Exploring the relationship between insulin resistance and restrictive lung diseases in type 2 diabetes

Background: Restrictive lung diseases (RLD) represent a potential complication for patients with type 2 diabetes (T2D) but its association with insulin resistance and other risk factors remain unclear. The influence of lifestyle interventions reducing insulin resistance on RLD is not yet known.

Methods: A cross-sectional analysis included 191 subjects (T2D=101; prediabetes=40; healthy=50). Six-month follow-up was conducted in 54 T2D subjects after Fasting-Mimicking-Diet (n=14), Mediterranean diet (n=13) and without diet (n=27). RLD parameters (VC, TLC-B, TLCO) and metabolic parameters were examined and statistical analyses were performed using correlation analysis and ANOVA cross-sectionally and longitudinally.

Results: T2D participants showed reduced VC (mean difference=-0.089; p=0.004) and TLC-B (mean difference=0.079; p=0.023) compared to healthy individuals. In Prediabetes, reduced VC (r=-0.544; p=0.001) and reduced TLC-B (r=-0.458; p=0.008) was mainly associated with increased adipose tissue insulin resistance, while in T2D overall insulin resistance (HOMA-IR) was associated with RLD (VC: r=-0.359; p<0.001; TLC-B: r=-0.245; p=0.014). Additionally, increased MASLD-Scores (FLI, NAFLD-Score) were associated with RLD-parameters in T2D (all p-values<0,05). The Fasting-Mimicking-Diet reduced significantly the risk factors HOMA-IR (Δ=-5.84/-4.09; p=0.002/0.014) and FLI (Δ=-13.83/-18.2; p=0.031/0.001) as compared to the other groups.

Conclusion: Our findings indicate that T2D is associated with reduced lung function, and this association may be partially mediated by insulin resistance and liver fibrosis/steatosis. Therefore, patients at risk should be screened for RLD in the future. Short term diet interventions could improve these risk factors, and did not lead to a decrease in lung function parameters.

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Artikel online veröffentlicht:
28. Mai 2025