J Korean Med Sci.  2012 Jul;27(7):756-760. 10.3346/jkms.2012.27.7.756.

Clinical Characteristics of Idiopathic Pulmonary Fibrosis Patients with Diabetes Mellitus: the National Survey in Korea from 2003 to 2007

• Kim YJ
• Park JW
• Kyung SY
• Lee SP
• Chung MP
• Kim YH
• Lee JH
• Kim YC
• Ryu JS
• Lee HL
• Park CS
• Uh ST
• Lee YC
• Kim KH
• Chun YJ
• Park YB
• Kim DS
• Jegal Y
• Lee JH
• Park MS
• Jeong SH

• KMID: 2157919
• DOI: http://doi.org/10.3346/jkms.2012.27.7.756

Abstract

Evidence suggests that diabetes mellitus (DM) is associated with idiopathic pulmonary fibrosis (IPF). According to the new IPF guidelines, high-resolution computed tomography (HRCT) is an essential means of diagnosing IPF. We investigated the relationship between IPF and DM in patients treated between 2003 and 2007. Newly diagnosed IPF patients in large university teaching hospitals in Korea were enrolled from January 2003 to December 2007. We retrospectively analyzed 1,685 patients using the interstitial lung disease (ILD) registry. In total, 299 IPF patients (17.8%) also had DM. The mean age of our subjects was 68.0 +/- 9.4 yr. HRCT showed significantly more reticular and honeycomb patterns in IPF patients with DM than in IPF patients without DM (P = 0.014, P = 0.028, respectively). Furthermore, significantly higher incidences of hypertension, cardiovascular diseases, and other malignancies (except lung cancer) were found in IPF patients with DM than in IPF patients without DM. In conclusion, IPF patients with DM are more likely to have the usual interstitial pneumonia (UIP) pattern, including reticular and honeycomb patterns, on HRCT than are those without DM.

Keyword

Idiopathic Pulmonary Fibrosis; Diabetes Mellitus; High Resolution Computed Tomography

MeSH Terms

Aged
Cardiovascular Diseases/epidemiology/etiology
Diabetes Mellitus, Type 2/*complications
Female
Humans
Hypertension/epidemiology/etiology
Idiopathic Pulmonary Fibrosis/complications/*diagnosis/radiography
Incidence
Male
Middle Aged
Neoplasms/epidemiology/etiology
Registries
Republic of Korea/epidemiology
Retrospective Studies
Tomography, X-Ray Computed

Reference

1. Selman M, King TE, Pardo A. American Thorac Society. European Respiratory Society. American College of Chest Physicians. Idiopathic pulmonary fibrosis: prevailing and evolving hypotheses about its pathogenesis and implications for therapy. Ann Intern Med. 2001. 134:136–151.

2. Park SW, Ahn MH, Jang HK, Jang AS, Kim DJ, Koh ES, Park JS, Uh ST, Kim YH, Park JS, et al. Interleukin-13 and its receptors in idiopathic interstitial pneumonia: clinical implications for lung function. J Korean Med Sci. 2009. 24:614–620.

3. Olson AL, Swigris JJ, Lezotte DC, Norris JM, Wilson CG, Brown KK. Mortality from pulmonary fibrosis increased in the United States from 1992 to 2003. Am J Respir Crit Care Med. 2007. 176:277–284.

4. Quadrelli S, Molinari L, Ciallella L, Spina JC, Sobrino E, Chertcoff J. Radiological versus histopathological diagnosis of usual interstitial pneumonia in the clinical practice: dose it have any survival difference? Respiration. 2010. 79:32–37.

5. Scott J, Johnston I, Britton J. What causes cryptogenic fibrosing alveolitis? A study of environmental exposure to dust. BMJ. 1990. 301:1015–1017.

6. Hubbard R, Lewis S, Richards K, Johnston I, Britton J. Occupational exposure to metal or wood dust and aetiology of cryptogenic fibrosing alveolitis. Lancet. 1996. 347:284–289.

7. Enomoto T, Usuki J, Azuma A, Nakagawa T, Kudoh S. Diabetes mellitus may increased risk for idiopathic fibrosis. Chest. 2003. 123:2007–2011.

8. Fernández Pérez ER, Daniels CE, Schroeder DR, St Sauver J, Hartman TE, Bartholmai BJ, Yi ES, Ryu JH. Incidence, prevalence, and clinical course of idiopathic pulmonary fibrosis: a population-based study. Chest. 2010. 137:129–137.

9. Garcia-Sancho Figueroa MC, Carrillo G, Pérez-Padilla R, Ferández-Plata MR, Buendia-Roldán I, Vargas HM, Selman M. Risk factors for idiopathic pulmonary fibrosis in a Mexican population. A case-control study. Respir Med. 2010. 104:305–309.

10. Gribbin J, Hubbard R, Smith C. Role of diabetes mellitus and gastro-oesophageal reflux in the aetiology of idiopathic pulmonary fibrosis. Respir Med. 2009. 103:927–931.

11. Kim YJ, Park JW, Kyung SY, An CH, Lee SP, Chung MP, Park HY, Jeong SH. Association of diabetes mellitus and metabolic syndrome with idiopathic pulmonary fibrosis. Tuberc Respir Dis. 2009. 67:113–120.

12. Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK, Colby TV, Cordier JF, Flaherty KR, Lasky JA, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011. 183:788–824.

13. American Thoracic Society. European Respiratory Society. American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June2001 and by the ERS Executive Committee, June 2001. Am J Respir Crit Care Med. 2002. 165:277–304.

14. Miyake Y, Sasaki S, Yokoyama T, Chida K, Azuma A, Suda T, Kudoh S, Sakamoto N, Okamoto K, Kobashi G, et al. Case-control study of medical history and idiopathic pulmonary fibrosis in Japan. Respirology. 2005. 10:504–509.

15. Souza CA, Müller NL, Flint J, Wright JL, Churg A. Idiopathic pulmonary fibrosis: spectrum of high-resolution CT findings. AJR Am J Roentgenol. 2005. 185:1531–1539.

16. Klein OL, Krishnan JA, Glick S, Smith LJ. Systemic review of the association between lung function and type 2 diabetes mellitus. Diabet Med. 2010. 27:977–987.

17. Baynes JW, Thorpe SR. Role of oxidative stress in diabetic complications: a new perspective on an old paradigm. Diabetes. 1999. 48:1–9.

18. Kuwano K, Nakashima N, Inoshima I, Hagimoto N, Fujita M, Yoshimi M, Maeyama T, Hamada N, Watanabe K, Hara N. Oxidative stress in lung epithelial cells from patients with idiopathic interstitial pneumonia. Eur Respir J. 2003. 21:232–240.

19. Maritim AC, Sanders RA, Watkins JB 3rd. Diabetes, oxidative stress, and antioxidants: a review. J Biochem Mol Toxicol. 2003. 17:24–38.

20. Rhyu DY, Yang Y, Ha H, Lee GT, Song JS, Uh ST, Lee HB. Role of reactive oxygen species in TGF-beta1-induced mitogen-activated protein kinase activation and epithelial-mesenchymal transition in renal tubular epithelial cells. J Am Soc Nephrol. 2005. 16:667–675.

21. Kinnula VL, Fattman CL, Tan RJ, Oury TD. Oxidative stress in pulmonary fibrosis: a possible role for redox modulatory therapy. Am J Respir Crit Care Med. 2005. 172:417–422.

22. Teramoto S, Fukuchi Y, Uejima Y, Shu CY, Orimo H. Superoxide anion formation and glutathione metabolism of blood in patients with idiopathic pulmonary fibrosis. Biochem Mol Med. 1995. 55:66–70.

23. Yu T, Robotham JL, Yoon Y. Increased production of reactive oxygen species in hyperglycemic conditions requires dynamic change of mitochondrial morphology. Proc Natl Acad Sci U S A. 2006. 103:2653–2658.

24. Panos RJ, Mortenson RL, Niccoli SA, King TE Jr. Clinical deterioration in patients with idiopathic pulmonary fibrosis: causes and assessment. Am J Med. 1990. 88:396–404.

25. Kizer JR, Zisman DA, Blumenthal NP, Kotloff RM, Kimmel SE, Strieter RM, Arcasoy SM, Ferrari VA, Hansen-Flaschen J. Association between pulmonary fibrosis and coronary artery disease. Arch Intern Med. 2004. 164:551–556.

26. Nathan SD, Basavaraj A, Reichner C, Shlobin OA, Ahmad S, Kiernan J, Burton N, Barnett SD. Prevealence and impact of coronary artery disease in idiopathic pulmonary fibrosis. Respir Med. 2010. 104:1035–1041.

27. Hubbard RB, Smith C, Le Jeune I, Gribbin J, Fogarty AW. The association between idiopathic pulmonary fibrosis and vascular disease: a population-based study. Am J Respir Crit Care Med. 2008. 178:1257–1261.

28. Matsushita H, Tanaka S, Saiki Y, Hara M, Nakata K, Tanimura S, Banba J. Lung cancer associated with usual interstitial pneumonia. Pathol Int. 1995. 45:925–932.