Sebastian-Valles Fernando, Hernando Alday Iñigo, Tapia-Sanchiz Maria Sara, Raposo-López Juan José, Garai Hierro Jon, Navas-Moreno Victor, Martínez-Alfonso Julia, Arranz Martin José Alfonso, Sampedro-Nuñez Miguel Antonio, Marazuela Mónica
Servicio de Endocrinología y Nutrición, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria de La Princesa, Madrid, España.
Servicio de Endocrinología y Nutrición, Hospital Universitario Basurto, Bilbao, España.
Med Clin (Barc). 2025 Apr 25;164(8):396-402. doi: 10.1016/j.medcli.2024.10.023. Epub 2024 Dec 20.
Smoking affects glycemic control in individuals with type1 diabetes (T1D); however, its impact in the era of continuous glucose monitoring (CGM) has not been thoroughly studied.
A retrospective cohort study was conducted at two centers, involving 405 T1D patients treated with multiple daily insulin injections and using CGM. The patients were matched using propensity scores based on sociodemographic and clinical characteristics. HbA1c levels were analyzed before and after a 2.2-year follow-up period. The analysis was performed using mixed linear regression and multivariable conditional logistic models.
The sample included 135 smokers and 270 non-smokers, with a mean age of 47.6years, and 50.1% were women. Both groups had a similar baseline HbA1c of 8.0 (1.5%). After follow-up, non-smokers reduced their HbA1c to 7.3 (1.1%), while smokers only reduced it to 7.7 (1.3%), 95%CI [-0,57-0,10]). The proportion of non-smokers achieving HbA1c<7% increased from 25% to 38.1%, 95%CI [0,14-0.36], whereas smokers showed no change (25.9%, 95%CI [-0.13-0.21]). Smoking was independently associated with a higher risk of not achieving HbA1c<7%, despite CGM use (odds ratio 1.89, 95%CI [1.13-3.17].
Smoking limits the glycemic control benefits of CGM in individuals with T1D. It is crucial to include smokers in clinical trials and to develop strategies to discourage smoking in this population to maximize the benefits of diabetes technology.
吸烟会影响1型糖尿病（T1D）患者的血糖控制；然而，其在持续葡萄糖监测（CGM）时代的影响尚未得到充分研究。
在两个中心进行了一项回顾性队列研究，纳入405例接受多次每日胰岛素注射并使用CGM的T1D患者。根据社会人口学和临床特征，使用倾向评分对患者进行匹配。在2.2年的随访期前后分析糖化血红蛋白（HbA1c）水平。使用混合线性回归和多变量条件逻辑模型进行分析。
样本包括135名吸烟者和270名非吸烟者，平均年龄为47.6岁，50.1%为女性。两组的基线HbA1c相似，均为8.0（1.5%）。随访后，非吸烟者将HbA1c降至7.3（1.1%），而吸烟者仅降至7.7（1.3%），95%置信区间[-0.57 - 0.10]）。HbA1c<7%的非吸烟者比例从25%增加到38.1%，95%置信区间[0.14 - 0.36]，而吸烟者无变化（25.9%，95%置信区间[-0.13 - 0.21]）。尽管使用了CGM，但吸烟与未达到HbA1c<7%的较高风险独立相关（优势比1.89，95%置信区间[1.13 - 3.17]）。
吸烟限制了CGM对T1D患者血糖控制的益处。将吸烟者纳入临床试验并制定策略以劝阻该人群吸烟，对于最大化糖尿病技术的益处至关重要。
