Chaturvedi N, Stephenson J M, Fuller J H
Department of Epidemiology and Public Health, University College, London, U.K.
Diabetes Care. 1995 Jun;18(6):785-92. doi: 10.2337/diacare.18.6.785.
To examine the relationship between smoking and both glycemic control and microvascular complications in patients with insulin-dependent diabetes mellitus (IDDM).
This was a prevalence survey of 3,250 men and women aged 15-60 years with IDDM from 31 diabetes centers in 16 European countries. Participants completed a questionnaire, had retinal photographs taken, and performed a 24-h urine collection. HbA1c, frequency of hypoglycemic and ketoacidotic episodes, urinary albumin excretion rates, and retinopathy were compared by smoking category.
The prevalence of smoking was 35% in men and 29% in women. Current smokers had poorer glycemic control and, among men, were more likely to have had a ketoacidotic episode than were those who never smoked. Ex-smokers had equivalent glycemic control and marginally more hypoglycemic episodes did than those who never smoked. Current smokers had a higher prevalence of microalbuminuria and total retinopathy than did those who never smoked. Ex-smokers had a higher prevalence of macroalbuminuria and proliferative retinopathy than did those who never smoked, but both had a similar prevalence of microalbuminuria. Adjustment for either current or long-term glycemic control could not fully account for these differences.
Smoking is associated with poorer glycemic control and an increased prevalence of microvascular complications compared with not smoking. Ex-smokers can achieve glycemic control equivalent to and have a prevalence of early complications similar to that of those who never smoked. We suggest that poorer glycemic control can account for some of the increased risk of complications in smokers, and that quitting smoking would be effective in reducing the incidence of complications. Urgent action is required to reduce the high smoking rates in people with IDDM.
研究胰岛素依赖型糖尿病（IDDM）患者吸烟与血糖控制及微血管并发症之间的关系。
这是一项对来自16个欧洲国家31个糖尿病中心的3250名年龄在15 - 60岁的IDDM男性和女性进行的患病率调查。参与者完成一份问卷，拍摄视网膜照片，并进行24小时尿液收集。根据吸烟类别比较糖化血红蛋白（HbA1c）、低血糖和酮症酸中毒发作频率、尿白蛋白排泄率以及视网膜病变情况。
男性吸烟率为35%，女性为29%。当前吸烟者血糖控制较差，且在男性中，与从不吸烟者相比，发生酮症酸中毒发作的可能性更高。戒烟者血糖控制情况与从不吸烟者相当，且低血糖发作次数略多。当前吸烟者微量白蛋白尿和总体视网膜病变的患病率高于从不吸烟者。戒烟者大量白蛋白尿和增殖性视网膜病变的患病率高于从不吸烟者，但两者微量白蛋白尿的患病率相似。对当前或长期血糖控制进行调整并不能完全解释这些差异。
与不吸烟相比，吸烟与较差的血糖控制及微血管并发症患病率增加有关。戒烟者可实现与从不吸烟者相当的血糖控制，且早期并发症的患病率相似。我们认为较差的血糖控制可部分解释吸烟者并发症风险增加的原因，戒烟对降低并发症发生率有效。需要采取紧急行动降低IDDM患者的高吸烟率。
