A six-year follow-up study of smoking habits and microvascular complications in young adults with type 1 diabetes

Abstract

SummaryOne hundred insulin-dependent diabetic patients (age < 45 years, 53 smokers) were foliowed for six years. The age, duration of diabetes and mean glycated haemoglobin levels, were comparable between the smokers and non-smokers. Microvascular complications (retinopathy and increased urine albumin excretion) were commoner and more severe in the smoking group at six years, particularly in heavy smokers. Of the 45 original smokers reviewed at six years, 12 (27%) had stopped, six of whom had developed microvascular complications. Only two of the 'heavy' initial smokers, likely to be at most risk, had stopped smoking, and three original nonsmokers had started smoking.Keywords: insulin-dependent diabetes, diabetic nephropathy, diabetic retinopathy, smoking, ischaemic heart disease A diabetic patient who smokes has a 4-6 fold increased risk of developing ischaemic heart disease compared with a non-smoking, nondiabetic subject." 2 Smoking may also promote the development and progression of diabetic microvascular disease, particularly diabetic nephropathy.""4 Unfortunately, many young people with diabetes start smoking,5 and smoking prevalence amongst diabetic patients is similar to the non-diabetic population.6 Anti-smoking counselling has little initial impact on smoking habits, although long-term data is lacking.7'8This study followed the smoking habits and the development of microvascular complications over six years in a cohort of young adult smokers with insulin-dependent diabetes mellitus (IDDM). The degree of nicotine dependence was measured by urine cotinine, a metabolite of nicotine. Patients and methodsFifty-three smokers with IDDM were recruited consecutively into a programme of anti-smoking counselling.7 None stopped smoking following this. During the same period, 47 patients who had never smoked were identified as a control group. At recruitment the two groups were comparable for age, duration of diabetes, and glycated haemoglobin (HbAl) concentration (table 1).In all patients urine cotinine was measured as an objective assessment of the smoking load over the previous 24 hours.9 All non-smokers had a cotinine:creatine ratio (COT:CR) < 1.5 jug/mg. The smoking group was subdivided into 29 'light' smokers (COT:CR<7 ug/mg) and 24 'heavy' smokers (COT:CR> 7 p,g/mg).Six years later, the two groups of patients were followed-up. Background retinopathy was defined as microaneurysms, haemorrhages or hard exudates in one or both eyes; proliferative retinopathy by the presence of soft exudates (cotton wool spots), active neovascularisation, or previous photocoagulation therapy. Nephropathy was identified by the measurement of urinary albumin excretion (Beckman rate nephelometric analyser) in at least two early morning urine specimens over a six-month period. A timed overnight urine sample confirmed the presence of microalbuminuria (urinary albumin excretion rate of 20-200 pig/min). Macroproteinuria (albustix positive) was confirmed by a 24 h urinary protein excretion of > 500 mg. Results are given as mean (SD) o...

Psychosocial Factors and Diabetes Mellitus: Evidence-Based Treatment Guidelines

“…Broadly, one can assume a negative association between smoking and metabolic control (LE IIb) [229,243] (LE III); [244] however, the data on this connection are contradictory (LE IIb) [245] (LE III) [246,247]. Smoking can represent a predictor variable for poor self-treatment behavior (LE IIb) [243] (LE III) [248]. Patients with diabetes who are tobacco dependent have an increased comorbidity with depression (LE III) [194] (LE IV) [249].…”

Risk Factors for Early Onset of Diabetic Nephropathy in Pediatric Type 1 Diabetes

“…In previous reports, male sex, smoking, and low birth weight have emerged as risk factors for the development of nephropathy in young adults with type 1 diabetes [8][9][10][11] . Black race, low socioeconomic status and the amount and source of protein and fat in the diet have also been related to DN 35 .…”

“…In addition to high blood glucose levels, increased blood pressure, smoking, dyslipidemia and retinopathy have been associated to the development and progression of DN [8][9][10][11] . DN is also associated to high frequency of death due to cardiovascular causes.…”

Characteristics Associated with Neuropathy and/or Retinopathy in a Hospital Outpatient Diabetic Clinic

“…Social and demographic factors that have previously been found to adversely influence diabetes outcomes are smoking, age at onset of diabetes, frequency of home blood glucose monitoring, socioeconomic status, diabetes knowledge, perceived coping ability and being male [7][8][9][10][11][12] .…”