Frequency of Pre-diabetes and Diabetes in Patients Presented with COPD and Association Between Blood Glucose Level & Severity of COPD in a Tertiary Level Hospital

Background: Reduced lung performance and incidence of type 2 diabetes share similar pathophysiological pathways (such as low grade inflammation, oxidative stress, insulin resistance, physical inactivity and weight gain, alterations in metabolism of adipokines, hypoxia), so diabetes are much more common in patients with COPD than in controls. Diabetes is associated with an increased risk of pulmonary infections, disease exacerbations and worsened COPD outcomes.

Methods: It is an Observational cross sectional study. The study was done in department of medicine, Dinajpur Medical College Hospital (former M Abdur Rahim Medical College Hospital, Dinajpur) from July 2018 to December 2018. Detailed information was obtained in each cases according to protocol. Complete history was taken either from patient or accompanying attendants. Thorough clinical examination was done. Relevant investigation reports were collected. All the information was recorded according to fixed protocol. Collected data were classified, edited, coded and entered into the computer for statistical analysis by using SPSS version 23.

Results: Patients with COPD exhibit a higher frequency of Pre-diabetes and Diabetes. Among 100 COPD patients, 75 ( 75% ) were non diabetes, 13 ( 13 % ) were pre-diabetes and 12 ( 12 % ) were diabetes. Relative risk of new onset type 2 diabetes is 1.4 & relative risk of pre diabetes is 2.82 . Very severe COPD & severe COPD were associated with greater new onset Pre-diabetes and type 2 diabetes mellitus than moderate & mild COPD. In this study, 21 ( 84 % ) were pre-diabetes & diabetes in severe COPD and that of 4 ( 16 % ) in without severe COPD. Relative risk of 3.96 ( 95% CI 1.47-10.69 ) and P value 0.002 . The difference of total number of pre-diabetes and diabetes were statistically significant (p<0.05) between severe COPD and without severe COPD groups. Study result showed 10 (83.3%) were diabetes in severe COPD and that of 2 (16.7 % ) were in without severe COPD. Relative risk of 5.42 (95% CI 1.00-38.57) and P value 0.023. The difference of total number of diabetes were statistically significant (p<0.05) between severe COPD and without severe COPD groups. These results were statistically significant even after adjustment for potential confounding factor age, sex, Infection, acute exacerbation of COPD.

Conclusion: COPD is associated with increase incidence of pre-diabetes & type 2 DM. Very severe COPD & severe COPD were associated with greater new onset Pre-diabetes and type 2 DM than moderate & mild COPD. So we have to screen for diabetes more frequently in COPD patient than normal individual. The result of the study will give an insight to screen the patient of COPD for pre- diabetes & diabetes more intensely and such approach can potentially improve the outcomes of both DM & COPD.