Smoking and Diabetes

BACKGROUND

As documented in the American Diabetes Association’s technical review “Smoking and Diabetes” (1), a large body of evidence from epidemiological, case-control, and cohort studies provides convincing documentation of the causal link between cigarette smoking and health risks. Cigarette smoking is the leading avoidable cause of mortality in the U.S., accounting for 400,000 deaths each year. Cigarette smoking accounts for one out of every five deaths in the U.S. and is the most important modifiable cause of premature death. Cigarettes provide the delivery system for nicotine, an addictive substance related to various pharmacological, biochemical, and psychological processes that interact to support a compulsive pattern of drug use.

Much of the prior work documenting the impact of smoking on health did not discuss separately results on subsets of individuals with diabetes, suggesting the identified risks are at least equivalent to those found in the general population. Other studies of individuals with diabetes consistently found a heightened risk of morbidity and premature death associated with the development of macrovascular complications among smokers. The cardiovascular burden of diabetes, especially in combination with smoking, has not been effectively communicated to people with diabetes or to health care providers, and there is little evidence that this risk factor is being addressed as consistently and comprehensively as its importance requires. Smoking is also related to the premature development of microvascular complications of diabetes and may even have a role in the development of type 2 diabetes (1).

General smoking prevalence decreased substantially up until about 1990 because of extensive public health …