If you ask what diseases can be caused by smoking, including doctors, you usually call lung cancer, less often cardiovascular diseases. As for the other diseases, it is usually considered that genetics, ecology, and many other factors independent of the person themselves influence their occurrence and course.
The assumption that smoking may have some effect, for example, on such a known disease as diabetes, even in some doctors may cause obvious bewilderment. It is widely believed that diabetes is a genetically caused disease that can suddenly and unexpectedly fall on a person at any age, and it follows from this the logical conclusion that smoking has nothing to do with it.
Public perceptions of what diabetes is, vary enormously. It seems to someone that this is a non-dangerous disease, almost eccentricity, resulting in the rejection of sweets, others perceive it as a severe pathology leading to disability and early death, which is in fact not amenable to treatment. Diabetes mellitus is an extremely common disease, contributing to a large proportion of cardiovascular mortality.
Most developed, and not only developed countries state an epidemic of diabetes mellitus. According to American data, every 250th person suffers from diabetes of the first type, and every 25th or second 15th person has diabetes of the second type. In all countries of the world, the number of registered patients with diabetes mellitus is steadily increasing.
So in the United States for 15 years from 1980 to 1995, it has more than doubled and currently stands at about 1 million people, that is, approximately every 50th citizen of Ukraine has diabetes. Obviously, this prevalence is associated with lifestyle, stress, eating habits. In recent years, several studies have been published concerning the effect of smoking on the development and progression of diabetes. Briefly, their results are as follows:
- smoking a mother during pregnancy increases the risk of developing diabetes in a child;
- smoking a person himself increases the likelihood of developing type 2 diabetes mellitus;
- Smoking aggravates diabetes mellitus of both the first and second types, increases the number of complications and the risk of death.
smoking cessation is an important factor in reducing the risk of both diabetes and its complications
Now about the results of these studies in more detail. But let’s start with what diabetes is of the first and second type, and how they differ.
SMOKING DECREASES COURSE OF DIABETES OF ANY TYPE
Smoking aggravates a number of problems caused by diabetes . The addition of smoking to diabetes actually doubles the risk of illness and death. Smoking is one of the factors that predispose patients with diabetes to various cardiovascular diseases. Mortality from cardiovascular diseases on the background of diabetes in smokers is three times higher than in non-smokers. Heart diseases are the leading cause of death among people with diabetes. Smoking increases the risk of heart attack. A study conducted over the course of 20 years collected information on the health and lifestyle of nurses. Among them were 7,000 patients with type 2 diabetes. It turned out that the risk of death for those who smoked from 1 to 14 cigarettes per day was 43% higher than for those diabetics who never smoked.
For those who recently quit smoking, the risk remained quite high (31% more than non-smokers), then it decreased, and was 11% higher than non-smokers, among those who quit smoking more than 10 years ago. Thus, the long-term cessation of smoking significantly reduced the risk of death, and the intensity of smoking influenced the additional risk of death associated with smoking: for those who smoked a lot, the risk of death was almost twice that of non-smokers.
The risk of the development of cardiovascular pathology in women who suffered from diabetes and smoked 15 or more cigarettes per day was 7 times higher than that of non-smokers. Diabetes mellitus affects the composition of blood lipids, which leads to a thickening of the walls of blood vessels. Smoking also leads to an increase in the concentration of cholesterol in the blood and damage to blood vessels. Smoking leads to an increase in blood pressure, for type II diabetes, smoking is a risk factor for stroke.
Diabetes affects the blood flow in the lower limbs, which can lead to their amputation.
Smoking aggravates these problems. Severe problems, expressed in gangrene of the feet, in 95% of cases are observed in those diabetic patients who smoke a lot.Diabetes can cause impotence. Smoking also worsens the condition of the penis. Smoking also increases the risk of diabetic eye disease (diabetic retinopathy ). Diabetic smokers are more likely to developneuropathy, that is, nerve damage, than non-smokers.
Smoking with diabetes increases the risk of kidney damage. Smoking cessation leads to a reduction in kidney problems. A study among 943 patients showed that patients with type 1 diabetes can quickly reduce the risk of microalbuminuria , which is the first symptom of kidney damage if they stop smoking and improve blood glucose control. Diabetes is actually the most important cause of renal failure, responsible for the development of 40% of new cases.
The effect of a combination of smoking and increased blood sugar concentration was more pronounced than the sum of the effects of these two factors separately. The authors of the study believe that smoking cessation leads to a reduction in the risk of complications from both the kidneys and other organs in patients with diabetes of both the first and second type. Smokers are more likely to have colds and infections of the respiratory tract, which leads to fluctuations in the concentration of glucose in the blood.
Smoking doubles the risk of limiting joint movement. Smoking leads to an increase in blood glucose concentrations, which makes it difficult to control diabetes.
In patients with type 1 diabetes, smoking increases the likelihood of ketoacidosis (that is, the formation of ketones and the associated acidification of the blood reaction) and the risk of all those complications associated with an increasedconcentration of glucose and ketones . In smokers with diabetes, gum disease is more likely to develop, resulting in tooth loss.
HOW SMOKING INFLUENCES SUGAR EXCHANGE
A study in 1980 found that after smoking two cigarettes, both those with diabetes and those without smokers had an increase in blood glucose, more pronounced in people with diabetes. With repeated exposure to smoking, the increase in blood glucose was more significant. Such an increase was not observed if the cigarettes did not contain nicotine or there was no inhalation of smoke during the smoking process, that is, the effect of smoking on the concentration of glucose in the blood was due to nicotine.
Researchers associate an increase in blood glucose with the mobilization of catecholamines, as well as with the stimulation of the production of somatotropic hormone and cortisol. Stimulation of the production of stress hormones, due to exposure to nicotine, leads to an increase in concentration of glucose in the blood . Smoking cessation reduces the risk of the above complications, and with prolonged non-smoking experience reduces the additional risk to almost zero.
In connection with helping patients with diabetes to stop smoking, it should be remembered that nicotine replacement therapy drugs may also increase blood glucose concentrations. Therefore, they should be used with the mandatory control of glucose concentration in the blood.
SMOKING CAN INCREASE RISK OF SECOND DIABETES TYPE
Some studies have shown that smoking interferes with the body’s ability to use glucose, violates the binding of glucose and thereby contributes to the development of diabetes of the second type. The results of a long-term study of American doctors indicate that a significant increase in the incidence of diabetes is associated with smoking. When smoking, blood glucose levels increase following its absorption in the oral cavity, and smoking can also degrade the insulin sensitivity of the cells.
This explains the causal relationship between smoking and diabetes. In the course of the work, the relationship between smoking and diabetes was studied among 21068 American male doctors aged 40 to 84 years. At the beginning of the study in 1982, none of them had a diagnosis of diabetes, cardiovascular disease, or cancer. During an average of 12 years of follow-up, 770 cases of diabetes were reported. Compared to never smokers, those who smoked 20 or more cigarettes daily had a relative risk of diabetes of 2.1. For those who smoked less than 20 cigarettes daily, the risk was 1.4.
For quitters, the relative risk was 1.2. After adjusting for factors such as body mass index and physical activity, the relative risk was 1.7 for those who smoked more than 20 cigarettes, 1.5 for smokers less than 20 cigarettes, and 1.1 for past smokers, compared with those who never smoked. The researchers concluded that smoking is an independent and modifiable factor in the development of diabetes . In another study, 1,266 Japanese men aged 35-59 years participated, who at the time of the study did not have a diagnosis of diabetes mellitus and did not take drugs for cardiovascular diseases.
Every year, all participants in the study determined the concentration of sugar in the blood and the body’s ability to bind glucose. It was found that men who smoked 31 or more cigarettes per day had a risk of developing type 2 diabetes, which was four times the risk for non-smokers. Smoking also increased the risk of glucose binding disorders . Smoking leads to the release of hormones that are insulin antagonists and can increase blood glucose levels . As mentioned above, overweight, distributed in the upper body, is a risk factor for type 2 diabetes. The risk of developing diabetes mellitus is especially high in individuals with paradoxical body proportions — low body mass index combined with high values of the ratio of waist circumference to hip circumference.
On the other hand, smoking is known to change the proportions of the body. In a study conducted by Korean scientists , the prevalence of such a paradoxical combination of body proportions was 4.7% among men and 3.8% among women. At the same time, smoking increased the risk of a paradoxical combination of body indices in men by 2.1 times, and in women by 2.5 times.
SMOKING MOTHER DURING PREGNANCY INCREASES THE RISK OF DIABETES AND OBESITY FOR A FUTURE CHILD
As published in January 2002 in the authoritative “British Medical Journal”, long-term studies of physicians have determined that diabetes or obesity of her unborn child may result from smoking a woman during pregnancy. Researchers at the Karolinska Institute (Stockholm, Sweden) used data from the British National Child Development Study.
The object of the study were 17 thousand people born during one week in March 1958. At birth, obstetricians found out from the pregnant women whether they had smoked during pregnancy, in particular after the fourth month of pregnancy. Born offspring were under medical supervision up to 33 years. As a result, it turned out that among those whose mothers smoked 10 or more cigarettes per day before their birth, the risk of diabetes increased by 4.5 times compared with non-smokers, and in the case of smoking fewer cigarettes, the risk increased 4.13 times.
The risk of obesity in those children who did not have diabetes was 34-38% higher compared with those whose mothers did not smoke. These conditions were detected at an early age, from the age of 16, when these diseases are very rare. At the same time, researchers believe that the estimates obtained can be considered conservative, since the examined people are likely to develop diseases in subsequent years.
The factor of smoking in adolescence was also taken into account, which also had an independent effect on the risk of developing type 2 diabetes. Researchers suggest that this relationship between maternal smoking and diabetes in a child may be due to changes in the metabolism of the fetus, developing under the influence of components of tobacco smoke. Smoking can have, on the one hand, a toxic effect on the fetus, on the other hand, causes nutritional deficiencies.
This lack of nutrition leads to the fact that the child’s body expects, as it were, in the world where he is to live, there is a lack of food, and therefore shows insulin resistance and a tendency to accumulate fat. Such metabolic programming turns out to be inadequate to current dietary habits with an abundance of high-calorie foods and a lack of physical activity.
Quite extensive previously published data also point to the relationship between maternal smoking during pregnancy and underweight at birth, on the one hand, and the relationship between underweight of the newborn and the development of conditions such as diabetes, obesity, high blood pressure and cardiovascular diseases, on the other. Thus, smoking a mother during pregnancy not only has a direct adverse effect on the child, but also has a long-term effect, which is already apparent in adulthood.
Thus, the onset and development of diabetes mellitus is largely a consequence of lifestyle, in particular, smoking, which affects both the likelihood of diabetes and the risk of developing its severe complications. I would like to hope that the above information will not remain abstract knowledge, but will be used for practical actions of doctors and not only doctors. It is important that:
- Pregnant women smokers learned that their smoking poses a risk of diabetes and obesity for their unborn child. This topic concerns, first of all, doctors working in women’s clinics, who can and should discuss with each pregnant woman the issue of smoking, and not only her own, but also about smoking in the family. This also applies to journalists who can draw attention to this problem. This also applies to everyone else who can talk to a pregnant woman who smokes about the risk of diabetes and other diseases of the child that may be caused by maternal smoking.
- All smokers who know about diabetes have learned that they put themselves at additional risk of the disease. This question may be raised by the attending physician, the local physician, who will ask each patient about smoking and advise on its termination. For those patients for whom, due to family or other circumstances, diabetes is a serious threat, this argument may prove decisive for them to quit.
- All people with diabetes learned about the dangers of smoking and received help in stopping it. Smoking cessation can be an effective factor in improving the quality of life of people with diabetes, and preventing it for everyone else. In fact, for patients with diabetes, stopping smoking is a vital action. In this regard, it is necessary for specialized services for smokers to emerge and function , for medical professionals involved in the treatment of diabetes to pay special attention to smoking issues.