Severe Hypoglycemia and Smoking in a Long-Term Type 1 Diabetic Population: Wisconsin Epidemiologic Study of Diabetic Retinopathy

Abstract

Objective To evaluate the relationship of severe hypoglycemia (SH) and smoking in a population-based cohort of persons with long-term type 1 diabetes.

Research Design and Methods Cross-sectional analysis of the population-based cohort of the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR). The analyses in this report were limited to 537 type 1 diabetes individuals with complete data who participated in the last examination phase (2000-2001). SH was defined as having one or more episodes of loss of consciousness or overnight hospitalization due to hypoglycemia in a one year period prior to the examination.

Results The prevalence of SH in this population was 14.3%. In univariate analysis, current smokers had a greater chance of having SH compared to never smokers: OR and 95% CI 2.40 (1.30-4.40). When controlling for relevant confounders such as age, gender, glycosylated hemoglobin, waist-hip ratio, orthostatic hypotension, alcohol consumption, intensive insulin treatment, past history of severe hypoglycemia, and late complications of diabetes (nephropathy, neuropathy, and retinopathy), the association remained statistically significant with current smoking presenting approximately 2.6 times greater odds of developing SH.

Conclusions Current smokers with type 1 diabetes have higher odds of SH episodes.