Population-based studies showing the negative impact of type 2 diabetes (T2D) on lung function are overviewed. Among the well-recognized pathophysiological mechanisms, the metabolic pathways related to insulin resistance (IR), low-grade chronic inflammation, leptin resistance, microvascular damage, and autonomic neuropathy are emphasized. Histopathological changes are exposed, and findings reported from experimental models are clearly differentiated from those described in humans. The accelerated decline in pulmonary function that appears in patients with cystic fibrosis (CF) with related abnormalities of glucose tolerance and diabetes is considered as an example to further investigate the relationship between T2D and the lung. Furthermore, a possible causal link between antihyperglycemic therapies and pulmonary function is examined. T2D similarly affects breathing during sleep, becoming an independent risk factor for higher rates of sleep apnea, leading to nocturnal hypoxemia and daytime sleepiness. Therefore, the impact of T2D on sleep breathing and its influence on sleep architecture is analyzed. Finally, the effect of improving some pathophysiological mechanisms, primarily IR and inflammation, as well as the optimization of blood glucose control on sleep breathing is evaluated. In summary, the lung should be considered by those providing care for people with diabetes and raise the central issue of whether the normalization of glucose levels can improve pulmonary function and ameliorate sleep-disordered breathing. Therefore, patients with T2D should be considered a vulnerable group for pulmonary dysfunction. However, further research aimed at elucidating how to screen for the lung impairment in the population with diabetes in a cost-effective manner is needed.

中文翻译：

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肺功能和睡眠呼吸：2型糖尿病护理的两个新目标

概述了基于人群的研究，这些研究表明2型糖尿病（T2D）对肺功能的负面影响。在公认的病理生理机制中，强调了与胰岛素抵抗（IR），轻度慢性炎症，瘦素抵抗，微血管损伤和自主神经病变有关的代谢途径。暴露了组织病理学变化，并且实验模型报告的发现与人类描述的发现有明显区别。囊性纤维化（CF）伴有糖耐量异常和糖尿病的患者出现的肺功能加速下降被认为是进一步研究T2D与肺之间关系的一个例子。此外，还检查了降糖治疗与肺功能之间的可能因果关系。T2D同样会影响睡眠期间的呼吸，从而成为导致更高的睡眠呼吸暂停的独立危险因素，从而导致夜间低氧血症和白天嗜睡。因此，分析了T2D对睡眠呼吸的影响及其对睡眠结构的影响。最后，评估了改善某些病理生理机制（主要是IR和炎症）以及优化对睡眠呼吸的血糖控制的效果。总之，应该为那些为糖尿病患者提供护理的人考虑肺部，并提出一个核心问题，即血糖水平正常化是否可以改善肺功能并改善睡眠呼吸障碍。因此，T2D患者应被视为肺功能不全的弱势人群。然而，