Research Article| Volume 23, ISSUE 2, P102-108, February 2013

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Smoking is associated with impaired long-term glucose metabolism in patients with type 1 diabetes mellitus

  • P.A. Gerber
    Corresponding author. Department of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Zurich, Ramistrasse 100, CH - 8091 Zurich, Switzerland. Tel.: +41 44 255 97 36; fax: +41 44 255 44 47.
    Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Zurich, Switzerland

    Competence Center for Systems Physiology and Metabolic Diseases Zurich, Switzerland
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  • R. Locher
    Division of Internal Medicine, University Hospital Zurich, Switzerland
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  • B. Schmid
    Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Zurich, Switzerland
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  • G.A. Spinas
    Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Zurich, Switzerland

    Competence Center for Systems Physiology and Metabolic Diseases Zurich, Switzerland
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  • R. Lehmann
    Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Zurich, Switzerland
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Published:November 28, 2011DOI:


      Background and Aims

      Smoking is known to negatively influence glucose metabolism both in healthy subjects and in patients with diabetes. The aim of this study was to compare glycemic control in patients with type 1 diabetes mellitus who were smokers with those who did not smoke during a prospective long-term follow-up.

      Methods and Results

      In a single center, 763 patients with type 1 diabetes mellitus were included, 160 (21.0%) of them were smokers. Patients were treated with intensive insulin therapy according to existing guidelines. Glucose control was monitored quarterly, diabetes related complications and cardiovascular risk factors were assessed at least once a year. Glucose control in smokers was significantly worse than in non-smokers at baseline and during follow-up (mean HbA1c during 5047 patient-years of follow-up 7.9 ± 1.3% in smokers and 7.3 ± 1.1% in non-smokers, p < 0.001) despite a higher insulin dosage in smokers (0.71 ± 0.30 U/kg vs. 0.65 ± 0.31 U/kg in non-smokers, p = 0.046). HDL cholesterol was lower in smokers at baseline (1.53 ± 0.45 vs. 1.68 ± 0.51 in non-smokers, p = 0.048). Diabetes related complications tended to occur with a higher frequency in smokers, with a significant difference in macroalbuminuria (9.8% vs. 4.8% in non-smokers, p = 0.047).


      Smoking is associated with worse glucose control in patients with type 1 diabetes mellitus despite the same treatment strategies as in non-smokers. Hyperglycemia, therefore, may contribute to an earlier incidence of diabetes related complications in these patients, in addition to direct toxic effects of smoking.


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