Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Zurich, Switzerland.
Nutr Metab Cardiovasc Dis. 2013 Feb;23(2):102-8. doi: 10.1016/j.numecd.2011.08.007. Epub 2011 Nov 25.
Smoking is known to negatively influence glucose metabolism both in healthy subjects and in patients with diabetes. The aim of this study was to compare glycemic control in patients with type 1 diabetes mellitus who were smokers with those who did not smoke during a prospective long-term follow-up.
In a single center, 763 patients with type 1 diabetes mellitus were included, 160 (21.0%) of them were smokers. Patients were treated with intensive insulin therapy according to existing guidelines. Glucose control was monitored quarterly, diabetes related complications and cardiovascular risk factors were assessed at least once a year. Glucose control in smokers was significantly worse than in non-smokers at baseline and during follow-up (mean HbA1c during 5047 patient-years of follow-up 7.9 ± 1.3% in smokers and 7.3 ± 1.1% in non-smokers, p < 0.001) despite a higher insulin dosage in smokers (0.71 ± 0.30 U/kg vs. 0.65 ± 0.31 U/kg in non-smokers, p = 0.046). HDL cholesterol was lower in smokers at baseline (1.53 ± 0.45 vs. 1.68 ± 0.51 in non-smokers, p = 0.048). Diabetes related complications tended to occur with a higher frequency in smokers, with a significant difference in macroalbuminuria (9.8% vs. 4.8% in non-smokers, p = 0.047).
Smoking is associated with worse glucose control in patients with type 1 diabetes mellitus despite the same treatment strategies as in non-smokers. Hyperglycemia, therefore, may contribute to an earlier incidence of diabetes related complications in these patients, in addition to direct toxic effects of smoking.
吸烟已知会对健康受试者和糖尿病患者的葡萄糖代谢产生负面影响。本研究的目的是在前瞻性长期随访中比较 1 型糖尿病患者中吸烟者和不吸烟者的血糖控制情况。
在一家单中心，共纳入了 763 名 1 型糖尿病患者，其中 160 名（21.0%）为吸烟者。根据现有指南，患者接受强化胰岛素治疗。每季度监测血糖控制情况，每年至少评估一次糖尿病相关并发症和心血管危险因素。尽管吸烟者的胰岛素用量更高（0.71 ± 0.30 U/kg 与非吸烟者的 0.65 ± 0.31 U/kg，p = 0.046），但在基线和随访期间（吸烟者的平均 HbA1c 为 5047 患者年随访期间为 7.9 ± 1.3%，而非吸烟者为 7.3 ± 1.1%，p < 0.001），吸烟者的血糖控制明显差于非吸烟者。吸烟者的 HDL 胆固醇水平在基线时较低（1.53 ± 0.45 与非吸烟者的 1.68 ± 0.51，p = 0.048）。糖尿病相关并发症在吸烟者中更常发生，且大量白蛋白尿的发生率存在显著差异（9.8%与非吸烟者的 4.8%，p = 0.047）。
尽管 1 型糖尿病患者的治疗策略与非吸烟者相同，但吸烟与血糖控制较差有关。因此，除了吸烟的直接毒性作用外，高血糖可能会导致这些患者更早发生糖尿病相关并发症。
