Smoking is associated with increased HbA1c values and microalbluminuria in patients with diabetes - Data from the National Diabetes Register in Sweden
ABSTRACT The aim was to examine trends in the proportion of smoking in diabetes patients, and to study associations between smoking, glycaemic control, and microalbuminuria.
Smoking habits were reported to the Swedish National Diabetes Register (NDR), with data from hospitals and primary health care. Patient characteristics included were age, gender, type of treatment, diabetes duration, HbA1c, BMI, blood pressure, antihypertensive and lipid-lowering drugs, and microalbuminuria.
The proportion of smokers in type 1 diabetes was 12-15% during 1996-2001, it was high in females<30 years (12-16%), and was higher in the age group 30-59 years (13-17%) than in older (6-9%) patients. The corresponding proportion of smoking in type 2 diabetes was 10-12%, higher in those less than 60 years of age (17-22%) than in older (7-9%) patients. Smoking type 1 and type 2 patients in 2001 had higher mean HbA1c but lower mean BMI values than non-smokers. Smokers also had higher frequencies of microalbuminuria, in both type 1 (18 vs 14%) and type 2 (20% vs 13%) diabetes. Multiple logistic regression analyses disclosed that smoking was independently associated with elevated HbA1c levels (p<0.001) and microalbuminuria (p<0.001), but negatively with BMI (p<0.001), in both type 1 and type 2 diabetes.
Smoking in patients with diabetes was widespread, especially in young female type 1, and in middle-aged type 1 and type 2 diabetes patients, and should be the target for smoking cessation campaigns. Smoking was associated with both poor glycaemic control and microalbuminuria, independently of other study characteristics.
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- "The application of the recommendations in a longitudinal cohort study (Heianza et al., 2011) has indicated that the hazard ratios for incident diabetes were similar in prediabetics discordantly diagnosed by either IFG or by hemoglobin A1c 5.7–6.4% (6.00 vs. 6.16). However, it has also become evident that hemoglobin A1c should not be used alone to screen for prediabetes in the general population, because the proportion of prediabetics with this phenotype was significantly lower than that of IFG (James et al., 2011; Lorenzo et al., 2010) and because hemoglobin A1c levels are higher in older (Lipska et al., 2010; Pani et al., 2008) and normal weight individuals (Lorenzo et al., 2010), cigarette smokers (Nilsson et al., 2004), and persons of African descent (Lorenzo et al., 2010; Selvin et al., 2009; Bersoux et al., 2011) or South Asian origin (Likhari and Gama, 2010). "
ABSTRACT: BACKGROUND: In 2010, the American Diabetes Association recommended that individuals with hemoglobin A1c 5.7-6.4% be classified as prediabetic even in the absence of impaired fasting glucose (IFG). AIM OF STUDY: To compare the clinical and metabolic characteristics of patients receiving antipsychotic drugs who have normal glucose tolerance (NGT), hemoglobin A1c 5.7-6.4% or IFG (fasting glucose 100-125mg/dL). METHOD: Body mass index, waist circumference, fasting glucose, insulin, lipids, hemoglobin A1c, and insulin resistance assessed with the homeostatic model (HOMA-IR) were measured in a consecutive cohort of adult psychiatric inpatients with NGT (N=423), hemoglobin A1c 5.7-6.4% (N=130), IFG (N=52) and IFG plus hemoglobin A1c 5.7-6.4% (n=39). RESULTS: The hemoglobin A1c 5.7-6.4% group had lower fasting insulin levels (9.8±5.6 vs. 15.5±11.4μU/mL, p<0.0001) and HOMA-IR (2.1±1.2 vs. 4.1±3.1, p<0.0001) than the IFG group, but were metabolically similar to those with NGT. The hemoglobin A1c 5.7-6.4% was the predominant prediabetic pattern in patients treated with antipsychotics other than clozapine or olanzapine. Patients with hemoglobin A1c 5.7-6.4% and those with IFG were statistically similar in age (40.1±13.6 vs. 39.7±10.3 years), body mass index (26.0±4.8 vs. 26.3±4.9) and waist circumference 93.1±13.9 vs. 98.1±12.1cm for males and 92.5±13.5 vs. 90.7±15.8cm for females. CONCLUSION: The hemoglobin A1c in the 5.7-6.4% range is common in euglycemic patients receiving antipsychotic drugs and this prediabetic pattern has metabolic and pharmacological features that differentiates it from IFG.European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 05/2012; 23(3). DOI:10.1016/j.euroneuro.2012.05.002 · 5.40 Impact Factor
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- "Smoking is a risk factor for type 2 diabetes , and in patients with diabetes smoking is associated with increased levels of HbA1c and microalbuminuria according to data from the Swedish National Diabetes Register . The Nurses Health Study showed that women with diabetes who smoke had mortality three to four times higher than women with diabetes who had never smoked . "
ABSTRACT: To evaluate an intervention programme on smoking cessation in patients with diabetes mellitus in primary healthcare. Regional controlled intervention study. Seventeen primary healthcare centres in Sweden. In the intervention centres, nurses with education in diabetes were given one half-day of training in motivational interviewing and smoking cessation. An invitation to participate in a smoking cessation group was mailed to patients from the intervention centres followed by a telephone call from the patient's diabetes nurse. The nurses who intervened were specially educated in smoking cessation. The control group received a letter containing advice to stop smoking and information about a one-year follow-up. Daily smokers with diabetes mellitus, 30-75 years of age. In the intervention centres 241 patients fulfilled the criteria and in the control centres 171 patients. Self-reported smoking habits after one year. In total, 21% of the smokers accepted group treatment. After 12 months, 20% (42/211) in the intervention centres reported that they had stopped smoking and 7% (10/140) in the control centres; 40% (19/47) of the smokers who had participated in group treatment reported that they had stopped smoking. A computerized record system for patients in primary healthcare was used to identify diabetic patients who were smokers. The selected group was invited to a stop smoking programme. At a one-year follow-up significantly more patients in the intervention centres had stopped smoking compared with patients in the control centres.Scandinavian Journal of Primary Health Care 07/2006; 24(2):75-80. DOI:10.1080/02813430500439395 · 1.61 Impact Factor
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ABSTRACT: Depression is common and disproportionately affects those with chronic medical comorbidity, such as diabetes mellitus (DM). Only a limited amount of information is available concerning the quality of guideline-concordant treatment of depression and its influence on glycemic control among those with DM. This is the first study to address these issues in a veteran population with DM. This is a retrospective cohort study (1997-2005) of veterans with and without DM from the Roudebush Veterans Affairs Medical Center in Indianapolis. Veterans with and without DM and a new episode of depression were identified. Administrative, clinical, and pharmacy data were linked to assess initiation of treatment, follow-up care, antidepressant dosage and duration, and change in antidepressant agent based on the Veterans Health Administration (VHA) clinical practice guidelines for depression. HbA1c levels were assessed following initiation of antidepressant therapy. Treatment of depression was not consistent with guideline recommendations. Only 60% of subjects received treatment within 30-days of the depression diagnosis. Veterans with DM were more likely to have received treatment within the first two weeks than veterans without DM. Few subjects received appropriate follow-up care for depression (<40%) or an adequate duration of antidepressant therapy (<9%), although most (88%) received a dosage consistent with guideline recommendations when treatment was provided. Most subjects (>75%) were treated with a serotonigenic agent and only 23% experienced a change in therapy during the treatment period, almost 84% of which received an adequate trial of therapy prior to the change or augmentation in agent. Presence of DM was associated with significantly increased odds for receipt of guideline-concordant care for depression in most multivariate analyses. Receipt of guideline-concordant care for depression was not a significant predictor of glycemic control but was associated with a clinically meaningful reduction of 0.5% in HbA1c levels. This research demonstrates that under-treatment of depression is common and may influence at least one medical outcome. Findings also support that the relationship between depression and DM is complex and that further research is necessary to help align current practice with evidence-based practices in the VHA.