Effect modification of glycemic control on association of lung function with all-cause and cardiovascular mortality in persons with type 2 diabetes - A retrospective cohort study

Cheng-Chieh Lin; Chia-Ing Li; Chuan-Wei Yang; Chiu-Shong Liu; Chih-Hsueh Lin; Shing-Yu Yang; Tsai-Chung Li

doi:10.1016/j.rmed.2024.107804

Effect modification of glycemic control on association of lung function with all-cause and cardiovascular mortality in persons with type 2 diabetes - A retrospective cohort study

Respir Med. 2024 Sep 7:234:107804. doi: 10.1016/j.rmed.2024.107804. Online ahead of print.

Authors

Cheng-Chieh Lin¹, Chia-Ing Li², Chuan-Wei Yang², Chiu-Shong Liu¹, Chih-Hsueh Lin³, Shing-Yu Yang⁴, Tsai-Chung Li⁵

Affiliations

¹ School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
² School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
³ School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
⁴ Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.
⁵ Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Audiology and Speech-Language Pathology, College of Medical and Health Science, Asia University, Taichung, Taiwan. Electronic address: [email protected].

PMID: 39251096
DOI: 10.1016/j.rmed.2024.107804

Abstract

Background: Poor glucose control might deteriorate the impaired pulmonary function, which can ultimately lead to mortality. However, few studies have examined the effect modification of glucose control on the association between pulmonary function and mortality. This study aimed to examine the association of pulmonary function with mortality and determine the effect modification of glycemic level on the association of pulmonary function with mortality in persons with type 2 diabetes (T2DM).

Methods: A retrospective cohort study included 3846 persons with T2DM with pulmonary function testing in Taiwan during 2002-2020. Expiratory volume in 1 s (FEV1) was measured as pulmonary function. Cox proportional hazards models were used and the effect modification of pulmonary function parameters and glucose control was assessed by their product terms.

Results: There were 733 deaths during an average follow-up of 7.83 years. Significant associations of FEV1 and mortality were found (hazards ratio [HR] for FEV1 Z-scores of <0 to -1, <-1 to -2 and <-2: 1.47 [1.20, 1.80], 2.48 [1.95, 3.14] and 3.07 [1.74, 5.44] compared with participants with Z-score ≥0, respectively. All p for trend<0.001). Significant effect modifications were found and the association between FEV1 and mortality was stronger in persons with good glycemic control compared with poor glycemic control (FEV1-FPG effect modification, P = 0.01; FEV1-HbA1c effect modification, P = 0.03).

Conclusion: Pulmonary function, measured by FEV1, is significantly associated with mortality in persons with T2DM. Significant effect modification of glucose control on the association between pulmonary function parameters and mortality was found.

Keywords: Diabetes; Glycemic control; Mortality; Pulmonary function.