Rev Diabet Stud, 2019, 15(1):1-15 DOI 10.1900/RDS.2019.15.1

Diabetes and Lung Disease: A Neglected Relationship

Jasmin Khateeb1,2, Eyal Fuchs2,3, Mogher Khamaisi1,4,5

1Department of Internal Medicine D, Rambam Health Care Campus, Haifa, Israel
2Pulmonary Division, Rambam Health Care Campus, Haifa, Israel
3Department of Internal Medicine C, Rambam Health Care Campus, Haifa, Israel
4Faculty of Medicine - Technion - Israel Institute of Technology, Haifa, Israel
5Division of Endocrinology, Diabetes and Metabolism, Haifa, Israel
Address correspondence to: Jasmin Khateeb, e-mail:


BACKGROUND: Diabetes mellitus is a systemic disorder associated with inflammation and oxidative stress which may target many organs such as the kidney, retina, and the vascular system. The pathophysiology, mechanisms, and consequences of diabetes on these organs have been studied widely. However, no work has been done on the concept of the lung as a target organ for diabetes and its implications for lung diseases. AIM: In this review, we aimed to investigate the effects of diabetes and hypoglycemic agent on lung diseases, including asthma, chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis, pulmonary hypertension, and lung cancer. We also reviewed the potential mechanisms by which these effects may affect lung disease patients. RESULTS: Our results suggest that diabetes can affect the severity and clinical course of several lung diseases. CONCLUSIONS: Although the diabetes-lung association is epidemiologically and clinically well-established, especially in asthma, the underlying mechanism and pathophysiology are not been fully understood. Several mechanisms have been suggested, mainly associated with the pro-inflammatory and proliferative properties of diabetes, but also in relation to micro- and macrovascular effects of diabetes on the pulmonary vasculature. Also, hypoglycemic drugs may influence lung diseases in different ways. For example, metformin was considered a potential therapeutic agent in lung diseases, while insulin was shown to exacerbate lung diseases; this suggests that their effects extend beyond their hypoglycemic properties.

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Rev Diabet Stud, 2019, 15(1):16-25 DOI 10.1900/RDS.2019.15.16

Effects of Resistance and Combined training on Vascular Function in Type 2 Diabetes: A Systematic Review of Randomized Controlled Trials

João E. dos Santos Araujo1, Fabrício Nunes Macedo1, André Sales Barreto1, Márcio R. Viana dos Santos1, Angelo R. Antoniolli2, Lucindo J. Quintans-Junior2

1Laboratory of Cardiovascular Pharmacology, Department of Physiology, Federal University of Sergipe, Sergipe, Brazil
2Laboratory of Neurosciences and Pharmacological Trials, Department of Physiology, Federal University of Sergipe, Sergipe, Brazil
Address correspondence to: João E. dos Santos Araujo, e-mail:


BACKGROUND: Cardiovascular disease (CVD) is the main cause of mortality in type 2 diabetes (T2D). Exercise can reduce the risk factors associated with CVD in T2D patients. However, research evaluating its beneficial effects in these patients has used different measurement protocols and types of exercise, complicating comparison. AIM: To assess the effects of resistance training (RT) and combined training (CT) on the vascular function of T2D patients. METHODS: A database search (MEDLINE, Scopus, and Web of Science) was performed to identify relevant articles that were published up to August 2017. Only original studies evaluating the effects of RT or CT interventions on vascular function in T2D patients were included. The articles were reviewed independently by at least three reviewers. The Cochrane guidelines were used to assess the methodological quality of the studies. Fourteen studies were finally included. Two studies only used RT and twelve studies used CT as intervention strategy. RESULTS and CONCLUSIONS: The results show that resistance training is a useful means for primary treatment of vascular diseases and maintenance of vascular function in T2D patients. However, more studies are necessary to gain full knowledge of the beneficial effects and to identify tailored exercise plans to optimize these benefits. The information provided in this review may help to improve current treatment of vascular diseases in T2D patients and to design future studies.

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Rev Diabet Stud, 2019, 15(1):35-48 DOI 10.1900/RDS.2019.15.35

Impact of Physical Exercise on Gut Microbiome, Inflammation, and the Pathobiology of Metabolic Disorders

Muhammad U. Sohail1, Hadi M. Yassine1, Aaqib Sohail2, Asmaa A. Al Thani1

1Biomedical Research Center, Qatar University, P.O. Box 2713, Doha, Qatar
2Research Group Biomarkers for Infectious Diseases, TWINCORE Centre for Clinical and Experimental Infection Research, Hannover, Germany
Address correspondence to: Muhammad U. Sohail, Biomedical Research Center, Zone 5, H10 Building, Qatar University, PO Box 2713, Doha, Qatar, e-mail:


BACKGROUND: The gastrointestinal tract (GIT) harbors a complex and diverse microbial composition that outnumbers our own body cells and their gene contents. These microbes play a significant role in host metabolism and energy homeostasis. Emerging evidence suggests that the GIT microbiome significantly contributes to host health and that impairments in the microbiome may cause the development of metabolic diseases. The microbiome architecture is shaped by several genetic and environmental factors, including nutrition and physical activity. Physical exercise has preventive or therapeutic effects in respiratory, cardiovascular, neuroendocrine, and muscular diseases. Yet, we still have little information of the beneficial effects of physical exercise on GIT health and microbial composition. Furthermore, we are not aware whether exercise-derived benefits on microbiome diversity can beneficially influence other tissues and body organs. OBJECTIVES: The aim of this article is to review the available literature on exercise-induced microbiome changes and to explain how these changes may induce inflammatory, immune, and oxidative responses that may contribute to the improvement of metabolic disorders. METHODS: A systemic and comprehensive search of the relevant literature using MEDLINE and Google Scholar databases was conducted during fall 2018 and spring 2019. The search identified sixty-two research and review articles that discussed exercise-induced microbiome changes. RESULTS: The review of the relevant literature suggests that exercise-induced microbial changes affect the host's immune pathways and improve energy homeostasis. Microbes release certain neuroendocrine and immune-modulatory factors that may lower inflammatory and oxidative stress and relieve patients suffering from metabolic disorders. CONCLUSIONS: Exercise-induced changes in microbial diversity are able to improve tissue metabolism, cardiorespiratory fitness, and insulin resistance.

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Rev Diabet Stud, 2019, 15(1):60-70 DOI 10.1900/RDS.2019.15.60

Systematic Review and Meta-Analysis of the Effects of Soy on Glucose Metabolism in Patients with Type 2 Diabetes

Soheil Soltanipour1, Tolou Hasandokht1, Robabeh Soleimani2, Marjan Mahdavi-Roshan1, Mir Mohammad Jalali3

1School of Medicine, Guilan University of Medical Sciences, Rasht, Guilan, Iran
2Kavosh Cognitive Behavior Sciences and Addiction Research Center, School of Medicine, Shafa Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran
3Otorhinolaryngology Research Center, School of Medicine, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran
Address correspondence to: Mir Mohammad Jalali,e-mail:


OBJECTIVE: This study aimed to assess the effects of soy consumption on glucose metabolism in patients with type 2 diabetes. METHODS: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review (PRISMA) principles. Literature published between 1990 and 2019 was searched. Primary outcomes were the effect of soy on fasting plasma glucose (FPG), insulin, and HbA1c. The data were pooled using random effects models. Heterogeneity was assessed using Cochran's Q and I2 statistics. Also, the Cochrane Collaboration's tool for assessing risk of bias was used, and sensitivity analysis and meta-regression were conducted. Publication bias was evaluated using Egger and Begg tests. RESULTS: Sixteen randomized clinical trials (RCTs) with a total of 471 participants were regarded as eligible and included in the study. Soy consumption had no significant effects on FPG, insulin, and HbA1c. After the "trim-and-fill" method was applied, soy revealed a significant effect size on FPG (adjusted Cohen's d: -0.18; p = 0.03). Also, subgroup analyses using studies with parallel design showed a significant improvement (moderate effect size) in FPG and insulin. Sensitivity analysis indicated the robustness of our findings. Among secondary outcomes, the results showed a significant effect of soy on HOMA-IR and total cholesterol levels. CONCLUSIONS: Although this systematic review and meta-analysis indicated no beneficial effects of soy consumption on FPG, insulin, and HbA1c in patients with type 2 diabetes, pooling of parallel studies showed different results from crossover studies. The quality of evidence revealed low levels of confidence for primary outcomes. Therefore, further research is recommended.

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Rev Diabet Stud, 2019, 15(1):74-82 DOI 10.1900/RDS.2019.15.74

Application of Topical Oxygen Therapy in Healing Dynamics of Diabetic Foot Ulcers - A Systematic Review

Megha Nataraj1, Arun G. Maiya1, Gagana Karkada1, Manjunatha Hande2, Gabriel S. Rodrigues3, Rajgopal Shenoy3, Shiva S. Prasad3

1Centre for Diabetic Foot Care and Research (CDFCR), Department of Physiotherapy, Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education (MAHE), Madhav Nagar, Manipal 576104, Karnataka, India
2Department of Medicine, Kasturba Medical College and Kasturba Hospital, Manipal Academy of Higher Education (MAHE), Madhav Nagar, Manipal 576104, Karnataka, India
3Department of Surgery, Kasturba Medical College and Kasturba Hospital, Manipal Academy of Higher Education (MAHE), Madhav Nagar, Manipal 576104, Karnataka, India
Address correspondence to: Arun G. Maiya, e-mail:


BACKGROUND: Individuals with diabetes may develop diabetic foot ulcers due to diabetic peripheral neuropathy. Multiple factors influence the ulcer healing process; oxygen helps in facilitating the different stages of wound healing. OBJECTIVE: The objective of this systematic review was to analyze the different levels of evidence available in the application of topical oxygen therapy, warm oxygen therapy, or other modes of topical oxygen delivery in the healing dynamics of diabetic foot ulcers. METHODS: Databases searched included Pubmed/Medline, Science Direct, Web of Science, Scopus, Cochrane, and CINAHL. The eligibility criteria of studies included participants ≥18 years with chronic non-healing diabetic foot ulcer (duration ≥3 months) receiving warm oxygen or topical oxygen therapy (TOT), and other modes of topical oxygen administration, which were compared with standard care group. Randomized and non-randomized studies were included. The primary outcome measure assessed was the rate of wound healing or wound closure. RESULTS: The review included 5 studies which used different modes of topical oxygen administration. The healing trajectory of the wounds was completely achieved in low-grade ulcers (grade 1), whereas all high-grade ulcers (grades 2, 3, and above) showed either 100% or 50% healing with a reduction in ulcer size and ulcer tissue depth. CONCLUSION: Topical oxygen therapy facilitates wound healing dynamics among individuals with chronic diabetic foot ulcers.

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