Objective Assessment of Smoking Habits by Urinary Cotinine Measurement in Adolescents and Young Adults With Type 1 Diabetes: Reliability of reported cigarette consumption and relationship to urinary albumin excretion

  1. Klaus-Michael Debatin, MD
  1. Department of Pediatrics, University of Ulm Ulm, Germany
  1. Address correspondence and reprint requests to Reinhard W. Holl, MD, University Children's Hospital, Prittwitzstr. 43, D-89070 Ulm, Germany.


OBJECTIVE To examine the relationship of objective smoking status to age, sex, longterm metabolic control, and urinary albumin excretion. Patients with type 1 diabetes who smoke are at increased risk to develop diabetic microvascular and macrovascular complications. While this has repeatedly been demonstrated in adults, smoking habits have rarely been investigated in adolescents.

RESEARCH DESIGN AND METHODS Urinary cotinine excretion has been determined by radioimmunoassay in 238 adolescents and young adults with type 1 diabetes. This biochemical parameter of nicotine use was related to age, to the number of cigarettes allegedly consumed per day, and to urinary albumin excretion.

RESULTS A total of 46 patients (19.3%) with urinary cotinine values >500 ng/ml were classified as smokers. In 26 patients (10.9%), cotinine values between 100 and 500 ng/ml were found (infrequent smokers or environmental nicotine exposure), while the remaining 166 patients excreted <100 ng/ml of cotinine in the urine (nonsmokers). Smokers were significantly older (20.2 ± 0.6 years [mean ± SE]) compared with the intermediate group (18.3 ± 0.7 years) or with nonsmokers (15.9 ± 0.4 years; P < 0.0001, Wilcoxon's signed-rank test). Of 46 smokers, 12 denied smoking cigarettes entirely, and among biochemically defined smokers, no correlation was present between urinary cotinine excretion and the reported number of cigarettes consumed per day. Urinary albumin excretion was significantly higher in smokers compared with nonsmokers (P < 0.003).

CONCLUSIONS These data demonstrate that cigarette smoking is common among German adolescents and young adults with type 1 diabetes in this study. Many patients deny nicotine use or refuse to disclose their smoking habits. Increased urinary albumin excretion is consistent with an increased risk of nephropathy in subjects with diabetes who smoke. Pediatricians in charge of adolescents with type 1 diabetes should actively discuss the risk of nicotine consumption with their patients.

  • Received July 21, 1997.
  • Revision received January 15, 1998.
  • Accepted January 15, 1998.
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