Smokers are insulin resistant, exhibit several aspects of the insulin resistance syndrome, and are at an increased risk for type 2 diabetes. Prospectively, the increased risk for diabetes in smoking men and women is around 50%. Many patients with type 1 and type 2 diabetes mellitus are at risk for micro- and macrovascular complications. Cigarette smoking increases this risk for diabetic nephropathy, retinopathy, and neuropathy, probably via its metabolic effects in combination with increased inflammation and endothelial dysfunction. This association is strongest in type 1 diabetic patients. The increased risk for macrovascular complications, coronary heart disease (CHD), stroke, and peripheral vascular disease, is most pronounced in type 2 diabetic patients. The development of type 2 diabetes is another possible consequence of cigarette smoking, besides the better-known increased risk for cardiovascular disease. In diabetes care, smoking cessation is of utmost importance to facilitate glycemic control and limit the development of diabetic complications.
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