The association between the prevalence of cigarette smoking and complications in patients with type 2 diabetes

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Erhan Onalan
Nevzat Gozel


cigarette smoking, diabetes mellitus, Elazığ


Background: This study including diabetic individuals from Elazığ province of Turkey was undertaken
to assess the association between complication risk and the prevalence of cigarette smoking, a growing
public health problem and a major cause of morbidity and mortality worldwide. Methods: In this descriptive
cross-sectional study, a total of 300 patients (150 male, 150 female) attending to our outpatient unit with a
diagnosis of Type 2 DM between May 2018 and October 2018 were included. History of cigarette smoking,
educational level, presence of complications and demographic characteristics, systolic and diastolic blood
pressure, and family history were recorded. Demographic data of interest included age, gender, waist and hip
circumference, and the body mass index. Results of biochemistry tests were collected from routine investigations. All statistical analyses were performed using a statistical software pack (SPSS 22.0). Quantitative data were analyzed with the t-test, while categorical data were examined using chi-square test. The results were
expressed with 95% confidence intervals at a significance level of p < 0.05. Results: Of the 300 participants,
77 (25%) were current smokers. Male and elderly patients were more likely to be smokers, who had a lower
BMI. A significant and inverse association between cigarette use and BMI was observed (p < 0.01). Smokers
had significantly higher HbA1c, triglyceride, and LDL (p < 0.01, p < 0.01, and p < 0.01, respectively).
Hypertension, level of education, duration of diabetes, and the presence of neuropathy, nephropathy, or retinopathy were not significantly associated with smoking, while coronary artery disease showed a significant
association (p < 0.01). Conclusion: Approximately one fourth (25%) of this diabetic cohort was smokers, who
had significantly increased occurrence of coronary artery disease. Also smokers had significant elevations in
LDL, triglycerides, and HbA1c as compared to non-smokers.


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1. Türkiye Endokrinoloji ve Metabolizma Derneği (TEMD): Diabetes Mellitus Çalışma ve Eğitim Grupları 2009. Diabetes Mellitus ve Komplikasyonlarının Tanı Tedavi ve İzlem Klavuzu.4. Baskı. İstanbul, 2009.
2. American Diabetes Association: Standards of medical care in diabetes-2011. Diabetes Care, 2011;34 (1):11-61.
3. World Health Organization. WHO Report On The Global Tobacco Epidemic, Brazil 2008.
4. Öğüş C, Özdemir T, Kara A, Şenol Y, Çilli A. Akdeniz Üniversitesi Tıp Fakültesi Dönem I ve VI Öğrencilerinin Sigara İçme Alışkanlıkları. Akciğer Arşivi 2004; 5:139-142.
5. Er A, Bekir C, Nayır T, Aykent N, Ongel K. Ocular vasodynamic changes in adolescent smokers. Opsta Medicina 2009; 15(3-4):126-32.
6. Elmadhoun W.M., Noor SK, Ibrahim AA, Bushara SO, Ahmed MH. Prevalence of diabetes mellitus and its risk factors in urban communities of north Sudan: population-based study. J Diabetes 2016;8: 839–46.
7. Awadallaa Heitham, Noorb Sufian K, ElmadhouncWadie M, AlmobarakdAhmed O, Elmake Nehad, Abdelazizf Sulaf I, et al. Diabetes complications in Sudanese individuals with type 2 diabetes: overlooked problems in Sub-Saharan Africa? Diabetes Metab Syndr. 2017 December; 11 Suppl 2: S1047-51.
8. Eltom MA, Babiker Mohamed AH, Elrayah-Eliadarous H, Yassin K, Noor SK, Elmadhoun WM, et al. Increasing prevalence of type 2 diabetes mellitus and impact of ethnicity in north Sudan. Diabetes Res Clin Pract 2018;136(February) 93–9, doi: Epub 2017 Dec 2.
9. LaRowe TL, Piper ME, Schlam TR, Fiore MC, Baker TB. Obesity and smoking: comparing cessation treatment seekers with the general smoking population. Obesity (Silver Spring) 2009;17: 1301–5.
10. Jong-Hyuck K, Wi-Young S. Association of smoking frequency and cigarette consumption with obesity in Korean adolescents. Bratisl Lek Listy 2012;113:599–603.
11. Fang H, Ali MM, Rizzo JA. Does smoking affect body weight and obesity in China? Econ Hum Biol 2009;7: 334–50.
12. Facchini FS, Hollenbeck CB, Jeppesen J, Chen YD, Reaven GM. Insulin resistance and cigarette smoking. Lancet. 1992;339(8802):1128-30.
13. Attvall S, Fowelin J, Lager I, Von Schenck H, Smith U. Smoking induces insulin resistanceea potential link with the insulin resistance syndrome. J Intern Med. 1993;233(4):327-32.
14. van der Vaart H, Postma DS, Timens W, ten Hacken NH. Acute effects of cigarette smoke on inflammation and oxidative stress: a review. Thorax. 2004;59(8):713-21.
15. Yanbaeva DG, Dentener MA, Creutzberg EC, Wesseling G, Wouters EFM. Systemic effects of smoking. Chest. 2007;131(5):1557-66.
16. Chowdhury P, MacLeod S, Udupa KB, Rayford PL. Pathophysiological effects of nicotine on the pancreas: an update. Exp Biol Med. 2002;227(7):445-54.
17. Barrett-Connor E, Khaw KT. Cigarette smoking and increased central adiposity. Ann Intern Med. 1989;111(10):783-7.
18. Troisi RJ, Heinold JW, Vokonas PS, Weiss ST. Cigarette smoking, dietary intake, and physical activity: effects on body fat distributionethe Normative Aging Study. Am J Clin Nutr. 1991;53(5):1104-11.
19. Bastard JP, Maachi M, Lagathu C, et al. Recent advances in the relationship between obesity, inflammation, and insulin resistance. Eur Cytokine Netw. 2006;17(1):4-12.
20. Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature. 2006;444(7121):840-6.
21. Roth, (Global Burden of Cardiovascular Diseases Collaboration group), et al. The burden of cardiovascular diseases among US States, 1990–2016. JAMA Cardiol 2018(April).
22. GBD 2015 Risk Factors Collaborators (2016).Global, regional, and national comparative risk assessmentof 79behavioural, environmental and occupational, and metabolic risks or clusters of risks,1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 8;388(10053):1659–1724.
23. Nilsson PM, Cederholm J, Eeg-Olofsson K, Eliasson B, Zethelius B, Fagard R, et al. Smoking as an independent risk factor for myocardial infarction or stroke in type 2 diabetes: a report from the Swedish national diabetes register. Eur J Cardiovasc Prev Rehabil 2009;16(4):506–12.
24. Reynolds Kristi, Liese Angela D, Anderson Andrea M, Dabelea Dana, Standiford Debra, Daniels Stephen R, et al. Prevalence of tobacco use and association between cardiometabolic risk factors and cigarette smoking in youth with type 1 or type 2 diabetes mellitus. J Pediatr 2011;158(April (4))594–601 el.
25. Schipf S, Schmidt CO, Alte D, Werner A, Scheidt-Nave C, John U, et al. Smoking prevalence in type 2 diabetes: results of the study of health in pomerania (SHIP) and the German national health interview and examination survey (GNHIES). Diabetes Med 2009;26(8):791–7.
26. Ford ES, Malarcher AM, Herman WH, Aubert RE. Diabetes mellitus and cigarette smoking. Findings from the 1989 national health interview survey. Diabetes Care 1994;17(July (7)):688–92.
27. Nilsson PM, Gudbjörnsdottir S, Eliasson B, Cederholm J, Steering Committee of the Swedish National Diabetes Register. Smoking is associated with increased HbA1c values and microalbuminuria in patients with diabetes–data from the national diabetes register in Sweden. Diabetes Metab 2004;(3):261–8.
28. Anan F, Takahashi N, Shinohara T, Nakagawa M, Masaki T, Katsuragi I, et al. Smoking is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients. Eur J Clin Invest 2006;36(7):459–65.
29. Wakabayashi I. Smoking and lipid-related indices in patients with diabetes mellitus. Diabet Med 2014;31(July (7)):868–78.