SMOKING AND DIABETES-MELLITUS

The goal of this review is to determine the effects of smoking on diab etes mellitus, whether it aggravates diabetic complications or influen ces insulin metabolism and action. Also available anti-smoking program mes applicable for diabetic patients have been studied. The prevalence of smoking among diabetic patients has been investigated by conductin g a meta-analysis. Compared with normal subjects, the prevalence of sm oking among diabetic patients is significantly higher (27 vs. 33%, p < 0.0001), IDDM patients largely accounting for this difference. Howeve r, care must be used in interpreting these data. Smoking presents an e xtra risk for development of macro- and microvascular complications in these patients, contributing to increased cardiovascular morbidity an d mortality. Smoking also increases the risk of diabetes itself. Neith er acute nor habitual smoking causes substantial changes in insulin se nsitivity in IDDM patients, whereas it does so in NIDDM. Studies in di abetic patients concerning anti-smoking strategies are scarce and only yield disappointing results. Making these patients abstain from smoki ng turns out to be extremely difficult, probably due to the considerab le psychosocial stress experienced.