austria): corticotropic hormone (CTG), adrenaline, noradrenaline, cortisol, free hydrocortisone; 17-ketosteroids, 17-oxycorticosteroids, glucogone, insulin, somatotropic hormone (STH); thyroid stimulating hormone (TSH); thyroxine (T₄); thyroxine (T₃).

Instrumental-functional and radiation research methods:

X-ray methods for lungs examining, computer spirography, fibrobronchoscopy of the bronchi was performed in all patients. Morphological changes were assessed using histological and morphometric methods.

RESULTS: Pathogenetic mechanisms of the bronchopulmonary system disorders in patients with type 1 diabetes mellitus are associated with a decrease in the function of external respiration due to the volumetric air flow rates of the predominantly central airways and an increase in bronchial resistance. Alveolar hypoventilation of a restrictive type with impaired diffusion of gases through the alveolar-capillary membrane was detected in patients with type 2 diabetes mellitus. Restrictive and obstructive type disorders with impaired ventilation-perfusion ratios and pulmonary blood flow are formed in patients with type 2 diabetes mellitus combined with coronary artery disease and obesity.

CONCLUSION:

A decrease in the function of external respiration due to the central respiratory tract and an increase in bronchial resistance were noted in 38.4% of patients with type 1 diabetes mellitus. Restrictive alveolar hypoventilation was registered in 23.3% of patients with type 2 diabetes mellitus, catarrhal endobronchitis – in 21.31% of patients with type 2 diabetes mellitus.
Damage and fibrosis of the alveolar tissue, damage to the endothelium and disorganization of the connective tissue of the lungs were characteristic of microscopic examination of the ultrastructure of the lungs in patients with diabetes mellitus.

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References

Klein B, Moss S, Klein R, Cruickshanks K. Is peak expiratory flow rate a predictor of complications in diabetes? The Wisconsin Epidemiologic Study of Diabetic Retinopathy. J Diabetes Complications. 2001;15:301-6. Available from: https://diabetesjournals.org/care/article/27/suppl_1/s84/24669/Retinopathy-in-Diabetes. https://doi.org/10.1016/s1056-8727(01)00170-2 PMid:11711323 DOI: https://doi.org/10.1016/S1056-8727(01)00170-2

Kostovski M, Simeonovski V, Mironska K, Tasic V, Gucev Z. Metabolic profiles in obese children and adolescents with insulin resistanceю. Open Access Maced J Med Sci. 2018;6(3):511-8. https://doi.org/10.3889/oamjms.2018.097 PMid:29610610. Available from: https://oamjms.eu/index.php/mjms/article/view/oamjms.2018.097/1977. DOI: https://doi.org/10.3889/oamjms.2018.097

Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26(2):319-38. https://doi.org/10.1183/09031936.05.00034805 PMid:16055882 Available from: https://erj.ersjournals.com/content/26/2/319

Ford ES, Mannino DM. Prospective association between lung function and the incidence of diabetes: Findings from the National Health and Nutrition Examination Survey Epidemiologic Follow-Up Study. Diabetes Care. 2004;27:2966-70. https://doi.org/10.2337/diacare.27.12.2966 DOI: https://doi.org/10.2337/diacare.27.12.2966

PMid:15562215. Available from: https://diabetesjournals.org/care/article/27/12/2966/26596/Prospective-Association-Between-Lung-Function-and.

Androsova TA. Functional and Morphological Manifestations of Pulmonary Lesions in Diabetes Mellitus: Abstract. Candidate of Medical Sciences, 14.00.05. St. Petersburg; 1992. p. 26. Available from: https://medical-diss.com/medicina/funktsionalnye-i-morfologicheskie-proyavleniya-legochnyh-porazheniy-pri-saharnom-daibete.

Tussupbekova M, Bakenova R, Stabayeva L, Imanbayeva G, Nygyzbayeva R, Mussabekova S, et al. Clinic – Morphologic and morphometric criteria for differential diagnosis of sarcoidosis and pulmonary tuberculosis. Open Access Maced J Med Sci. 2019;7(9):1480-5. https://doi.org/10.3889/oamjms.2019.315 PMid:31198459 DOI: https://doi.org/10.3889/oamjms.2019.315

Abikenova F, Meyramov G, Zhautikova S, Abdikadirova K, Zhienbayeva C, Talaspekova Y, et al. Investigation of antidiabetogenic effect of the iodine-selenium concentrate in animals with chronic alloxan diabetes of varying severity. Open Access Maced J Med Sci. 2021;9(A):535-40. https://doi.org/10.3889/oamjms.2021.5873 DOI: https://doi.org/10.3889/oamjms.2021.5873

Zhautikova S, Abdikadirova K, Zhienbayeva K, Suleimenova B, Talaspekova Y, Karipova A, et al. Pathogenetic mechanisms of relationship of metabolic and morphofunctional disorders of thyroid and adrenal glands in diabetes mellitus and obesity. Open Access Maced J Med Sci. 2022;10(B):232-9. https://oamjms.eu/index.php/mjms/article/view/8151 DOI: https://doi.org/10.3889/oamjms.2022.8151

Abdikadirova KH, Amreyeva K, Zhautikova S, Kostyleva O, Abikenova F, Chergizova B, et al. Morphological changes in the hepatic tissue at the impact of industrial copper-bearing dust in the experiment. Open Access Maced J Med Sci. 2020;8(E):653-6. https://doi.org/10.3889/oamjms.2020.3473 DOI: https://doi.org/10.3889/oamjms.2020.3473

Jangildinova S, Ivassenko S, Kelmyalene A, Yessilbayeva B, Dyussenbekova B. Determination of the product of DNA oxidation in the blood of women living in the sub-aral area. Open Access Maced J Med Sci. 2019;7(10):1672-4. https://doi.org/10.3889/oamjms.2019.333 PMid:31210821 DOI: https://doi.org/10.3889/oamjms.2019.333

Okassova AK, Ilderbayev OZ, Nursafina AZ, Zharmakhanova GM, Rakhimova BB, Bayan YT, et al. Evaluation of lipid peroxidation under immobilization stress in irradiated animals in experiment. Open Access Maced J Med Sci. 2021;9(A):119-22. https://doi.org/10.3889/oamjms.2021.5781 DOI: https://doi.org/10.3889/oamjms.2021.5781

Abdikadirova KR, Amreeva KE, Kalishev MG, Zhautikova SB. Evaluation of the effectiveness of alimentary correction of pathological changes in hepatic tissue under the influence of industrial copper-containing dust in the experiment. Med Tr Prom Ekol. 2019;59(7):438-43. https://doi.org/10.31089/1026-9428-2019-59-7-438-43 DOI: https://doi.org/10.31089/1026-9428-2019-59-7-438-443

Kumar R, Malik S, Tiwari R, Zhautivova SB, Rakhimovna AH, Raj T, et al. Pathophysiology of cardiovascular diseases and the role of vitamins, and herbal extracts in the reduction of cardiovascular risks. Cardiovasc Hematol Agents Med Chem. 2021;19(2):175-86. https://doi.org/10.2174/1871525718666201217102638 DOI: https://doi.org/10.2174/1871525718666201217102638

PMid:33334299. Available from: https://www.ingentaconnect.com/content/ben/chamc/2021/00000019/00000002/art00009.

Okassova AK, Britko V, Okassov DB, Tatina YS, Tolegenova AI, Kuvatbaeva KN, et al. Study of lipid peroxidation-antioxidant defense systems in rats under radiation exposure. Open Access Maced J Med Sci. 2022;10(A):236-9. https://doi.org/10.3889/oamjms.2022.8352 DOI: https://doi.org/10.3889/oamjms.2022.8352

Kaminsky DA. Spirometry and diabetes: Implications of reduced lung functions. Diabetes Care. 2004;27:837-8. https://doi.org/10.2337/diacare.27.3.837 PMid:14988314. Available from: https://diabetesjournals.org/care/article/27/3/837/23051/Spirometry-and-DiabetesImplications-of-reduced. DOI: https://doi.org/10.2337/diacare.27.3.837

Bloomgarden ZT. Developments in diabetes and insulin resistence. Diabetes Care. 2006;29:161-7. Available from: https://www.endocrinepractice.org/article/S1530-891X(20)42870-8/ fulltext. DOI: https://doi.org/10.2337/diacare.29.01.06.dc06-zb01

Knuiman MW, James AL, Divitini ML, Ryan G, Bartholomew H C, Musk A W. Lung function, respiratory symptoms and mortality: Results from the Buselton Health Study. Ann Epidemiol. 1999;9:297-306. https://doi.org/10.1016/s1047-2797(98)00066-0 PMid:10976856. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1047279798000660?via%3Dihub. DOI: https://doi.org/10.1016/S1047-2797(98)00066-0

Makarevich AE, Valevich VE, Pochtavtsev AU. Evaluation of pulmonary hypertension in COPD patients with diabetes. Adv Med Sci. 2007;52:265-72.Available from: https://pubmed.ncbi.nlm.nih.gov/18217431/ PMid:18217431

Sokolov E.I., Zaichikova O.S. Diabetic heart: Metabolic reasons for the development of cardiomyopathy. Problems of Endocrinology. 1996;42(6):20-6. (In Russ.). Available from: https://www.probl-endojournals.ru/probl/article/view/12056 DOI: https://doi.org/10.14341/probl12056

Ragino YI, Shcherbakova LV, Denisova DV, Kuzminykh NA, Yachmeneva MP, Voevoda MI. Blood lipids and angina pectoris (according to the epidemiological cardiological questionnaire of Rose) in the population of 25-45 years of Novosibirsk. Cardiology. 2019;59:30-5. https://doi.org/10.18087/cardio.2600 PMid:30990150. Available from: https://lib.ossn.ru/jour/article/view/576/394. DOI: https://doi.org/10.18087/cardio.2600

Dudinskaya EN, Machekhina LV. Insulin resistance as a link between diabetes mellitus, obesity, dyslipidemia and cardiovascular diseases. Effective pharmacotherapy. Endocrinology. 2021;17(5):6-8. Available from: https://umedp.ru/articles/insulinorezistentnost_kak_svyazuyushchee_zveno_mezhdu_sakharnym_diabetom_ozhireniem_dislipidemiey_i_.html.

Alimova SA, Zhuraeva KI. The use of the questionnaire method in the early diagnosis of angina pectoris as a screening test during preventive examinations of the population. Electron Sci J Biol Integrat Med. 2017;6:4-9. Available from: https://cyberleninka.ru/article/n/primenenie-oprosnogo-metoda-v-ranney-diagnostike-stenokardii-v-kachestve-skriniruyuschego-testa-pri-profilakticheskih-obsledovaniyah.

Medovshchikov VV, Eshniyazov NB, Khasanova ER, Vatsik MV, Tukhsanboev ES, Babaeva LA, et al. First identified type 2 diabetes mellitus and prediabetes in hospitalized patients with cardiovascular diseases: Frequency, compliance of baseline levels of blood pressure, lipids and HbA 1c with target values. Med J Clin Pharmacol Ther. 2020;4:31-5. Available from: https://clinpharm-journal.ru/articles/2020-4/vpervye-vyyavlennye-saharnyj-diabet-2-go-tipa-i-prediabet-u-gospitalizirovannyh-patsientov-s-serdechno-sosudistymi-zabolevaniyami-chastota-sootvetstvie-ishodnyh-urovnej-ad-lipidov-i-hba-1c-tselevym-zn/. DOI: https://doi.org/10.32756/0869-5490-2020-4-31-35

Kurashvili LV, Semechkina EA, Avdonina TS, Zueva GF, Zakharova IR. Spectrum of blood lipids in patients with insulin-dependent diabetes mellitus and coronary heart disease. Probl Endocrinol. 1998;44(3):1012. https://doi.org/10.14341/probl199844310-12 DOI: https://doi.org/10.14341/probl199844310-12

Stavem K, Aaser E, Sandvik L. Lung function, smoking and mortality in a 26-year follow-up of healthy middle-aged males. Eur Respir J. 2005;25:618-25. https://doi.org/10.1183/0903193 6.05.00008504 PMid:15802334 Available from: https://erj.ersjournals.com/content/25/4/618. DOI: https://doi.org/10.1183/09031936.05.00008504

Izmerova NF, Chuchalina AG. Occupational Diseases of the Respiratory Organs. National Guidelines. Series. Moscow: GEOTAR-Media; 2015. p. 792. Available from: https://www.rosmedlib.ru/book/ISBN9785970435748.html.

Spirographic Diagnostics of Violations of the Ventilation Function of the Lungs: A Manual for Doctors: 2nd edition, Supplement. Blagoveshchensk; 2013. p. 44. Available from: https://docplayer.com/26037783-Spirograficheskaya-diagnostika-narusheniy-ventilyacionnoy-funkcii-legkih.html.

Mergentay A, Kulov DB, Bekembayeva GS, Koikov VV, Omarkulov BK, Mussabekova SA. The analysis of working load of general practitioners in the republic of Kazakhstan. Res J Pharm Tech. 2019;12(5):2283-8. https://doi.org/10.5958/0974-360X.2019.00381.0 DOI: https://doi.org/10.5958/0974-360X.2019.00381.0

Kalyagin AN, Asner TV. The Concept of Insufficiency of Function External Respiration. Spirography. Diagnosis of Obstructive and Restrictive Respiratory Failure. Irkutsk; 2005. p. 28. Available from: https://mir.ismu.baikal.ru/src/downloads/efa0f3ed_kalyagin_asner_spiro.pdf.

Santos E, Fonseca CM, Manco JC, Gallo Junior L. Cholinergic bronchomotor tone and airway caliber in insulin-dependent diabetes mellitus. Chest. 1992;101:1038-43. https://doi.org/10.1378/chest.101.4.1038 PMid:1555418. Available from: https://journal.chestnet.org/article/S0012-3692(16)32725-8/fulltext. DOI: https://doi.org/10.1378/chest.101.4.1038

Oivin IA. Statistical processing of experimental research results. Pathol Physiol Exp Ther. 1960;4:76-85.

Fletcher R, Fletcher S, Wagner E. Clinical epidemiological foundations of evidence-based medicine. The media sphere. Moscow; 1998. p. 345. Available from: https://kingmed.info/media/book/4/3455.pdf.

Kamysheva EP. Chronic nonspecific lung diseases, heart pathology and diabetes mellitus. TOP Med. 1997;5:17-8.

Mori H, Okubo M, Okamura M. Abnormalities of pulmonary function in patients with non-insulin-dependent diabetes mellitus. Intern Med. 1992;31:189-93. Available from: https://www.jstage.jst.go.jp/article/internalmedicine1992/31/2/31_2_189/_article. DOI: https://doi.org/10.2169/internalmedicine.31.189

Fuso L, Cotroneo P, Basso S. Postural variations of pulmonary diffusing capacity in insulin-dependent diabetes mellitus. Chest. 1996;110:1009-13. https://doi.org/10.1378/chest.110.4.1009 DOI: https://doi.org/10.1378/chest.110.4.1009

PMid:8874261. Available from: https://journal.chestnet.org/article/S0012-3692(15)46439-6/fulltext.

Stojkovikj J, Zafirova-Ivanovska B, Kaeva B, Anastasova S, Angelovska I, Stojkovikj D. The prevalence of diabetes mellitus in COPD patients with severe and very severe stage of the disease. Open Access Maced J Med Sci. 2016;4(2):253-8. https://doi.org/10.3889/oamjms.2016.060 DOI: https://doi.org/10.3889/oamjms.2016.060

PMid:27335596. Available from: https://oamjms.eu/index.php/mjms/article/view/oamjms.2016.060/1020.

Weiss S. Pulmonary function as a phenotype physiologic marker of cardiovascular morbidity and mortality. Chest. 2001;99:265-6. https://doi.org/10.1378/chest.99.2.265 DOI: https://doi.org/10.1378/chest.99.2.265

PMid:1989778. Available from: https://journal.chestnet.org/article/S0012-3692(16)48817-3/fulltext.

Benbassat C, Stern E, Kramer M. Pulmonary function in patients with diabetes mellitus. Am J Med Sci. 2001;322:127-32. Available from: https://www.amjmedsci.org/article/S0002-9629(15)34592-4/fulltext. DOI: https://doi.org/10.1097/00000441-200109000-00003

Abd El Dayem SM, Nazif HK, Abd EI-Kader M, El-Tawil M. Study of adiponectin level in diabetic adolescent girls in relation to glycemic control and complication of diabetes. Open Access Maced J Med Sci. 2015;3(4):613-8. Available from: https://oamjms.eu/index.php/mjms/article/view/oamjms.2015.098/614. DOI: https://doi.org/10.3889/oamjms.2015.098