Exp Clin Endocrinol Diabetes 2018; 126(09): 590-591
DOI: 10.1055/a-0715-2743
Commentary
© Georg Thieme Verlag KG Stuttgart · New York

Diabetic Pulmopathy: A New Clinical Challenge for Diabetology

Stefan Kopf
1   University Hospital of Heidelberg, Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine I), Heidelberg, Germany
2   German Center of Diabetes Research (DZD), associated Partner in the DZD; München-Neuherberg, Germany
,
Peter P. Nawroth
1   University Hospital of Heidelberg, Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine I), Heidelberg, Germany
2   German Center of Diabetes Research (DZD), associated Partner in the DZD; München-Neuherberg, Germany
3   Joint-IDC, Institute for Diabetes and Cancer at Helmholtz Zentrum Munich and University of Heidelberg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
27 September 2018 (online)

Breathlessness is a frequent symptom in patients with diabetes [1]. The first diseases which have to be excluded are coronary heart disease and inflammatory diseases of the upper respiratory tract [2]. However, epidemiological studies have long shown that patients with diabetes mellitus are overrepresented among the group of patients with idiopathic pulmonary fibrosis (IPF) [3] [4]. These patients are characterized by a more severe disease progression compared to IPF patients without diabetes [4] [5]. Thus, the speculation arises that pulmonary fibrosis might be associated with diabetes.

Since the lung is the organ with the most extreme exposure to oxygen and consecutive oxidative stress, this organ is prone to be also a target of metabolic abnormalities in diabetes [6] [7] [8]. Diabetes by itself is associated with an increase in reactive oxygen species, leading to inflammation, cell destruction and finally to fibrosis – also in the lung [7] [9] [10]. Furthermore, it’s well known that antioxidant defense mechanisms are reduced in diabetes, as are defense mechanisms against dicarbonyl stress [11]. Therefore it is surprising that pulmonary dysfunction in diabetes has been neglected for so long time. However, before the term diabetic pulmopathy can be established, mechanistic studies proving cause-effect-relationship between diabetes and pulmonary fibrosis are mandatory. The first data indicate that indeed pulmonary fibrosis might be a consequence of diabetes [12] [13] [14].