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Diabetes Care 30:e2 2007
DOI: 10.2337/dc06-2295
© 2007 by the American Diabetes Association
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Letters: Comments and Responses

Cigarette Smoking Is Associated With Low Glomerular Filtration Rate in Male Patients With Type 2 Diabetes

Response to De Cosmo et al.

Kazumi Saito, MD1,2, Nobuhiro Yamada, MD, PHD1 and Hirohito Sone, MD, PHD, FACP1,2

1 Department of Internal Medicine, University of Tsukuba Institute of Clinical Medicine, Tsukuba, Japan
2 Department of Nutritional Medicine, Ochanomizu University, Tokyo, Japan

Address correspondence to Hirohito Sone, MD, PhD, FACP, Associate Professor, Department of Nutritional Medicine, Ochanomizu University, 2-1-1 Otsuka, Bunkyo-ku, Tokyo, Japan, 112-8610. E-mail: sone.hirohito{at}ocha.ac.jp

We read with interest the article by De Cosmo et al. (1) in the recent issue of Diabetes Care. The authors concluded from their cross-sectional data that cigarette smoking enhanced the risk of renal dysfunction in patients with type 2 diabetes despite their failure to demonstrate a significant dose effect; i.e., a relationship between the number of cigarettes smoked per day and the progression of nephropathy. While the authors suggested that these somewhat conflicting findings may have been due to indication bias, we would like to respectfully offer another explanation—that exclusion of ex-smokers from the analysis accounted for the negative dose effect. Sawicki et al. (2) reported that pack-years of cigarettes smoked was a dose-dependent risk factor for the progression of nephropathy in type 1 diabetic patients. Their prospective data demonstrated that the progression of nephropathy was statistically less common in individuals who never smoked compared with current smokers, with the values for ex-smokers being somewhere in the middle of these two groups. In addition, two prospective studies (3,4) in type 2 diabetic patients reported that those who were current or ex-smokers were at a significantly elevated risk of developing nephropathy. These studies strongly suggest that the inclusion of ex-smokers is imperative when evaluating a diabetic patient’s risk of nephropathy.

References

  1. De Cosmo S, Lamaccha O, Rauseo A, Viti R, Gesualdo L, Pilotti A, Trischitta V, Cignarelli M: Cigarette smoking is associated with low glomerular filtration rate in male patients with type 2 diabetes. Diabetes Care 29:2467–2470, 2006[Abstract/Free Full Text]
  2. Sawicki PT, Didjurgeit U, Mühlhauser I, Bender R, Heinemann L, Berger M: Smoking is associated with progression of diabetic nephropathy. Diabetes Care 17:126–131, 1994[Abstract]
  3. Forsblom CM, Groop PH, Ekstrand A, Tötterman KJ, Sane T, Saloranta C, Groop L: Predictors of progression from normoalbuminuria to microalbuminuria in NIDDM. Diabetes Care 21:1932–1938, 1998[Abstract]
  4. Retnakaran R, Cull CA, Thorne KI, Adler AI, Holman RR: Risk factors for renal dysfunction in type 2 diabetes: U.K. Prospective Diabetes Study 74. Diabetes 55:1832–1839, 2006[Abstract/Free Full Text]

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This article has been cited by other articles:


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 Diabetes CareHome page
K. Saito, H. Sone, K. Kawai, S. Tanaka, S. Kodama, M. Shu, E. Suzuki, K. Kondo, S. Yamamoto, H. Shimano, et al.
Risk Imparted by Various Parameters of Smoking in Japanese Men With Type 2 Diabetes on Their Development of Microalbuminuria: Analysis from the Tsukuba Kawai Diabetes Registry
Diabetes Care, May 1, 2007; 30(5): 1286 - 1288.
[Full Text] [PDF]

Home page
 Diabetes CareHome page
S. De Cosmo, O. Lamacchia, L. Gesualdo, V. Trischitta, and M. Cignarelli
Cigarette Smoking Is Associated With Low Glomerular Filtration Rate in Male Patients With Type 2 Diabetes: Response to Saito et al.
Diabetes Care, March 1, 2007; 30(3): e3 - e3.
[Full Text] [PDF]

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