Department of Endocrinology, Diabetology and Metabolic Diseases, CHU Dijon, Dijon, France.
Department of Endocrinology, Diabetology and Metabolic Diseases, University Hospital of Brest, Brest, France.
Ann Endocrinol (Paris). 2024 Dec;85(6):614-622. doi: 10.1016/j.ando.2024.08.001. Epub 2024 Aug 30.
Smoking increases insulin resistance via multiple mechanisms but is a poorly understood risk factor for onset of type-2 diabetes. It is also associated with impaired beta-cell function in humans, but again the mechanisms are poorly understood. Mechanistic studies of the impact of smoking on carbohydrate metabolism mainly evaluated nicotine as the causal agent, and more rarely other tobacco constituents, making it impossible to conclude that the risk of diabetes is linked to the effects of nicotine alone. Active smoking also has negative impact on glycemic control in both type-1 and type-2 diabetic patients. It increases the risk of all-cause mortality and worsens the chronic complications of diabetes. Impact on microangiopathic complications in type-2 diabetic patients, however, is more controversial. Data on pharmacological and behavioral strategies for smoking cessation used in the general population are more sparse in diabetic patients, despite opportunities with recent therapeutic trials involving varenicline and GLP-1 analogues. It is essential for diabetic patients to stop smoking, and diabetologists must get involved in smoking cessation as they have done for many years in therapeutic education, which can easily include measures to help patients stop smoking.
吸烟可通过多种机制增加胰岛素抵抗，但作为 2 型糖尿病发病的一个风险因素，其机制仍未被充分理解。吸烟还与人类胰岛β细胞功能受损有关，但同样其机制也未被充分阐明。有关吸烟对碳水化合物代谢影响的机制研究主要评估了尼古丁作为致病因子的作用，而其他烟草成分则较少被评估，这使得我们无法得出结论，即糖尿病的风险仅与尼古丁的作用有关。主动吸烟也会对 1 型和 2 型糖尿病患者的血糖控制产生负面影响。它会增加全因死亡率，并使糖尿病的慢性并发症恶化。然而，关于吸烟对 2 型糖尿病患者微血管并发症的影响，目前仍存在争议。尽管最近的一些涉及维拉唑尼和 GLP-1 类似物的治疗试验为糖尿病患者提供了机会，但在普通人群中用于戒烟的药理学和行为策略的数据在糖尿病患者中更为稀缺。对于糖尿病患者来说，戒烟至关重要，而且糖尿病医生必须像他们多年来在治疗教育中所做的那样，参与到戒烟中来，这其中可以很容易地包括帮助患者戒烟的措施。
