Gill G V, Rolfe M, MacFarlane I A, Huddle K R
Department of Medicine, Baragwanath Hospital, University of Witwatersrand, Johannesburg, South Africa.
Diabet Med. 1996 Nov;13(11):996-9. doi: 10.1002/(SICI)1096-9136(199611)13:11<996::AID-DIA269>3.0.CO;2-B.
Cigarette smoking is a major arteriosclerotic risk factor, and this is enhanced by the presence of diabetes mellitus. Although smoking rates are increasing in many African countries, they have been little studied. We have critically assessed smoking among black diabetic and general medical patients at Baragwanath Hospital in Soweto, South Africa. As well as direct questioning of patients, we also used urinary cotinine:creatinine ratio as an objective marker. The admitted smoking rate was 16% in 118 diabetic patients, compared with 22% in 105 medical patients. Using a validated biochemical index of smoking (urinary cotinine:creatinine > 1.0 microgram mg-1) the rates were 37% and 33%, respectively. Most of the excess however was due to women who took snuff, and when excluded, the estimated real rates were 20% (diabetic) and 24% (medical). Amongst diabetic smokers mean cotinine:creatinine ratio was higher than in medical smokers (4.7 +/- 6.0 v 1.8 +/- 2.0 micrograms mg-1) despite admitted similar smoking consumption. A separate control group of British smokers had a mean level of 3.6 +/- 1.3 though their consumption was twice that of the South African groups. We conclude that smoking is common among South African black diabetic patients (20%), though it is less than reported figures for the black general population (28%), and British diabetic patients (35%). Questionnaire studies may seriously underestimate smoking rates, though this effect is considerably less in African compared with British smokers. Urinary cotinine also allows quantification of the 'smoking load', which is rarely reflected by admitted cigarette consumption.
吸烟是动脉粥样硬化的主要危险因素，糖尿病的存在会加剧这种情况。尽管许多非洲国家的吸烟率在上升，但相关研究却很少。我们对南非索韦托巴拉格瓦纳特医院的黑人糖尿病患者和普通内科患者的吸烟情况进行了严格评估。除了直接询问患者，我们还使用尿可替宁与肌酐比值作为客观指标。118名糖尿病患者的入院吸烟率为16%，而105名内科患者的吸烟率为22%。使用经过验证的吸烟生化指标（尿可替宁与肌酐>1.0微克/毫克），这两个比率分别为37%和33%。然而，大部分差异是由于吸鼻烟的女性造成的，排除这些女性后，估计实际吸烟率为20%（糖尿病患者）和24%（内科患者）。在糖尿病吸烟者中，尽管报告的吸烟量相似，但平均可替宁与肌酐比值高于内科吸烟者（4.7±6.0对1.8±2.0微克/毫克）。一组单独的英国吸烟者对照组的平均水平为3.6±1.3，尽管他们的吸烟量是南非组的两倍。我们得出结论，吸烟在南非黑人糖尿病患者中很常见（20%），尽管低于黑人普通人群（28%）和英国糖尿病患者（35%）的报告数字。问卷调查研究可能会严重低估吸烟率，不过与英国吸烟者相比，非洲吸烟者的这种影响要小得多。尿可替宁还可以量化“吸烟负荷”，这很少能通过报告的吸烟量反映出来。
