{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T16:02:27Z","timestamp":1790524947661,"version":"4.1.0"},"reference-count":38,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Insulin resistance (IR), a core component in the development of type 2 diabetes mellitus (T2DM), is increasingly recognized for its role in cardiovascular and pulmonary complications. This review explores the relationship between IR, right ventricular dysfunction (RVD), and decreased lung volume in patients with T2DM. Emerging evidence suggests that IR contributes to early structural and functional alterations in the right ventricle, independent of overt cardiovascular disease. The mechanisms involved include oxidative stress, inflammation, dyslipidemia, and obesity\u2014factors commonly found in metabolic syndrome and T2DM. These pathophysiological changes compromise right ventricular contractility, leading to reduced pulmonary perfusion and respiratory capacity. RVD has been associated with chronic lung disease, pulmonary hypertension, and obstructive sleep apnea, all of which are prevalent in the diabetic population. As RVD progresses, it can result in impaired gas exchange, interstitial pulmonary edema, and exercise intolerance\u2014highlighting the importance of early recognition and management. Therapeutic strategies should aim to improve insulin sensitivity and cardiac function through lifestyle interventions, pharmacological agents such as SGLT2 inhibitors and GLP-1\/GIP analogs, and routine cardiac monitoring. These approaches may help slow the progression of RVD and its respiratory consequences. Considering the global burden of diabetes and obesity, and the growing incidence of related complications, further research is warranted to clarify the mechanisms linking IR, RVD, and respiratory dysfunction. Understanding this triad will be crucial for developing targeted interventions that improve outcomes and quality of life in affected patients.<\/jats:p>","DOI":"10.3390\/jpm15080336","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T13:11:11Z","timestamp":1754313071000},"page":"336","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Impact of Insulin Resistance on Lung Volume Through Right Ventricular Dysfunction in Diabetic Patients\u2014Literature Review"],"prefix":"10.3390","volume":"15","author":[{"given":"Daniel","family":"Radu","sequence":"first","affiliation":[{"name":"Department of Emergency, Ilfov County Emergency Clinical Hospital, 022104 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana-Andreea","family":"Parli\u021beanu","sequence":"additional","affiliation":[{"name":"Department of Diabetes, \u2018Marius Nasta\u2019 Institute of Pneumology, 050159 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4769-2011","authenticated-orcid":false,"given":"Andra-Elena","family":"Nica","sequence":"additional","affiliation":[{"name":"Department of Diabetes, \u2018Carol Davila\u2019 University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiana","family":"Voineag","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Universitatea Dun\u0103rea de Jos, 800201 Gala\u021bi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Octavian-Sabin","family":"Alexe","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Universitatea Dun\u0103rea de Jos, 800201 Gala\u021bi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra Maria","family":"Cristea","sequence":"additional","affiliation":[{"name":"Department of Pneumology, \u2018Marius Nasta\u2019 National Institute of Pneumology, 050159 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Livia","family":"Georgescu","sequence":"additional","affiliation":[{"name":"Department of Pneumology, \u2018Marius Nasta\u2019 National Institute of Pneumology, 050159 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9858-1162","authenticated-orcid":false,"given":"Roxana Maria","family":"Neme\u0219","sequence":"additional","affiliation":[{"name":"Department of Pneumology, \u2018Marius Nasta\u2019 National Institute of Pneumology, 050159 Bucharest, Romania"},{"name":"Faculty of Medicine, Titu Maiorescu University, 031592 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea Taisia","family":"Tiron","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u2018Carol Davila\u2019 University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra Floriana","family":"Neme\u0219","sequence":"additional","affiliation":[{"name":"Department of Neonatology, \u2018Carol Davila\u2019 University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3G","DOI":"10.1016\/S0002-9149(02)02553-5","article-title":"Insulin resistance as the core defect in type 2 diabetes mellitus","volume":"90","author":"Goldstein","year":"2002","journal-title":"Am. J. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1007\/s12019-005-0005-y","article-title":"Role of impaired insulin secretion and insulin resistance in the pathogenesis of type 2 diabetes mellitus","volume":"31","author":"Szoke","year":"2005","journal-title":"Compr. Ther."},{"key":"ref_3","first-page":"3","article-title":"Pathogenesis of type 2 diabetes: The relative contribution of insulin resistance and impaired insulin secretion","volume":"113","author":"Groop","year":"2000","journal-title":"Int. J. Clin. Pract. Suppl."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1513\/AnnalsATS.202107-766OC","article-title":"Insulin Resistance Is Associated with Right Ventricular Dysfunction","volume":"19","author":"Min","year":"2022","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"H113","DOI":"10.1152\/ajpheart.00440.2018","article-title":"Right ventricular dysfunction and remodeling in diabetic cardiomyopathy","volume":"316","author":"Kang","year":"2019","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1186\/s12933-024-02472-z","article-title":"Impact of diabetes mellitus on right ventricular dysfunction and ventricular interdependence in hypertensive patients with heart failure with reduced ejection fraction assessed via 3.0 T cardiac MRI","volume":"23","author":"Zhang","year":"2024","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1007\/s13300-016-0167-x","article-title":"Diabetes Dyslipidemia","volume":"7","author":"Schofield","year":"2016","journal-title":"Diabetes Ther."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Bale, B.F., Doneen, A.L., Leimgruber, P.P., and Vigerust, D.J. (2022). The critical issue linking lipids and inflammation: Clinical utility of stopping oxidative stress. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.1042729"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Fakhry, B., Peterson, L., Comhair, S.A.A., Sharp, J., Park, M.M., Tang, W.H.W., Neumann, D.R., DiFilippo, F.P., Farha, S., and Erzurum, S.C. (2024). Blood Cholesterol and Triglycerides Associate with Right Ventricular Function in Pulmonary Hypertension. medRxiv.","DOI":"10.1101\/2024.01.20.24301498"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"28J","DOI":"10.1016\/S0002-9149(99)00355-0","article-title":"Insulin resistance and lipid metabolism","volume":"84","author":"Howard","year":"1999","journal-title":"Am. J. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e010524","DOI":"10.1161\/CIRCHEARTFAILURE.123.010524","article-title":"Obesity Modifies Clinical Outcomes of Right Ventricular Dysfunction","volume":"16","author":"Ma","year":"2023","journal-title":"Circ. Heart Fail."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1936","DOI":"10.1161\/CIRCULATIONAHA.115.019351","article-title":"Fatty acid metabolic defects and right ventricular lipotoxicity in human pulmonary arterial hypertension","volume":"133","author":"Brittain","year":"2016","journal-title":"Circulation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e123611","DOI":"10.1172\/jci.insight.123611","article-title":"Human PAH is characterized by a pattern of lipid-related insuli resistance","volume":"4","author":"Hemnes","year":"2019","journal-title":"JCI Insight"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.ccl.2012.03.005","article-title":"Right ventricular dysfunction in chronic lung disease","volume":"30","author":"Kolb","year":"2012","journal-title":"Cardiol. Clin."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"R169","DOI":"10.1186\/cc9264","article-title":"Pulmonary vascular and right ventricular dysfunction in adult critical care: Current and emerging options for management: A systematic literature review","volume":"14","author":"Price","year":"2010","journal-title":"Crit. Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3618","DOI":"10.1093\/eurheartj\/ehac237","article-title":"2022 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"43","author":"McDonagh","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_17","first-page":"957","article-title":"Right ventricular dysfunction: Pathophysiology, experimental models, evaluation, and treatment","volume":"77","author":"Real","year":"2024","journal-title":"Cardiologia"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/j.healun.2017.08.011","article-title":"Interleukin-6 is independently associated with right ventricular function in pulmonary arterial hypertension","volume":"37","author":"Prins","year":"2017","journal-title":"J. Heart Lung Transplant."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2401321","DOI":"10.1183\/13993003.01321-2024","article-title":"Pathophysiology of the right ventricle and its pulmonary vascular interaction","volume":"64","author":"Hemnes","year":"2024","journal-title":"Eur. Respir. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e008574","DOI":"10.1161\/CIRCHEARTFAILURE.121.008574","article-title":"Inflammatory glycoprotein 130 signaling links changes in microtubules and junctophilin-2 to altered mitochondrial metabolism and right ventricular contractility","volume":"15","author":"Prisco","year":"2022","journal-title":"Circ. Heart Fail."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1038\/s44161-022-00113-w","article-title":"Identification of LTBP-2 as a plasma biomarker for right ventricular dysfunction in human pulmonary arterial hypertension","volume":"1","author":"Boucherat","year":"2022","journal-title":"Nat. Cardiovasc. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1038\/s44161-023-00338-3","article-title":"Transcriptional profiling unveils molecular subgroups of adaptive and maladaptive right ventricular remodeling in pulmonary hypertension","volume":"2","author":"Khassafi","year":"2023","journal-title":"Nat. Cardiovasc. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2400420","DOI":"10.1183\/13993003.00420-2024","article-title":"Poor cardiac output reserve in pulmonary arterial hypertension is associated with right ventricular stiffness and impaired interventricular dependence","volume":"64","author":"Lancaster","year":"2024","journal-title":"Eur. Respir. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"100391","DOI":"10.1016\/j.cpcardiol.2018.08.003","article-title":"Impact of Nutrition on Cardiovascular Function, Current Problems in Cardiology","volume":"45","author":"Bianchi","year":"2020","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_25","first-page":"S518","article-title":"Abstract 1563: Weight Loss Improves Right Atrial and Ventricular Function and Metabolism in Obese Humans","volume":"120","author":"Kurup","year":"2009","journal-title":"Circulation"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"JC27","DOI":"10.7326\/J23-0002","article-title":"SGLT2 inhibitors reduce adverse renal and CV outcomes in patients with or without diabetes","volume":"176","author":"Patel","year":"2023","journal-title":"Ann. Intern. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1882","DOI":"10.1161\/CIRCULATIONAHA.122.059595","article-title":"GLP-1 Receptor Agonists for the Reduction of Atherosclerotic Cardiovascular Risk in Patients With Type 2 Diabetes","volume":"146","author":"Marx","year":"2022","journal-title":"Circulation"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1056\/NEJMoa2404881","article-title":"SURMOUNT-OSA Investigators. Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity","volume":"391","author":"Malhotra","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1056\/NEJMoa2410027","article-title":"SUMMIT Trial Study Group. Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity","volume":"392","author":"Packer","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_30","first-page":"112","article-title":"Pathophysiological mechanisms and benefits of SGLT-2 inhibitors in a patient with cerebral artery aneurysm: A case report","volume":"29","author":"Nemes","year":"2025","journal-title":"Exp. Ther. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1177\/2047487319878371","article-title":"Diabetes as a cardiovascular risk factor: An overview of global trends of macro and micro vascular complications","volume":"26","author":"Ceriello","year":"2019","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_32","first-page":"e57226","article-title":"The Importance of Evaluating Sudomotor Function in the Diagnosis of Cardiac Autonomic Neuropathy","volume":"16","author":"Nica","year":"2024","journal-title":"Cureus"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.1016\/j.amjmed.2017.12.046","article-title":"Diabetes Mellitus Associates with Increased Right Ventricular Afterload and Remodeling in Pulmonary Arterial Hypertension","volume":"131","author":"Whitaker","year":"2018","journal-title":"Am. J. Med."},{"key":"ref_34","unstructured":"(2025, May 20). Available online: https:\/\/www.who.int\/health-topics\/diabetes#tab=tab_1."},{"key":"ref_35","unstructured":"(2025, May 20). Available online: https:\/\/www.who.int\/news\/item\/01-03-2024-one-in-eight-people-are-now-living-with-obesity."},{"key":"ref_36","unstructured":"(2025, May 20). OWENS ROBERT, MSD Manual Professional Edition, 2024\/08, MSD Manual, Obstructive Sleep Apnea (OSA). Available online: https:\/\/www.msdmanuals.com\/professional\/pulmonary-disorders\/sleep-apnea\/obstructive-sleep-apnea-osa."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Parli\u021beanu, O.-A., B\u0103lteanu, M.-A., Zaharia, D.C., Constantinescu, T., Cristea, A.M., Dumitrache-Rujinscki, \u0218., Nica, A.E., Voineag, C., Alexe, O.S., and Tabacu, E. (2025). The Impact of SARS-CoV-2 Infection on Glucose Homeostasis in Hospitalized Patients with Pulmonary Impairment. Diagnostics, 15.","DOI":"10.3390\/diagnostics15050554"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Mahler, B., Parliteanu, O.A., Alexe, O., R\u00ee\u0219c\u0103 Popazu, C., Ene, C.E., Timar, B., and Constantinescu, T. (2023). Mucormycosis in a Patient with Severe COVID-19 Disease\u2014The First Case Report in Romania and a Literature Review. Medicina, 59.","DOI":"10.3390\/medicina59030555"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/15\/8\/336\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:20:40Z","timestamp":1760034040000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/15\/8\/336"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,1]]},"references-count":38,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["jpm15080336"],"URL":"https:\/\/doi.org\/10.3390\/jpm15080336","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,1]]}}}