Smoking and Metabolic Control in Adolescents with Type 1 Diabetes

• Published in: The Journal of pediatrics Vol. 154; no. 1; pp. 20 - 23.e1
• Main Authors: Hofer, Sabine E., MD, Rosenbauer, Joachim, MD, PhD, Grulich-Henn, Juergen, MD, Naeke, Andrea, MD, Fröhlich-Reiterer, Elke, MD, Holl, Reinhard W., MD, PhD
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Mosby, Inc 2009; Elsevier
• Subjects: Adolescent; Austria - epidemiology; Biological and medical sciences; Body Mass Index; Cardiovascular Diseases - blood; Cardiovascular Diseases - epidemiology; Child; Comorbidity; Diabetes Mellitus, Type 1 - epidemiology; Diabetes. Impaired glucose tolerance; Diabetic Angiopathies - blood; Diabetic Angiopathies - epidemiology; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; General aspects; Germany - epidemiology; Glycated Hemoglobin A - analysis; Humans; Male; Medical sciences; Multivariate Analysis; Pediatrics; Prevalence; Risk Factors; Smoking - blood; Smoking - epidemiology; Tobacco, tobacco smoking; Toxicology; Young Adult; Body mass index; HDL; BMI-SDS; High-density lipoprotein; Body mass index standard deviation score; BMI; Endocrinopathy; Human; Immunopathology; Pediatrics; Tobacco; Surveillance; Type 1 diabetes; Adolescent; Tobacco smoking; Check; Autoimmune disease; Metabolism
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2008.07.052

Objective To relate self-reported smoking frequency to metabolic control and other cardiovascular risk factors in adolescents with type 1 diabetes. Study design In the multicenter Diabetes Patienten Verlaufsdokumentationssystem database from Germany and Austria, anonymized records on 27 561 patients < 20 years of age with documented smoking status were available for analysis. Results Self-reported smoking was negligible in patients younger than 11 years (0.1%), increasing to 5% in 11- to 15-year-old patients, and 28.4% in the 15- to 20-year-old age group. Multivariate analysis with adjustment for age, diabetes duration, sex, insulin therapy, and center differences, revealed that smokers had higher HbA1c-levels compared with non-smokers (9.1% vs 8.0%, P < .0001). Diastolic blood pressure was higher (68.2 vs 67.6 mm Hg, P < .0001), and the lipid profile was unfavorable in patients who smoke: Triglycerides and total cholesterol were higher and high-density lipoprotein–cholesterol was lower (all P < .0001). Conclusions Smokers display significantly worse metabolic control and a higher cardiovascular risk profile. Although not attested in trials, we state that education about smoking, smoking prevention, and psychological help for smoking cessation should be an integral part of comprehensive pediatric care for adolescent patients with type 1 diabetes.