title: The temporal relationship between poor lung function and the risk of diabetes.
abstract: BACKGROUND
  The association between impaired lung function and diabetes risk has been established in the past, however the temporal and causal relationships between the two remain unclear. We assessed the relationship between baseline FEV1 and FVC and risk of incident diabetes at different time intervals for participants in the Malmö Preventive Project cohort.
  
  
  METHODS
  Baseline lung function was assessed in 20,295 men and 7416 women during 1974-1992; mean age 43.4 ± 6.6 and 47.6 ± 7.8, respectively. Sex-specific quartiles of FEV1%predicted and FVC%predicted were created (Q4 = highest; reference). Follow-up time was divided into 10-year time intervals from baseline examination. Cox proportional hazards regression was used to assess the incidence of diabetes according to quartiles of FEV1 and FVC%predicted, after adjustments for baseline glucose and potential confounding factors.
  
  
  RESULTS
  Over 37-years' follow-up there were 3753 and 993 incident diabetes events in men and women, respectively. When comparing FEV1%predicted in men (Q1 vs. Q4), the HR for diabetes was 1.64 (1.21-2.22) for events <10 years after baseline, 1.52 (1.27-1.81) for events 10-20 years after baseline, 1.39 (1.22-1.59) for events 20-30 years after baseline, and 1.46 (1.08-1.97) for events occurring >30 years after baseline. A broadly similar pattern was seen for FVC%predicted and for women.
  
  
  CONCLUSIONS
  Low FEV1 precedes and significantly predicts future diabetes. This risk is still significant many years after the baseline FEV1 measurement in middle-aged men. These results suggest that there is a relationship between impaired lung function and diabetes risk beyond the effects of hyperglycemia on lung function.
authors.affiliation: Department of Clinical Sciences Malmö, Lund University, CRC 60:13, Jan Waldenströms gata 35, S-20502, Malmö, Sweden. suneela.zaigham@med.lu.se.
authors.forename: Suneela
authors.initials: S
authors.lastname: Zaigham
authors.affiliation: Department of Clinical Sciences Malmö, Lund University, CRC 60:13, Jan Waldenströms gata 35, S-20502, Malmö, Sweden.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Nilsson
authors.affiliation: Department of Translational Medicine, Lund University, Malmö, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Wollmer
authors.affiliation: Department of Clinical Sciences Malmö, Lund University, CRC 60:13, Jan Waldenströms gata 35, S-20502, Malmö, Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Engström
mesh_terms: D000328:Adult; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D015994:Incidence; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D013147:Spirometry; D013548:Sweden; D014797:Vital Capacity
keywords: Diabetes; Incidence; Lung function