吸烟增加1型糖尿病患者出现严重低血糖概率

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Smoking Linked to Severe Hypoglycemia in Type 1 Diabetics

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NEW YORK (Reuters Health) Jun 21 - Current smokers with type 1 diabetes have about a 2.6-times higher risk of developing a severe hypoglycemia episode compared with their counterparts who have never smoked, according to the results of a study published in the June issue of Diabetes Care.

\"Smoking has been reported to be associated with hypoglycemia in previous clinical studies, and it has been studied but not related to severe hypoglycemia in population-based studies,\" Dr. Ronald Klein, of the University of Wisconsin-Madison, and colleagues write. \"Smoking, through its effect on hormone regulation and insulin clearance, has been hypothesized to result in severe hypoglycemia.\"

To further investigate, the researchers examined the association between severe hypoglycemia and smoking in 537 subjects in the Wisconsin Epidemiologic Study of Diabetic Retinopathy who took part in the last examination phase (2000 to 2001).

The authors defined severe hypoglycemia as at least one episode of loss of consciousness or overnight hospitalization in a 1-year period before the examination phase. Subjects were classified as never smokers if they had smoked fewer than 100 cigarettes in their lifetime, current smokers if they had smoked more than 100 cigarettes and continued to smoke, and past smokers if they had smoked more than 100 cigarettes but had stopped smoking.

The mean age was 45.3 years, duration of diabetes was 31.3 years and the mean A1C was 7.8%. Overall, 57.7% of the participants were never smokers, 27.0% were past smokers, and 15.3% were current smokers.

At least one episode of severe hypoglycemia was reported by 78 patients (14.5%) of the subjects, but the current smokers were more likely to have had an episode. The results of multivariable analysis indicated that current smokers have a 2.60-fold increased risk of having severe hypoglycemia while controlling for confounders in two models, Dr. Klein and colleagues write.

Compared with the never smokers, smokers also had an odds ratio of 2.65, 2.68, and 2.10 of developing nephropathy, neuropathy, and retinopathy, respectively, they note.

Dr. Klein's group suggests that smoking increases the risk of hypoglycemia by impairing insulin clearance leading to hyperinsulinemia and increasing the risk of postprandial hypoglycemia, or possibly by worsening metabolic control.

Diabetes Care 2007;30:1437-1441.