Department of Internal Medicine, Niigata University Faculty of Medicine, Japan.
Mayo Clin Proc. 2012 Sep;87(9):853-61. doi: 10.1016/j.mayocp.2012.04.016.
To evaluate the effect of elevated fasting plasma glucose (FPG) and hemoglobin A(1c) (HbA(1c)) concentrations on lung dysfunction and to prospectively investigate whether reduced lung function would be independently predictive of diabetes.
From January 6, 1997, through December 22, 2008, we observed 5346 men with no history of diabetes or lung dysfunction. Hazard ratios (HRs) for incident diabetes (FPG ≥126 mg/dL, HbA(1c) ≥6.5%, or self-reported clinician-diagnosed diabetes) were estimated for spirometry indices as continuous and categorical variables.
Elevated HbA(1c) concentrations within the normal range were significantly and more strongly associated with reduced forced vital capacity and forced expiratory volume in the first second after expiration (FEV(1)) than were FPG concentrations. During a 4.0-year follow-up, diabetes developed in 214 individuals. A 10-point decrease in percentage of FEV(1) predicted value was associated with an increased HR of 1.21 (95% confidence interval [CI], 1.09-1.34; P=.001) for diabetes after adjustment for demographic factors and body mass index. This association remained significant even after adjustment for metabolic factors, smoking status, and FPG or HbA(1c) concentrations but was attenuated substantially after adjustment for baseline HbA(1c) values (HR, 1.13; 95% CI, 1.01-1.26; P=.03). Lower quartile (Q) categories of percentage of FEV(1) predicted value were associated with increased risk of diabetes independently of known predictors including HbA(1c) (HR, 1.73; 95% CI, 1.14-2.62 for Q1; and HR, 1.76; 95% CI, 1.15-2.69 for Q2).
Reduced lung function was significantly related to chronic glycemic exposure within a normal range. Relatively low pulmonary function was an independent risk factor for diabetes in apparently healthy Japanese men.
评估空腹血糖（FPG）和血红蛋白 A1c（HbA1c）升高对肺功能障碍的影响，并前瞻性研究肺功能降低是否可独立预测糖尿病。
1997 年 1 月 6 日至 2008 年 12 月 22 日，我们观察了 5346 名无糖尿病或肺功能障碍病史的男性。使用连续变量和分类变量估计了肺功能指标作为发生糖尿病（FPG≥126mg/dL、HbA1c≥6.5%或自我报告的临床诊断糖尿病）的风险比（HR）。
正常范围内升高的 HbA1c 浓度与用力肺活量和用力呼气量第一秒（FEV1）的降低显著相关，相关性强于 FPG 浓度。在 4.0 年的随访期间，214 人发生了糖尿病。FEV1 预测值下降 10 个点与糖尿病的 HR 增加 1.21（95%置信区间[CI]，1.09-1.34；P=.001）相关，经调整人口统计学因素和体重指数后得出。即使在调整代谢因素、吸烟状况以及 FPG 或 HbA1c 浓度后，该相关性仍然显著，但在调整基线 HbA1c 值后，相关性显著减弱（HR，1.13；95%CI，1.01-1.26；P=.03）。较低的 FEV1 预测值百分比（Q）类别与糖尿病的风险增加独立相关，包括已知的预测因素（HR，1.73；95%CI，1.14-2.62 用于 Q1；HR，1.76；95%CI，1.15-2.69 用于 Q2）。
正常范围内的慢性血糖暴露与肺功能降低显著相关。相对较低的肺功能是日本健康男性糖尿病的独立危险因素。
