Vol 9, No 2 (2020)
Research paper
Published online: 2020-02-11

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Impact of smoking and nicotine addiction on HbA1c levels and diabetic microvascular complications

Hüseyin Akkuzulu1, Cenk Aypak1, Ayşe Özdemir1, Süleyman Görpelioğlu1
Clin Diabetol 2020;9(2):112-117.


Introduction. In this study we aimed to determine whether a difference in complications between smok­ers and non-smokers exists in type 2 diabetes mellitus (T2DM) and to evaluate if there is a correlation between microvascular complications and Fagerström test score.

Material and methods. Patients with T2DM who at­tended the family medicine outpatient clinics were enrolled in the study. Smokers and non-smokers were compared according to their metabolic outcomes and presence of microvasculer complications. The level of smoking addiction was determined by Fagerström Test for Nicotine Dependence.

Results. Fasting blood glucose (FBG), low-density lipoprotein, systolic and diastolic blood pressures were found to be higher in smokers. The presence of neuropathy was significantly higher in smokers. The presence of retinopathy rate increased with increasing level of smoking addiction. The nicotine dependence test score were found to be positively correlated with HbA1c and FBG levels whereas, negatively correlated with body mass index among smokers.

Conclusions. Assessing the cigarette smoking status of diabetic patients at the initial clinic visit and indicating the importance of smoking cessation should be the essential part of diabetes follow up program.

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  1. World Health Organization (WHO). 2016.
  2. Cho NH, Shaw JE, Karuranga S, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018; 138: 271–281.
  3. Ogurtsova K, da Rocha Fernandes JD, Huang Y, et al. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017; 128: 40–50.
  4. World health statistics 2018: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.
  5. Nagrebetsky A, Brettell R, Roberts N, et al. Smoking cessation in adults with diabetes: a systematic review and meta-analysis of data from randomised controlled trials. BMJ Open. 2014; 4(3): e004107.
  6. Aeschbacher S, Schoen T, Clair C, et al. Association of smoking and nicotine dependence with pre-diabetes in young and healthy adults. Swiss Med Wkly. 2014; 144: w14019.
  7. Willi C, Bodenmann P, Ghali WA, et al. Active smoking and the risk of type 2 diabetes: a systematic review and meta-analysis. JAMA. 2007; 298(22): 2654–2664.
  8. Zhang L, Curhan GC, Hu FB, et al. Association between passive and active smoking and incident type 2 diabetes in women. Diabetes Care. 2011; 34(4): 892–897.
  9. Yeom H, Lee JH, Kim HC, et al. The association between smoking tobacco after a diagnosis of diabetes and the prevalence of diabetic nephropathy in the korean male population. J Prev Med Public Health. 2016; 49(2): 108–117.
  10. Bentata Y, Karimi I, Benabdellah N, et al. Does smoking increase the risk of progression of nephropathy and/or cardiovascular disease in type 2 diabetic patients with albuminuria and those without albuminuria? Am J Cardiovasc Dis. 2016; 6(2): 66–69.
  11. Jiang N, Huang F, Zhang X. Smoking and the risk of diabetic nephropathy in patients with type 1 and type 2 diabetes: a meta-analysis of observational studies. Oncotarget. 2017; 8(54): 93209–93218.
  12. Clair C, Cohen MJ, Eichler F, et al. The effect of cigarette smoking on diabetic peripheral neuropathy: a systematic review and meta-analysis. J Gen Intern Med. 2015; 30(8): 1193–1203.
  13. Katulanda P, Ranasinghe P, Jayawardena R. Prevalence of retinopathy among adults with self-reported diabetes mellitus: the Sri Lanka diabetes and Cardiovascular Study. BMC Ophthalmol. 2014; 14: 100.
  14. Parving HH, Mauer M, Fioretto P, et al. Diabetic nephropathy. In: Brenner B, ed. Brenner and Rector’s The Kidney. Vol. 1. Philadelphia, PA: Elsevier. 2012: 1411–1454.
  15. 10. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes — 2018. Diabetes Care. 2017; 41(Supplement 1): S105–S118.
  16. Soulimane S, Simon D, Herman WH, et al. DETECT-2 Study Group, DESIR Study Group. HbA1c, fasting and 2 h plasma glucose in current, ex- and never-smokers: a meta-analysis. Diabetologia. 2014; 57(1): 30–39.
  17. Clair C, Bitton A, Meigs JB, et al. Relationships of cotinine and self-reported cigarette smoking with hemoglobin A1c in the U.S.: results from the National Health and Nutrition Examination Survey, 1999-2008. Diabetes Care. 2011; 34(10): 2250–2255.
  18. Grøndahl MF, Bagger JI, Lund A, et al. Effects of smoking versus nonsmoking on postprandial glucose metabolism in heavy smokers compared with nonsmokers. Diabetes Care. 2018; 41(6): 1260–1267.
  19. Kar D, Gillies C, Zaccardi F, et al. Relationship of cardiometabolic parameters in non-smokers, current smokers, and quitters in diabetes: a systematic review and meta-analysis. Cardiovasc Diabetol. 2016; 15(1): 158.
  20. Piatti P, Setola E, Galluccio E, et al. Smoking is associated with impaired glucose regulation and a decrease in insulin sensitivity and the disposition index in first-degree relatives of type 2 diabetes subjects independently of the presence of metabolic syndrome. Acta Diabetol. 2014; 51(5): 793–799.
  21. Morimoto A, Tatsumi Y, Miyamatsu N, et al. Association between smoking and post-load plasma glucose levels using a 75-g oral glucose tolerance test: the Saku Study. Diabetes Res Clin Pract. 2014; 106(2): e38–e40.
  22. Yürekli A, Önder Z, Elibol M, et al. The Economics of Tobacco and Tobacco Taxation In Turkey. Paris: International Union Against Tuberculosis and Lung Disease. 2010.
  23. Alomari MA, Khabour OF, Alzoubi KH, et al. Central and peripheral cardiovascular changes immediately after waterpipe smoking. Inhal Toxicol. 2014; 26(10): 579–587.
  24. Cryer PE, Haymond MW, Santiago JV, et al. Norepinephrine and epinephrine release and adrenergic mediation of smoking-associated hemodynamic and metabolic events. N Engl J Med. 1976; 295(11): 573–577.
  25. Li G, Wang H, Wang Ke, et al. The association between smoking and blood pressure in men: a cross-sectional study. BMC Public Health. 2017; 17(1): 797.
  26. He BM, Zhao SP, Peng ZY. Effects of cigarette smoking on HDL quantity and function: implications for atherosclerosis. J Cell Biochem. 2013; 114(11): 2431–2436.
  27. Gedebjerg A, Almdal TP, Berencsi K, et al. Prevalence of micro- and macrovascular diabetes complications at time of type 2 diabetes diagnosis and associated clinical characteristics: A cross-sectional baseline study of 6958 patients in the Danish DD2 cohort. J Diabetes Complications. 2018; 32(1): 34–40.
  28. Omae T, Nagaoka T, Yoshida A. Effects of habitual cigarette smoking on retinal circulation in patients with type 2 diabetes. Invest Ophthalmol Vis Sci. 2016; 57(3): 1345–1351.
  29. Marshall G, Garg SK, Jackson WE, et al. Factors influencing the onset and progression of diabetic retinopathy in subjects with insulin-dependent diabetes mellitus. Ophthalmology. 1993; 100(8): 1133–1139.
  30. Moss S, Klein R, Klein B. Cigarette smoking and ten-year progression of diabetic retinopathy. Ophthalmology. 1996; 103(9): 1438–1442.
  31. Baggio B, Budakovic A, Dalla Vestra M, et al. Effects of cigarette smoking on glomerular structure and function in type 2 diabetic patients. J Am Soc Nephrol. 2002; 13(11): 2730–2736.
  32. Pinto-Sietsma SJ, Mulder J, Janssen WM, et al. Smoking is related to albuminuria and abnormal renal function in nondiabetic persons. Ann Intern Med. 2000; 133(8): 585–591.
  33. Tozawa M, Iseki K, Iseki C, et al. Influence of smoking and obesity on the development of proteinuria. Kidney Int. 2002; 62(3): 956–962.