Pulmonary involvement in diabetes mellitus

Diabetes mellitus involves the lungs in the course of the complex phenomena it generates. Recent research in animal diabetes as well as in human diabetes demonstrated biochemical changes at the pulmonary level such as the suppression of anyline p-hydroxilase, the reduction of the activity of glutathione-peroxidase, the development of NO-dependent endothelial dysfunction, microsomal disorders, increased heparan sulphate at the level of the vascular basement membrane, increased levels of advanced glycation end-products and the derangement of bronchial mucus production by amyline. Structural modifications of the lung parenchyma were observed such as the narrowing of the alveolar space, the flattening of the alveolar epithelium and the expansion of the interstitium. Aside from the involvement of the pulmonary vessels there is the involvement of the basement membranes of the alveolar epithelium, the bronchial epithelium and the pulmonary capillaries. The consequences of local oxidative stress, the increased vascular permeability and the modifications in mucus secretion lead to the reduction of pulmonary volumes, pulmonary diffusion capacity, elastic recoil with involvement of restrictive lung disorders, diminished bronchial reactivity and diminished bronchodilatation. Data of pulmonary pathology obtained from patients as well as pulmonary involvement of children born of diabetic mothers are presented succinctly.