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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.

  1. Kazumi Saito, MD12,
  2. Nobuhiro Yamada, MD, PHD1 and
  3. Hirohito Sone, MD, PHD, FACP12
  1. 1Department of Internal Medicine, University of Tsukuba Institute of Clinical Medicine, Tsukuba, Japan
  2. 2Department of Nutritional Medicine, Ochanomizu University, Tokyo, Japan
  1. 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
Diabetes Care 2007 Mar; 30(3): e2-e2. https://doi.org/10.2337/dc06-2295
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Response to De Cosmo et al.

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.

Footnotes

  • DIABETES CARE

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
    OpenUrlAbstract/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
    OpenUrlAbstract/FREE Full Text
  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
    OpenUrlAbstract/FREE Full Text
  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
    OpenUrlAbstract/FREE Full Text
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Diabetes Care: 30 (3)

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March 2007, 30(3)
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Cigarette Smoking Is Associated With Low Glomerular Filtration Rate in Male Patients With Type 2 Diabetes
Kazumi Saito, Nobuhiro Yamada, Hirohito Sone
Diabetes Care Mar 2007, 30 (3) e2; DOI: 10.2337/dc06-2295

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Cigarette Smoking Is Associated With Low Glomerular Filtration Rate in Male Patients With Type 2 Diabetes
Kazumi Saito, Nobuhiro Yamada, Hirohito Sone
Diabetes Care Mar 2007, 30 (3) e2; DOI: 10.2337/dc06-2295
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