Diabetic Patients Who Smoke: Are They Different?

Abstract

BACKGROUND We wanted to identify differences between diabetic patients who smoke and those who do not smoke to design more effective strategies to improve their diabetes care and encourage smoking cessation.METHODS A random sample of adult health plan members with diabetes were mailed a survey questionnaire, with telephone follow-up, asking about their attitudes and behaviors regarding diabetes care and smoking. Among the 1,352 respondents (response rate 82.4%), we found 188 current smokers whose answers we compared with those of 1,264 nonsmokers, with statistical adjustment for demographic characteristics and duration of diabetes. RESULTSSmokers with diabetes were more likely to report fair or poor health (odds ratio [OR] = 1.5, P = .03) and often feeling depressed (OR = 1.7, P = .004). Relative to nonsmokers, smokers had lower rates of checking blood glucose levels, were less physically active, and had fewer diabetes care visits, glycated hemoglobin (A 1c ) tests, foot examinations, eye examinations, and dental checkups (P ≤.01). Smokers also reported receiving and desiring less support from family and friends for specifi c diabetic self-management activities and had lower readiness to quit smoking than has been observed in other population groups.CONCLUSIONS Clinicians should be aware that diabetic patients who smoke are more likely to report often feeling depressed and, even after adjusting for depression, are less likely to be active in self-care or to comply with diabetes care recommendations. Diabetic patients who smoke are special clinical challenges and are likely to require more creative and consistent clinical interventions and support. INTRODUCTIONS moking has long been known to worsen the prognosis of patients with diabetes. Mulhauser' s literature review in 1990 1 concluded that the frequency of smoking in adults with diabetes was comparable to that in the general population and that smoking is a major risk factor for both macrovascular and microvascular complications. Subsequent systematic reviews have strengthened these conclusions while adding evidence that smoking increases insulin resistance, worsens diabetes control, and may even induce the disease.2,3 Many cross-sectional and prospective studies of patients who have diabetes also show that cardiovascular and all-cause mortality is higher in those who smoke than in those who do not smoke. [4][5][6][7] Thus, the 1 in 5 persons with diabetes who also smoke represent a particularly important target for intervention, both by clinicians and by policy makers in health plans and public health.Despite this information, and despite strong evidence that clinician support of smoking cessation is effective for smokers among the general population and those with diabetes, [8][9][10] only 58% of patients with diabetes who smoke reported that a physician had ever advised them to stop or cut down on their smoking. In the past, many diabetes care specialists and some professional organizations have concentrated largely on glucose-oriented diabetes ca...

O Paciente Diabético na Clínica Odontológica: Diretrizes Para o Acolhimento e Atendimento

“…A literatura científica tem sustentado que o tabagismo piora o prognóstico de pacientes com diabetes. Pacientes devem compreender que parar de fumar é uma das duas formas mais importantes para reduzir as complicações macrovasculares em pacientes com diabetes, da mesma forma que o controle da hipertensão 16 . O uso do tabaco é a causa isolada mais importante de mortes prematuras e evitáveis.…”

Is there an impatience genotype leading to non-adherence to long-term therapies?

“…By the end of the dinner (t2), the curves describing the force of my desires have crossed, producing a preference reversal [26]. Rationally, I order the dessert Carroll [16]), which is itself associated with patient adherence: for instance, diabetic patients who smoke are less adherent to recommendations concerning bloodglucose monitoring and exercise and skip more medical appointments than non-smokers [30]; by contrast nonsmokers accept a complex treatment more easily [31]. Smokers are less adherent to bisphosphonate therapy [32].…”

On TRACK

“…Several readers found meaning and a call to action in the study of diabetic smokers by Solberg et al 16 From different vantage points, these commentators [17][18][19] factors, and behavior change. They call for systems support that allows the clinician to prioritize and individualize, while involving staff, and especially patients, in matching the treatment to the patient' s needs and readiness to change.…”