Chest
Clinical InvestigationsNeuromuscular DiseaseNeuroadrenergic Denervation of the Lung in Type I Diabetes Mellitus Complicated by Autonomic Neuropathy
Section snippets
Subjects
Twenty patients with type I diabetes mellitus (9 male, 11 female; mean ± SD age, 44.30 ± 9.86 years) diagnosed according to standardized criteria were studied.13 AN was diagnosed in 11 patients (AN group), and 9 patients did not have AN and were considered control patients (C group). AN was diagnosed according to a standardized procedure including four cardiovascular autonomic tests (Table 1). Normal, borderline, and abnormal responses to each maneuver of autonomic stimulation are reported in
Results
Table 2 shows demographic, clinical, and respiratory function data of the patients. Both groups had comparable and normal lung volumes and bronchial reactivity to methacholine. Three AN group patients but no C group patients had abnormal Dlco values. The quality of the metabolic control, as expressed by GHb, did not distinguish groups. Prevalence of proteinuria (> 3.5 mg/dL) and of diabetic retinopathy were significantly and tendentially higher in the AN group.
Table 3 shows the results of
Discussion
The present study demonstrates that loss of neuroadrenergic innervation of the lung might be a feature of AN complicating type I diabetes mellitus. The lack of correlation between alveolar permeability to water-soluble tracers and 123I-MIBG clearance guarantees that present findings really reflect neuroadrenergic denervation. The strong parallelism between the severity of AN, expressed by standardized indexes, and lung neuroadrenergic denervation further supports this conclusion. However,
ACKNOWLEDGMENT
This article is dedicated to Dr. Patrizia Cotroneo.
References (37)
- et al.
Relationship between diabetes control and pulmonary function in insulin-dependent diabetes mellitus
Am J Med
(1991) - et al.
Respiratory muscle function and hypoxic ventilatory control in patients with type I diabetes
Chest
(1999) - et al.
Hypoxic and hypercapnic breathlessness in patients with type I diabetes mellitus
Chest
(2000) - et al.
Cholinergic bronchomotor tone and airway caliber in insulin-dependent diabetes mellitus
Chest
(1992) - et al.
Pulmonary complications of diabetes mellitus
Pneumonia Infect Dis Clin North Am
(1995) - et al.
Infection and diabetes: the case for glucose control
Am J Med
(1982) - et al.
Pulmonary complications in diabetes mellitus
Mayo Clin Proc
(1989) - et al.
Metabolic functions of the lung: of what clinical relevance?
Chest
(1982) - et al.
Systemic infection, the sepsis syndrome, and the lungs
A comparison of the microvascular lesions in diabetes mellitus with those in normal aging
J Am Geriatr Soc
(1982)
Epsilon-amino-lysine bound glucose in human tissue obtained at autopsy
Diabetes
Is the lung a “target organ” in diabetes mellitus?
Arch Intern Med
Lung volume and distensibility in insulin-dependent diabetes mellitus
Am Rev Respir Dis
Inspiratory muscle performance and pulmonary function changes in insulin-dependent diabetes mellitus
Am Rev Respir Dis
Bronchial reactivity in diabetic patients
Rev Mal Respir
Diminished bronchial reactivity to cold air in diabetic patients with autonomic neuropathy
BMJ
Potential use of iodine-123 metaiodobenzylguanidine radioaerosol as a marker of pulmonary neuroadrenergic function
Eur J Nucl Med
Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance
Diabetes
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