Cox regression was performed for lung disease development both in those with (T2DM → lung disease) and without (Healthy → lung disease) established type 2 diabetes (T2DM) and for T2DM development in those with previously established lung disease (lung disease → T2DM). Analysis was adjusted for waist circumference (WC), smoking, forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity (FVC), glycated haemoglobin (HbA1c), body mass index (BMI), sex, presence of T2DM, and age. HR: hazard ratio; CI: confidence interval
CK and PLM: Conceptualization, Writing—review & editing, Supervision. PS: Conceptualization, Supervision. KC: Data curation. RL: Data curation, Investigation, Formal analysis, Writing—original draft. All authors read and approved the submitted version.
Conflicts of interest
The authors declare that they have no conflicts of interest.
Ethical approval
This research has been conducted using the UK Biobank Resource under application number 48433.
Consent to participate
All UK Biobank participants consented to take part in the UK Biobank project. Approved researchers working under approved projects can access the data for health-related research purposes. Participants were removed from analysis if they later revoked their consent.
Consent to publication
Not applicable.
Availability of data and materials
The data analysed in this study were obtained from UK Biobank. Requests for access to these datasets should be directed to the access management team (AMT), access@ukbiobank.ac.uk.
Funding
CK, PLM, and PS wish to acknowledge funding of a PhD studentship to RL from the Department for the Economy (DfE), Northern Ireland. PS wishes to acknowledge funding of a PhD studentship to KC from the Department for the Economy (DfE), Northern Ireland, and funding support from the Ulster University for the UK Biobank project number 48433. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.
References
Pitocco D, Fuso L, Conte EG, Zaccardi F, Condoluci C, Scavone G, et al. The diabetic lung--a new target organ?Rev Diabet Stud. 2012;9:23–35. [DOI] [PubMed] [PMC]
Lawlor DA, Ebrahim S, Smith GD. Associations of measures of lung function with insulin resistance and Type 2 diabetes: findings from the British Women’s Heart and Health Study.Diabetologia. 2004;47:195–203. [DOI] [PubMed]
Shah SH, Sonawane P, Nahar P, Vaidya S, Salvi S. Pulmonary function tests in type 2 diabetes mellitus and their association with glycemic control and duration of the disease.Lung India. 2013;30:108–12. [DOI] [PubMed] [PMC]
Ehrlich SF, Quesenberry CP Jr, 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;33:55–60. [DOI] [PubMed] [PMC]
Ford ES. The epidemiology of obesity and asthma.J Allergy Clin Immunol. 2005;115:897–909. [DOI] [PubMed]
Ofulue AF, Thurlbeck WM. Experimental diabetes and the lung: II. In vivo Connective Tissue Metabolism.Am Rev Respir Dis. 1988;138:284–9. [DOI] [PubMed]
Kolahian S, Leiss V, Nürnberg B. Diabetic lung disease: fact or fiction?Rev Endocr Metab Disord. 2019;20:303–19. [DOI] [PubMed] [PMC]
Varun K, Zoltan K, Alba S, Manuel B, Elisabeth K, Dimitrios T, et al. Elevated markers of DNA damage and senescence are associated with the progression of albuminuria and restrictive lung disease in patients with type 2 diabetes.EBioMedicine. 2023;90:104516. [DOI] [PubMed] [PMC]
The R Project for Statistical Computing [Internet].R Foundation; [cited 2023 Oct 27]. Available from: https://www.R-project.org/
Hanscombe KB, Coleman JRI, Traylor M, Lewis CM. ukbtools: An R package to manage and query UK Biobank data.PLoS One. 2019;14:e0214311. [DOI] [PubMed] [PMC]
The most trusted IDE for open source data science [Internet].Boston: Posit Software, PBC formerly RStudio, PBC; c2025 [cited 2023 Oct 27]. Available from: https://posit.co/products/open-source/rstudio/
Alberti KG, Zimmet P, Shaw J. Metabolic syndrome—a new world-wide definition. A Consensus Statement from the International Diabetes Federation.Diabet Med. 2006;23:469–80. [DOI] [PubMed]
Stanojevic S, Kaminsky DA, Miller MR, Thompson B, Aliverti A, Barjaktarevic I, et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests.Eur Respir J. 2022;60:2101499. [DOI] [PubMed]
Lee JM, Lee SA, Han CH, Lee SM, Kim CJ, Lee SC, et al. Body mass index as a predictor of mortality in bronchiectasis: A nationwide population-based study.Respir Med. 2021;180:106370. [DOI] [PubMed]
Wang X, Balaña-Corberó A, Martínez-Llorens J, Qin L, Xia Y, Zha J, et al. Respiratory and Peripheral Muscle Weakness and Body Composition Abnormalities in Non-Cystic Fibrosis Bronchiectasis Patients: Gender Differences.Biomedicines. 2022;10:334. [DOI] [PubMed] [PMC]
Khateeb J, Fuchs E, Khamaisi M. Diabetes and Lung Disease: A Neglected Relationship.Rev Diabet Stud. 2019;15:1–15. [DOI] [PubMed] [PMC]
Del Pino-Sedeño T, González de León B, Pérez Martín EF, Martín Gandolfo AM, Estupiñán Ramírez M, Redondo M, et al. Relationship between glycemic control and chronic obstructive pulmonary disease in patients with type 2 diabetes: A nested case-control study.Prim Care Diabetes. 2020;14:729–35. [DOI] [PubMed]
Sherman CB. The health consequences of cigarette smoking. Pulmonary diseases.Med Clin North Am. 1992;76:355–75. [DOI] [PubMed]
Cho SJ, Stout-Delgado HW. Aging and Lung Disease.Annu Rev Physiol. 2020;82:433–59. [DOI] [PubMed] [PMC]
Suastika K, Dwipayana P, Siswadi MS, Kuswardhani TRA. Age is an Important Risk Factor for Type 2 Diabetes Mellitus and Cardiovascular Diseases.In: Glucose Tolerance. InTech; 2012. [DOI]
Maddatu J, Anderson-Baucum E, Evans-Molina C. Smoking and the risk of type 2 diabetes.Transl Res. 2017;184:101–7. [DOI] [PubMed] [PMC]
Nordström A, Hadrévi J, Olsson T, Franks PW, Nordström P. Higher Prevalence of Type 2 Diabetes in Men Than in Women Is Associated With Differences in Visceral Fat Mass.J Clin Endocrinol Metab. 2016;101:3740–6. [DOI] [PubMed]
Ciarambino T, Crispino P, Leto G, Mastrolorenzo E, Para O, Giordano M. Influence of Gender in Diabetes Mellitus and Its Complication.Int J Mol Sci. 2022;23:8850. [DOI] [PubMed] [PMC]
Silveyra P, Fuentes N, Rodriguez Bauza DE. Sex and Gender Differences in Lung Disease.Adv Exp Med Biol. 2021;1304:227–58. [DOI] [PubMed] [PMC]
van den Borst B, Gosker HR, Zeegers MP, Schols AM. Pulmonary function in diabetes: a metaanalysis.Chest. 2010;138:393–406. [DOI] [PubMed]
Wang MY, Yang J, Ke H, Wang B, Liang BM, Ou XM, et al. Association of chronic obstructive pulmonary disease with type 2 diabetes mellitus.Chin Med J (Engl). 2014;127:3185–6. [DOI]
Liu J, Song X, Zheng S, Ding H, Wang H, Sun X, et al. A prospective study on physical performance of Chinese chronic obstructive pulmonary disease males with type 2 diabetes.Medicine (Baltimore). 2021;100:e27126. [DOI] [PubMed] [PMC]
Hwang JL, Weiss RE. Steroid-induced diabetes: a clinical and molecular approach to understanding and treatment.Diabetes Metab Res Rev. 2014;30:96–102. [DOI] [PubMed] [PMC]
Kalhan SC, Adam PA. Inhibitory effect of prednisone on insulin secretion in man: model for duplication of blood glucose concentration.J Clin Endocrinol Metab. 1975;41:600–10. [DOI] [PubMed]
Fry A, Littlejohns TJ, Sudlow C, Doherty N, Adamska L, Sprosen T, et al. Comparison of Sociodemographic and Health-Related Characteristics of UK Biobank Participants With Those of the General Population.Am J Epidemiol. 2017;186:1026–34. [DOI] [PubMed] [PMC]
