In a new study entitled “Non-emphysematous chronic obstructive pulmonary disease is associated with diabetes mellitus” published in BMC Pulmonary Medicine the authors suggest chronic obstructive pulmonary disease without emphysema is associated with an increased risk for diabetes.

Chronic obstructive pulmonary disease (COPD) is an obstructive lung disease characterized by impaired air flow, escalating with time, and sometimes emphysema — a condition where the inner walls of lungs’ alveoli (the air sacs) weaken and eventually rupture. COPD symptoms include shortness of breath, cough and mucus production.

While heterogeneity of COPD led to the development of a classification system with disease subgroups, the authors hypothesized that a broader distinction between airway-predominant and emphysema-predominant COPD can be useful for clinicians, by identifying clinical features associated with each condition. Thus, in this study, the authors generated a classification system to distinguish both phenotypes using chest computed tomography (CT) scans. The distinction is achieved by the identifying if emphysema is present or absent in the analyzed patients.

The authors analyzed data from the Genetic Epidemiology of COPD Study (COPDGene), a large study performed in the United States that enrolled more than 10,000 smokers with and without COPD, and included volumetric chest CT scans for all the individuals.

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Based on chest CT scans, the team was able to identify and distinguish between high and low emphysema. From 4,197 COPD patients analyzed, they identified 1,687 and 1,817 patients as emphysema-predominant and non-emphysematous, respectively. While emphysema-predominant COPD patients exhibited more severe symptoms of airflow obstruction and increased exercise limitations, non-emphysematous COPD patients were associated with an increased prevalence of diabetes. This association was further confirmed in the ECLIPSE study (short for Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points).

Thus, the authors note the importance of these findings in determining the clinical implications of the association between non-emphysematous COPD and diabetes. According to the U.S. Preventive Services Task Force (USPTF) and similar agencies, diabetes testing is recommended for adults with hypertension and hyperlipidemia, or in adults with blood pressure higher than 135/80 mmHg. According to their results, the authors suggest that COPD patients, specifically the non-emphysematous patients, should also be tested for diabetes routinely.