Abstract
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).
Conclusion
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.
Keywords
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References
- Mortality from all causes and from coronary heart disease related to smoking and changes in smoking during a 35-year follow-up of middle-aged Finnish men.Eur Heart J. 2000 Oct; 21: 1621-1626
- High risk of cardiovascular disease in patients with type 1 diabetes in the U.K.: a cohort study using the general practice research database.Diabetes Care. 2006 Apr; 29: 798-804
- Smoking induces insulin resistance–a potential link with the insulin resistance syndrome.J Intern Med. 1993 Apr; 233: 327-332
- Acute effect of cigarette smoking on glucose tolerance and other cardiovascular risk factors.Diabetes Care. 1996 Feb; 19: 112-118
- A prospective study of cigarette smoking and the incidence of diabetes mellitus among US male physicians.Am J Med. 2000 Nov; 109: 538-542
- Impact of cigarette smoking on the incidence of Type 2 diabetes mellitus in middle-aged Japanese men: the Osaka Health Survey.Diabet Med. 1999 Nov; 16: 951-955
- Cardiovascular risk factors and the 25-year incidence of diabetes mellitus in middle-aged men. The Zutphen Study.Am J Epidemiol. 1989 Dec; 130: 1101-1108
- Prospective study of risk factors for development of non-insulin dependent diabetes in middle aged British men.BMJ. 1995 Mar 4; 310: 560-564
- Smoking is associated with increased HbA1c values and microalbuminuria in patients with diabetes–data from the National Diabetes Register in Sweden.Diabetes Metab. 2004 Jun; 30: 261-268
- Cigarette smoking and insulin resistance in patients with noninsulin-dependent diabetes mellitus.J Clin Endocrinol Metab. 1997 Nov; 82: 3619-3624
- The relationship between smoking and microvascular complications in the EURODIAB IDDM Complications Study.Diabetes Care. 1995 Jun; 18: 785-792
- Smoking and metabolic control in adolescents with type 1 diabetes.J Pediatr. 2009 Jan; 154 (e1): 20-23
- Smoking and metabolic control in patients with insulin-dependent diabetes mellitus.J Intern Med. 1990 Feb; 227: 101-106
- The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group.N Engl J Med. 1993 Sep 30; 329: 977-986
- Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge.Clin Chem. 1972 Jun; 18: 499-502
- Proteinuria and other markers of chronic kidney disease: a position statement of the national kidney foundation (NKF) and the national institute of diabetes and digestive and kidney diseases (NIDDK).Am J Kidney Dis. 2003 Oct; 42: 617-622
- A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy.Diabetes Care. 1994 Nov; 17: 1281-1289
- Diabetes control and complications trial (DCCT): results of feasibility study. The DCCT research group.Diabetes Care. 1987 Jan-Feb; 10: 1-19
- Smoking reduces insulin absorption from subcutaneous tissue.Br Med J. 1982 Jan 23; 284 (Clin Res Ed): 237
- Cigarette smoking and HDL cholesterol: the Framingham offspring study.Atherosclerosis. 1978 May; 30: 17-25
- Insulin resistance is a risk factor for high blood pressure regardless of body size and fat distribution in obese children.Nutr Metab Cardiovasc Dis. 2010 May; 20: 266-273
- Hyperinsulinemia predicts coronary heart disease risk in healthy middle-aged men: the 22-year follow-up results of the Helsinki Policemen Study.Circulation. 1998 Aug 4; 98: 398-404
- Prominent role of low HDL-cholesterol in explaining the high prevalence of the metabolic syndrome in polycystic ovary syndrome.Nutr Metab Cardiovasc Dis. 2009 Dec; 19: 797-804
- The role of HDL cholesterol in metabolic syndrome predicting cardiovascular events. The Gubbio population study.Nutr Metab Cardiovasc Dis. 2011 May; 21: 315-322
- Cigarette smoking increases the risk of albuminuria among subjects with type I diabetes.JAMA. 1991 Feb 6; 265: 614-617
- Cigarette smoking and prevalence of microangiopathy in juvenile-onset insulin-dependent diabetes mellitus.Diabetes Care. 1978 May-Jun; 1: 146-149
- Risk factors for development of incipient and overt diabetic nephropathy in type 1 diabetic patients: a 10-year prospective observational study.Diabetes Care. 2002 May; 25: 859-864
- Cigarette smoking and neuropathy in diabetic patients.Diabetes Care. 1990 Apr; 13: 434-437
- Cigarette smoking and ten-year progression of diabetic retinopathy.Ophthalmology. 1996 Sep; 103: 1438-1442
- Higher HDL cholesterol levels are associated with a lower incidence of chronic kidney disease in patients with type 2 diabetes.Nutr Metab Cardiovasc Dis. 2009 Oct; 19: 580-586
- Cigarette smoking behavior is strongly related to educational status: the CARDIA study.Prev Medicine. 1990 Mar; 19: 158-169
- Glycemic control and transfer of health care among adolescents with insulin dependent diabetes mellitus.J Adolesc Health. 1996 Jan; 18: 44-47
- Sociodemographic characteristics of cigarette smoking initiation in the United States. Implications for smoking prevention policy.Jama. 1990 Sep 26; 264: 1550-1555
- Psychosocial correlates of glycemic control: the Pittsburgh Epidemiology of diabetes complications (EDC) study.Diabetes Research Clinical Practice. 1993 Aug-Sep; 21: 187-195
Article info
Publication history
Published online: November 28, 2011
Accepted:
August 24,
2011
Received in revised form:
July 23,
2011
Received:
March 13,
2011
Identification
Copyright
© 2011 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
