The Relationship Between Diabetes Mellitus and Pulmonary Diseases: A Systematic Review

Document Type : Systematic review


1 Internist, Assistant Professor of Internal Medicine, Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Pulmonologist, Lung Disease research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Pulmonologist, Lung Disease research Center, Mashhad University of Medical Sciences, Mashhad, Iran

4 Pharmaciest, Mashhad University of Medical Sciences, Mashhad, Iran

5 General Practitioner, Health Center, Mashhad University of Medical Sciences, Mashhad, Iran

6 Resident of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

7 Resident of Infectious Diseases, Mashhad University of Medical Sciences, Mashhad, Iran


Diabetes mellitus (DM) as a chronic disease could lead to micro- and macrovascular disorder. Also, some evidence demonstrated that pulmonary involvement is more frequent in DM patients than the healthy population. Hence, we tried to perform a systematic search to considering pulmonary disease among the DM patients. Articles were identified through searching databases including PubMed, Google Scholar, Web of Sciences, Embase, and Scopus from 2000 to 2016. We reviewed systematically all studies reporting pulmonary disease among the diabetic patients. A total of 452 relevant records were identified by the electronic search, of which a total of 19 studies were identified as eligible papers that were original articles for the frequency of pulmonary disease among patients with DM. The incidence of pulmonary diseases has reported among diabetic patients that TB was reported to have a higher frequency when compared to other pulmonary disorder in diabetic patients. Therefore, conducting further studies on these two disorders is recommended, particularly in regions where the incidence of diabetes is increasing rapidly, and tuberculosis remains endemic.


  1. Aronson D. Hyperglycemia and the pathobiology of diabetic complications. 2008.
  2. Mojon P. Oral health and respiratory infection. Journal-Canadian Dental Association. 2002;68(6):340-5.
  3. Barrett-Connor E, Frette C. NIDDM, impaired glucose tolerance, and pulmonary function in older adults: the Rancho Bernardo Study. Diabetes Care. 1996;19(12):1441-4.
  4. McKeever TM, Weston PJ, Hubbard R, Fogarty A. Lung function and glucose metabolism: an analysis of data from the Third National Health and Nutrition Examination Survey. American journal of epidemiology. 2005;161(6):546-56.
  5. Goldman MD. Lung dysfunction in diabetes. Diabetes Care. 2003;26(6):1915-8.
  6. Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. European Respiratory Journal. 2008;32(4):962-9.
  7. Rana JS, Mittleman MA, Sheikh J, Hu FB, Manson JE, Colditz GA, et al. Chronic obstructive pulmonary disease, asthma, and risk of type 2 diabetes in women. Diabetes care. 2004;27(10):2478-84.
  8. Alisjahbana B, Sahiratmadja E, Nelwan EJ, Purwa AM, Ahmad Y, Ottenhoff TH, et al. The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. Clinical Infectious Diseases. 2007;45(4):428-35.
  9. Dooley KE, Tang T, Golub JE, Dorman SE, Cronin W. Impact of diabetes mellitus on treatment outcomes of patients with active tuberculosis. The American journal of tropical medicine and hygiene. 2009;80(4):634-9.
  10. Leung CC, Lam TH, Chan WM, Yew WW, Ho KS, Leung GM, et al. Diabetic control and risk of tuberculosis: a cohort study. American journal of epidemiology. 2008;167(12):1486-94.
  11. Shah BR, Hux JE. Quantifying the risk of infectious diseases for people with diabetes. Diabetes care. 2003;26(2):510-3.
  12. Ponce-de-Leon A, de Lourdes Garcia-Garcia M, Garcia-Sancho MC, Gomez-Perez FJ, Valdespino-Gomez JL, Olaiz-Fernandez G, et al. Tuberculosis and diabetes in southern Mexico. Diabetes Care. 2004;27(7):1584-90.
  13. Dyck RF, Klomp H, Marciniuk DD, Tan L, Stang MR, Ward HA, et al. The relationship between diabetes and tuberculosis in Saskatchewan: comparison of registered Indians and other Saskatchewan people. Canadian Journal of Public Health/Revue Canadienne de Sante'e Publique. 2007:55-9.
  14. Movahed M-R, Hashemzadeh M, Jamal MM. The prevalence of pulmonary embolism and pulmonary hypertension in patients with type II diabetes mellitus. CHEST Journal. 2005;128(5):3568-71.
  15. Singla R, Khan N, Al-Sharif N, Al-Sayegh M, Shaikh M, Osman M. Influence of diabetes on manifestations and treatment outcome of pulmonary TB patients. The International Journal of Tuberculosis and Lung Disease. 2006;10(1):74-9.
  16. Jick SS, Lieberman ES, Rahman MU, Choi HK. Glucocorticoid use, other associated factors, and the risk of tuberculosis. Arthritis Care & Research. 2006;55(1):19-26.
  17. Enomoto T, Usuki J, Azuma A, Nakagawa T, Kudoh S. Diabetes mellitus may increase risk for idiopathic pulmonary fibrosis. CHEST Journal. 2003;123(6):2007-11.
  18. Alisjahbana B, Van Crevel R, Sahiratmadja E, Den Heijer M, Maya A, Istriana E, et al. Diabetes mellitus is strongly associated with tuberculosis in Indonesia. The International Journal of Tuberculosis and Lung Disease. 2006;10(6):696-700.
  19. Gribbin J, Hubbard R, Smith C. Role of diabetes mellitus and gastro-oesophageal reflux in the aetiology of idiopathic pulmonary fibrosis. Respiratory medicine. 2009;103(6):927-31.
  20. Wang C, Yang C, Chen H, Chuang S, Chong I, Hwang J, et al. Impact of type 2 diabetes on manifestations and treatment outcome of pulmonary tuberculosis. Epidemiology and infection. 2009;137(02):203-10.
  21. Perez A, BROWN HS, Restrepo BI. Association between tuberculosis and diabetes in the Mexican border and non-border regions of Texas. The American journal of tropical medicine and hygiene. 2006;74(4):604-11.
  22. Ehrlich SF, Quesenberry CP, Van Den Eeden SK, Shan J, Ferrara A. Patients diagnosed with diabetes are at increased risk for asthma, chronic obstructive pulmonary disease, pulmonary fibrosis, and pneumonia but not lung cancer. Diabetes Care. 2010;33(1):55-60.
  23. Stevenson CR, Forouhi NG, Roglic G, Williams BG, Lauer JA, Dye C, et al. Diabetes and tuberculosis: the impact of the diabetes epidemic on tuberculosis incidence. BMC public health. 2007;7(1):234.
  24. Golsha R, Rezaei S, Shafiee A, Najafi L, Dashti M, Roshandel G. Pulmonary tuberculosis and some underlying conditions In Golestan Province of Iran, During 2001-2005. Journal of Clinical and Diagnostic Research. 2009;3(1):1302-6.
  25. Lange P, Parner J, Schnohr P, Jensen G. Copenhagen City Heart Study: longitudinal analysis of ventilatory capacity in diabetic and nondiabetic adults. European Respiratory Journal. 2002;20(6):1406-12.
  26. Lange P, Groth S, Kastrup J, Mortensen J, Appleyard M, Nyboe J, et al. Diabetes mellitus, plasma glucose and lung function in a cross-sectional population study. European Respiratory Journal. 1989;2(1):14-9.
  27. Davis TM, Knuiman M, Kendall P, Vu H, Davis WA. Reduced pulmonary function and its associations in type 2 diabetes: the Fremantle Diabetes Study. Diabetes research and clinical practice. 2000;50(2):153-9.
  28. Tiengo A, Fadini G, Avogaro A. The metabolic syndrome, diabetes and lung dysfunction. Diabetes & metabolism. 2008;34(5):447-54.
  29. Organization WH. World Health Organization: Global TB database. 2006
  30. Corbett EL, Watt CJ, Walker N, Maher D, Williams BG, Raviglione MC, et al. The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Archives of internal medicine. 2003;163(9):1009-21.
  31. Kim SJ, Hong YP, Lew WJ, Yang SC, Lee EG. Incidence of pulmonary tuberculosis among diabetics. Tubercle and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease. 1995;76(6):529-33. Epub 1995/12/01.
  32. Mugusi F, Swai AB, Alberti KG, McLarty DG. Increased prevalence of diabetes mellitus in patients with pulmonary tuberculosis in Tanzania. Tubercle. 1990;71(4):271-6. Epub 1990/12/01.
  33. Restrepo B, Fisher-Hoch S, Crespo J, Whitney E, Perez A, Smith B, et al. Type 2 diabetes and tuberculosis in a dynamic bi-national border population. Epidemiology and infection. 2007;135(03):483-91.
  34. Shetty N, Shemko M, Vaz M, D'souza G. An epidemiological evaluation of risk factors for tuberculosis in South India: a matched case control study. The International Journal of Tuberculosis and Lung Disease. 2006;10(1):80-6.
  35. Boucot KR, Dillon ES, Cooper DA, Meier P, Richardson R. Tuberculosis among diabetics: the Philadelphia survey. American review of tuberculosis. 1952;65(1:2):1-50. Epub 1952/01/01.
  36. HF R. The association of diabetes tuberculosis.  . N Eng J Med. 1934;210(1).
  37. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes estimates for the year 2000 and projections for 2030. Diabetes care. 2004;27(5):1047-53.
  38. Firsova VA, Ovsiankina ES, Kaminskaia GO, Rusakova LI, Grigor'eva ZP, Ryzhova AP, et al. [Carbohydrate metabolism impairment and specific features of the course of tuberculosis in adolescents with diabetes mellitus]. Problemy tuberkuleza. 2000(4):17-9. Epub 2000/09/12. Narusheniia uglevodnogo obmena i osobennosti techeniia tuberkuleza u podrostkov, bol'nykh sakharnym diabetom.
  39. Hendy M, Stableforth D. The effect of established diabetes mellitus on the presentation of infiltrative pulmonary tuberculosis in the immigrant Asian community of an inner city area of the United Kingdom. British journal of diseases of the chest. 1983;77(1):87-90. Epub 1983/01/01.
  40. Mboussa J, Monabeka H, Kombo M, Yokolo D, Yoka-Mbio A, Yala F. [Course of pulmonary tuberculosis in diabetics]. Revue de pneumologie clinique. 2003;59(1):39-44.
  41. Mos-Antkowiak R. [Tuberculosis in patients with alcoholism, peptic ulcer, diabetes mellitus or mental disorders]. Pneumonologia i alergologia polska. 1991;59(1-2):43-7. Epub 1991/01/01. Gruzlica u chorych z alkoholizmem, choroba wrzodowa, cukrzyca lub zaburzeniami psychicznymi.
  42. Nissapatorn V, Kuppusamy I, Jamaiah I, Fong M, Rohela M, Anuar AK. Tuberculosis in diabetic patients: a clinical perspective. The Southeast Asian journal of tropical medicine and public health. 2005;36(4):213-20.
  43. Bacakoğlu F, Başoğlu Ö, Çok G, Sayıner A, Ateş M. Pulmonary tuberculosis in patients with diabetes mellitus. Respiration. 2001;68(6):595-600.
  44. Koskinen SV, Reunanen AR, Martelin TP, Valkonen T. Mortality in a large population-based cohort of patients with drug-treated diabetes mellitus. American journal of public health. 1998;88(5):765-70. Epub 1998/05/20.
  45. Shaikh MA, Singla R, Khan NB, Sharif NS, Saigh MO. Does diabetes alter the radiological presentation of pulmonary tuberculosis. Saudi medical journal. 2003;24(3):278-81.
  46. Win T, Sharples L, Groves AM, Ritchie AJ, Wells FC, Laroche CM. Predicting survival in potentially curable lung cancer patients. Lung. 2008;186(2):97-102.
  47. Hanbali A, Al-Khasawneh K, Cole-Johnson C, Divine G, Ali H. Protective Effect of Diabetes Against Metastasis in Patients With Non–Small Cell Lung Cancer. Archives of internal medicine. 2007;167(5):513-.
  48. Hall GC, Roberts CM, Boulis M, Mo J, MacRae KD. Diabetes and the risk of lung cancer. Diabetes Care. 2005;28(3):590-4.
  49. Moran A, Dunitz J, Nathan B, Saeed A, Holme B, Thomas W. Cystic fibrosis–related diabetes: current trends in prevalence, incidence, and mortality. Diabetes care. 2009;32(9):1626-31.
  50. Bismuth E, Laborde K, Taupin P, Velho G, Ribault V, Jennane F, et al. Glucose tolerance and insulin secretion, morbidity, and death in patients with cystic fibrosis. The Journal of pediatrics. 2008;152(4):540-5. e1.
  51. Cawood T, McKenna M, Gallagher C, Smith D, Chung W, Gibney J, et al. Cystic fibrosis-related diabetes in adults. Irish medical journal. 2006;99(3):83-6.
  52. Koch C, Rainisio M, Madessani U, Harms H, Hodson M, Mastella G, et al. Presence of cystic fibrosis‐related diabetes mellitus is tightly linked to poor lung function in patients with cystic fibrosis: Data from the European Epidemiologic Registry of Cystic Fibrosis. Pediatric pulmonology. 2001;32(5):343-50.
  53. Lanng S, Thorsteinsson B, Nerup J, Koch C. Influence of the development of diabetes mellitus on clinical status in patients with cystic fibrosis. European journal of pediatrics. 1992;151(9):684-7. Epub 1992/09/01.
  54. Marshall B, Butler S, Stoddard M, Moran A, Liou T, Morgan W. Epidemiology of cystic fibrosis-related diabetes. The Journal of pediatrics. 2005;146(5):681-7.
  55. Manson JE, Colditz GA, Stampfer MJ, Willett WC, Krolewski AS, Rosner B, et al. A prospective study of maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women. Arch Intern Med. 1991;151(6):1141-7. Epub 1991/06/01.
  56. Balkau B, Eschwege E, Papoz L, Richard JL, Claude JR, Warnet JM, et al. Risk factors for early death in non-insulin dependent diabetes and men with known glucose tolerance status. BMJ (Clinical research ed). 1993;307(6899):295-9. Epub 1993/07/31.
  57. Kornum JB, Thomsen RW, Riis A, Lervang H-H, Schønheyder HC, Sørensen HT. Diabetes, Glycemic Control, and Risk of Hospitalization With Pneumonia A population-based case-control study. Diabetes Care. 2008;31(8):1541-5.
  58. Pozzilli P, Leslie RD. Infections and diabetes: mechanisms and prospects for prevention. Diabetic medicine : a journal of the British Diabetic Association. 1994;11(10):935-41. Epub 1994/12/01.
  59. Society AT, America IDSo. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: controlling tuberculosis in the United States. American Journal of Respiratory and Critical Care Medicine. 2005;172(9):1169.
  60. Health Do. Department of Health: Stopping tuberculosis in England: an action plan from the chief medical officer London: : Department of Health; 2004.