Smokers with IDDM Experience Excess Morbidity: The Colorado IDDM Registry

Abstract

OBJECTIVE--To determine whether there is an association between smoking and the self-reported morbidity of people with IDDM and to evaluate the nature of a possible interaction between smoking and IDDM in increasing the risk of morbidity among smokers with IDDM. RESEARCH DESIGN AND METHODS--Subjects were non-Hispanic whites aged 18-28 yr who participated in the Colorado IDDM Registry Follow-up Survey (case subjects, n = 24) or the 1985 NHIS (control subjects, n = 5876). Assessments of self-reported morbidity included any hospitalization in the past year; bed days, sick days, and limited-activity days in the past 2 wk; and ratings of poor health. The criteria outlined by Saracci were used to determine whether smoking was associated with greater morbidity among IDDM case compared to control subjects (smoking by IDDM interaction). RESULTS--Age- and sex-adjusted ORs, estimated from logistic regression, showed that people with IDDM reported excess morbidity compared with control subjects, regardless of smoking status. Smokers with IDDM reported morbidity 3-10 times as often as nonsmoking control subjects and were 2-3 times more likely to report morbidity than nonsmokers with IDDM. The smoking by IDDM interaction was more than multiplicative for all morbidity measures. Fifty to 75% of excess morbidity in young smokers with IDDM over simple additive effects was related to the interaction between smoking and IDDM. CONCLUSIONS--There was excess reported morbidity among people with IDDM who smoked, greater than that expected from the combined effects of smoking and IDDM. Smoking cessation in young people with IDDM may alleviate some of this excess, but more study is needed to determine whether smoking serves as an indicator of poor IDDM care practices or has a physiological impact that compounds the morbidity experienced by people with IDDM.

Atherosclerosis in childhood and adolescent type 1 diabetes: early disease, early treatment?

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Smoking Rates and the State of Smoking Interventions for Children and Adolescents With Chronic Illness

“…91 Children and adolescents with diabetes who smoke regularly are at 50% to 75% greater risk for morbidity and mortality in later life than youngsters with diabetes who do not smoke. [92][93][94] Smoking Rates Gold and Gladstein 95 reported that more than half of a sample of 79 diabetic adolescents and young adults aged 11 to 25 years reported tobacco or alcohol use at least once, and 12% to 25% reported use Ͼ5 times in their lifetime. Within their sample, white adolescents were significantly more likely to be smokers than Hispanic or black adolescents.…”

Independent Factors Associated With Major Depressive Disorder in a National Sample of Individuals With Diabetes

“…In addition to the deleterious effects of smoking on the mental health of individuals with diabetes, smoking is also hazardous to physical health. There is evidence that smoking is an independent risk factor for cardiovascular disease (43) and is strongly associated with higher 24-h blood pressures (44), poor glycemic control (45), increased prevalence of microvascular complications (45), diabetic nephropathy (46), and excess morbidity (47). Therefore, there is a need to discourage smoking initiation in individuals with diabetes and encourage smoking cessation in current smokers.…”