The Prevalence of Diabetes Mellitus in Chronic Obstructive Pulmonary Disease Patients

Mariska Pangaribuan, Faisal Yunus, Triya Damayanti, Rochsismandoko Rochsismandoko


Backgrounds: Type 2 diabetes mellitus (DM) is a common comorbidity of COPD. COPD may be considered as a risk factor for new onset type 2 DM via multiple pathophysiological alterations such as systemic inflammation, smoking, oxidative stress, obesity and inhaled corticosteroid use. Exact prevalence of DM in COPD patients in Indonesia still unclear. Co-morbid conditions like DM have great impact on the outcome of COPD in the form of severity, morbidity and mortality.
Methods: A cross sectional study was done in Asthma-COPD clinic Persahabatan Hospital from February to March 2017 to screen COPD patients for DM. Sixty-four subjects were recruited. Interview, physical examination and laboratory testing were performed in all subjects.
Results: A total of 64 patients with COPD (Males=60, Female=4) with mean age 65±8.7 were screened for DM. Patients with known history of DM were 12 subjects (18.8%) and were enrolled as Known DM cases. Remaining 52 subjects (81.3%) whose DM status was unclear were screened by random or fasting blood sugar and HbA1c. Two subjects (3.1%) were considered as newly diagnosed DM cases. Prevalence of DM in present study was 21.9%. Number of patients with prediabetes was 16 subjects (25%). There was no significant relationship between gender, age, smoking, nutritional status, airflow limitation and inhaled corticosteroid use in occurrence of DM among COPD patients.
Conclusions: Prevalence of DM in COPD patients in the present study is 21.9%. It is important to screen all COPD patients for DM routinely.


COPD, diabetes mellitus, prevalence


Adeloye D, Chua S, Lee C, Basquill C, Papana A, Theodoratou E, et al. Global and regional estimates of COPD prevalence: Systematic review and meta–analysis. J Glob Health. 2015;5(2):020415.

Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2017. Cited 2017 March 21. Available from:

Regional COPD Working Group. COPD prevalence in 12 Asia-Pacific countries and regions: projections based on the COPD prevalence estimation model. Respirology. 2003;8(2):192-8.

Perhimpunan Dokter Paru Indonesia (PDPI). PPOK (Penyakit Paru Obstruktif Kronik) Diagnosis dan Penatalaksanaa. Jakarta: Penerbit Universitas Indonesia (UI-Press). 2016.

Nguyen VN, Yunus F, Nguyen TPA, Dao BV, Damayanti T, Wiyono WH, et al. The prevalence and patient characteristics of chronic obstructive pulmonary disease in non-smokers in Vietnam and Indonesia: An observational survey. Respirology. 2015;20:602-11.

Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J. 2009;33(5):1165-85.

Cazzola M, Bettoncelli G, Sessa E, Cricelli C, Biscione G. Prevalence of comorbidities in patients with chronic obstructive pulmonary disease. Respiration. 2010;80:112-9.

Pusat Data dan informasi Kementerian Kesehatan RI(InfoDATIN). Situasi dan analisis Diabetes. Diunduh tanggal 18 Mei 2017.Tersedia di

World Health Organization – Diabetes country profiles, 2016. Global Report on Diabetes. Diunduh tanggal 18 Mei 2017. Tersedia di

Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J. 2008;32:962-9.

Crisafulli E, Costi S, Luppi F, Cirelli G, Cilione C, Coletti O, et al. Role of comorbidities in a cohort of patients with COPD undergoing pulmonary rehabilitation. Thorax. 2008;63:487-92.

Mahishale V, Mahishale A, Patil B, Sindhuri A, Eti A. Screening for diabetes mellitus in patients with chronic obstructive pulmonary disease in tertiary care hospital in India. Niger Med J. 2015;56:122-5.

Parappil A, Depczynski B, Collett P, Marks GB. Effect of comorbid diabetes on length of stay and risk of death in patients admitted with acute exacerbations of COPD. Respirology. 2010;15:918-22.

Feary JR, Rodrigues LC, Smith CJ, Hubbard RB, Gibson JE. Prevalence of major comorbidities in subjects with COPD and incidence of myocardial infarction and stroke: a comprehensive analysis using data from primary care. Thorax. 2010;65:956-62.

Arliny Y, Faisal Y, Wiyono WH, Rochsismandoko. Kadar Finrinogen dan faktor risiko sindrom metabolik pada pasien Penyakit Paru Obstruktif Kronik stabil. Tesis Departemen Pulmonologi dan Kedokteran Respirasi. Jakarta: Universitas Indonesia, 2010.

Heianza Y, Hara S, Arase Y, Saito K, Fujiwara K, Tsuji H, et al. HbA1c 5.7-6.4% and impaired fasting plasma glucose for diagnosis of prediabetes and risk of progression to diabetes in Japan (TOPICS 3): a longitudinal cohort study. Lancet. 2011;378:147-55.

Li G, Zhang P, Wang J, Gregg EW, Yang W, Gong Q, et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet. 2008:371:1783-9.

Diabetes Prevention Program Reasearch Group. Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. N Engl J Med. 2002;346:393-403

Zhong N, Wang C, Yao W, Chen P, Kang J, Huang S, et al. Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey. Am J Respir Crit Care Med .2007;176:753-60.

Arnetz L, Ekberg NR, Alvarsson M. Sex differences in type 2 diabetes: focus on disease course and outcomes. Diabetes Metab Syndr Obes. 2014;7:409-20.

Rana JS, Mittleman MA, Sheikh J, Hu FB, Manson JE, Colditz GA, et al. Chronic obstructive pulmonary disease, asthma, and risk of type 2 diabetes in women. Diabetes Care. 2004;27(10):2478-84.

Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM. Global burden of COPD: systematic review and meta-analysis. Eur Respir J. 2006;28:523-32.

Barzilai N, Huffman DM, Muzumdar RH, Bartke A. The Critical Role of Metabolic Pathways in Aging. Diabetes. 2012;61:1315-22.

Agusti A, Calverley PM, Celli B, Coxson HO, Edwards LD, Lomas DA, et al. Characterisation of COPD heterogeneity in the ECLIPSE cohort. Respir Res .2010;11:122.

O'Byrne PM, Rennard S, Gerstein H, Radner F, Peterson S, Lindberg B, et al. Risk of new onset diabetes mellitus in patients with asthma or COPD taking inhaled corticosteroids. Respir Med .2012;106:1487-93.

Xie XT, Liu Q, Wu J, Wakui M. Impact of cigarette smoking in type 2 diabetes development. Acta Pharmacol Sin. 2009;30:784-7.

Manson JE, Ajani UA, Liu S, Nathan DM, Hennekens CH. A prospective study of cigarette smoking and the incidence of diabetes mellitus among US male physicians. Am J Med .2000;109:538-42.

Yeh H-C, Punjabi NM, Wang N-Y, Pankow JS, Duncan BB, Brancati FL. Vital Capacity as a Predictor of Incident Type 2 Diabetes. Diabetes care. 2005;28:1472-9.

Ford ES, Mannino DM. Prospective association between lung function and the incidence of diabetes: findings from the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Diabetes Care. 2004;27:2966-70.

Stojkovikj J, Zafirova-Ivanovska B, Kaeva B, Angelovska I, Stojkovikj D. The Prevalence of Diabetes Mellitus in COPD Patients with Severe and Very Severe Stage of the Disease. Maced J Med Sci. 2016;4:253-8

Miller J, Edwards LD, Agustí A, Bakke P, Calverley PMA, Celli B, et al. Comorbidity, systemic inflammation and outcomes in the ECLIPSE cohort. Respir Med.2013;107(9):1376-84.

Egbuonu F, Antonio FA, Edavalath M. Effect of Inhaled Corticosteroids on Glycemic Status. Open Respir Med J. 2014;8:101-5.

Suissa S, Kezouh A, Ernst P. Inhaled Corticosteroids and the Risks of Diabetes Onset and Progression. Am J Med.2010;123:1001-6.

Faul JL, Wilson SR, Chu JW, Canfield J, Kuschner WG. The Effect of an Inhaled Corticosteroid on Glucose Control in Type 2 Diabetes. Clin Med Res. 2009;7:14-20.

Chen C-Y and Liao K-M. Chronic Obstructive Pulmonary Disease is associated with risk of Chronic Kidney Disease: A Nationwide Case-Cohort Study. Scientific Reports.2016;6:25855.

Yoshizawa T, Okada K, Furuichi S, Ishiguro T, Yoshizawa A, Akahoshi T, et al. Prevalence of chronic kidney diseases in patients with chronic obstructive pulmonary disease: assessment based on glomerular filtration rate estimated from creatinine and cystatin C levels. Int J Chron Obstruct Pulmon Dis. 2015;10:1283-9.



  • There are currently no refbacks.

Jurnal Respirologi Indonesia
pISSN: 0853-7704 - eISSN: 2620-3162
Address: Jalan Cipinang Bunder No. 19, Cipinang, Pulogadung, Jakarta Timur, DKI Jakarta 13240, Indonesia
Phone: +62-21-2247-4845

An official publication by
the Indonesian Society of Respirology (ISR)

Creative Commons License
Creative Commons Attribution-NonCommercial 4.0 International License