Tobacco Info

From Tobacco Info No. 7 - October 2011
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Studies confirm smoking and second-hand smoke are risk factors for type 2 diabetes

The correlation between lung cancer and smoking has been common knowledge for decades. The Canadian Cancer Society estimates that some 20,000 people in the country will die from the disease this year, with over 80% of those deaths directly or indirectly related to smoking.

But did you know that smoking is a risk factor for developing type 2 diabetes?

The science behind diabetes

Numerous studies demonstrate important links between smoking and the onset of diabetes and its complications. A seven-year German study by researcher Kowall and colleagues published in the European Journal of Epidemiology in April 2010 found that smoking is a risk factor for developing type 2 diabetes for people between the ages of 55 to 74. In 2007, a study published in the Journal of the American Medical Association also found that smoking is associated with an increased risk of type 2 diabetes.

In a study published in the American Journal of Public Health in 1993, Rimm and colleagues from the Harvard School of Public Health found that current smokers had an increased risk of diabetes and observed a significant dose-response trend for higher risk among heavier smokers. During  1,277,589 person-years of follow up, 2,333 women were clinically diagnosed with diabetes. The relative risk of diabetes, adjusted for obesity and other risk factors, was 40% higher among women who smoked 25 or more cigarettes per day compared with non-smokers.  This data suggests that cigarette smoking may be an independent, modifiable risk factor for type 2 diabetes.

These same concerns apply to second-hand smoke (SHS) exposure for diabetics as it has been found that chronic exposure to SHS is almost as deleterious to one’s health as being a pack-a-day smoker, this according to a 2005 University of California, San Francisco study published in the journal Circulation. SHS has been classified as a Class A carcinogen (pollutants with adequate human data indicating the chemical causes cancer in people) in both Canada and the US. SHS increases the risk of developing diabetes. In fact, the study cites that 21.8% of smokers will develop diabetes, while the same is true for 17.2% of non-smokers with SHS exposure, 14.4% of smokers who quit and 11.5% of non-smokers without SHS exposure.

Pregnant women should avoid tobacco and nicotine, including SHS exposure, as fetal and neonatal exposure to nicotine use may increase the risk of type 2 diabetes, this according to a 2008 study by Purdue University published in the Oxford Journal’s Toxicological Studies.

Research also shows that diabetics face increased risks of complications and death if they keep lighting up. Just like high blood glucose levels, the noxious chemicals in cigarette smoke attack blood vessels, hardening the arteries and impairing the blood’s ability to carry oxygen to the tissues. Therefore, according to the Canadian Diabetes Association, quitting smoking is one of the most important things people living with diabetes can do to help prevent or delay the onset of complications.

In a study by Patasi and Hall, published in the organization’s magazine Canadian Diabetes in the spring of 2010, the Diabetes Association reported that people suffering from diabetes are at a three times higher risk of heart attack and stroke compared to a non-smoker with diabetes, and as such, almost 80% will die as a result of these illnesses. In addition, the combination of high blood glucose and smoking dramatically increases damage to the blood vessels that feed the heart, brain, eyes, kidneys and peripheral nerves. Smoking also decreases the body’s ability to produce insulin, making diabetes even more difficult to control. 

A study published in Diabetes Care in July 2007 recommended that healthcare professionals treating diabetic patients be more active in educating about the risks of smoking and assess smoking status of all diabetic patients, advise diabetic smokers to quit and pay closer attention to diabetic smokers for signs of complications by making sure that all necessary preventive care and examinations are performed.

Diabetes Association awareness campaigns

There is very little awareness among Canadians of the potentially deadly relationship between diabetes and smoking. This is not surprising given the limited attention and resources devoted to the relationship by the Canadian Diabetes Association. However, the Association has done some community outreach initiatives in order to help shed some light on the subject.

In 2010, the Association issued press releases on the subject in recognition of World No Tobacco Day, stating, “the Canadian Diabetes Association is urging Canadians living with diabetes who smoke to take charge of their health by knowing their risks and to take action to quit smoking.

The organization’s website includes a page dedicated to quitting smoking and an online interactive Healthy Living Series video presentation about Smoking and Diabetes. There is also a resource for young people with information on smoking entitled Generation D: A young adult’s guide to diabetes self-management.

Educational literature is distributed at all community events,” wrote Randi Garcha, spokesperson for the Canadian Diabetes Association in an email, “and we also work with health care professionals.

Ultimately, more needs to be done. Garcha’s organization believes that health officials need to be directly involved in cessation treatments for diabetics. The official position statement reads, “health professionals should inform their patients with diabetes of the unique risks incurred by smoking or by exposure to smoke, emphasize the benefits of quitting and review available treatment options. Smoking cessation products should be covered on provincial formularies for high-risk patients, such as those with diabetes. Governments should enact legislation to protect citizens from exposure to tobacco smoke in public places, and support programs in schools that have proven to be effective in convincing young people not to start smoking.

By Joe Strizzi