title: Diabetic polyneuropathy is associated with respiratory muscle impairment in type 2 diabetes.
abstract: OBJECTIVE
  Diabetes has a major negative effect on intensive care unit outcome. This has been partly attributed to impaired respiratory neuromuscular function. However, data on respiratory neuromuscular involvement in diabetes are lacking. This study therefore aimed to assess respiratory neuromuscular function related to diabetic polyneuropathy in patients with type 2 diabetes.
  
  
  METHODS
  Respiratory neuromuscular function was assessed by the use of volitional tests and twitch mouth (TwPmo) and twitch transdiaphragmatic (TwPdi) pressures during non-volitional bilateral anterior magnetic phrenic nerve stimulation in 21 male type 2 diabetic patients without pulmonary disease and in 23 healthy, well-matched controls (forced expiratory volume in 1 s 103 +/- 11 vs 103 +/- 12% predicted; p = 0.9).
  
  
  RESULTS
  Both volitionally assessed maximal inspiratory and expiratory mouth pressures, and sniff nasal and transdiaphragmatic pressures were comparable between diabetic patients and controls (p > 0.1 for all). TwPmo was reduced in diabetic patients compared with controls (1.3 +/- 0.5 vs 1.0 +/- 0.4 kPa; p = 0.04), while TwPdi was comparable (1.7 +/- 0.5 vs 1.6 +/- 0.7 kPa; p = 0.6). Following subgroup analysis, patients with no or mild polyneuropathy (n = 10) as assessed by neurological disability scoring had normal respiratory neuromuscular function, whereas patients with moderate or severe polyneuropathy (n = 11) presented with markedly impaired respiratory neuromuscular function as indicated by TwPmo (1.3 +/- 0.4 vs 0.8 +/- 0.3 kPa; p = 0.01) and TwPdi (1.9 +/- 0.6 vs 1.1 +/- 0.4 kPa; p < 0.01).
  
  
  CONCLUSIONS
  With regard to volitional tests, diabetes does not affect respiratory neuromuscular function. In contrast, the application of non-volitional phrenic nerve stimulation provides strong evidence that diabetic polyneuropathy, as simply assessed by neurological disability scoring, is associated with substantially impaired respiratory neuromuscular function in type 2 diabetic patients.
authors.affiliation: Department of Pneumology, University Hospital Freiburg, Killianstrasse 5, 79106, Freiburg, Germany.
authors.forename: H-J
authors.initials: HJ
authors.lastname: Kabitz
authors.forename: F
authors.initials: F
authors.lastname: Sonntag
authors.forename: D
authors.initials: D
authors.lastname: Walker
authors.forename: A
authors.initials: A
authors.lastname: Schwoerer
authors.forename: S
authors.initials: S
authors.lastname: Walterspacher
authors.forename: S
authors.initials: S
authors.lastname: Kaufmann
authors.forename: F
authors.initials: F
authors.lastname: Beuschlein
authors.forename: J
authors.initials: J
authors.lastname: Seufert
authors.forename: W
authors.initials: W
authors.lastname: Windisch
mesh_terms: D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000503:physiopathology*; D006801:Humans; D001239:Inhalation; D007320:Inspiratory Capacity; D008297:Male; D009055:Mouth / Q000502:physiology; D053580:Muscle Strength / Q000502:physiology; D018908:Muscle Weakness / Q000503:physiopathology*; D010791:Phrenic Nerve / Q000473:pathology; D011312:Pressure; D015656:Respiratory Mechanics / Q000502:physiology; D012132:Respiratory Muscles / Q000473:pathology / Q000503:physiopathology*; D012137:Respiratory System / Q000503:physiopathology*