Smoking and Metabolic Control in Adolescents with Type 1 Diabetes
Received 26 November 2007; received in revised form 21 May 2008; accepted 24 July 2008. published online 22 September 2008.
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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.
aDepartment of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
bDepartment of Pediatrics, Medical University of Graz, Graz, Austria
cInstitute of Biometrics and Epidemiology, German Diabetes Center at Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
dDepartment of Pediatrics, Medical University of Heidelberg, Heidelberg, Germany
eDepartment of Pediatrics, University of Dresden, Dresden, Germany
fInstitute of Epidemiology, University of Ulm, Ulm, Germany
Reprint requests: Dr. Sabine Hofer, Medical University of Innsbruck, Department of Pediatrics, Anichstrasse 35, A-6020 Innsbruck, Austria
The DPV initiative is financially supported by the German Ministry of Health, the German Diabetes Foundation, the German Diabetes Association, the National Action Forum against Diabetes mellitus (NAFDM), the Dr. Bürger-Büsing Foundation, the German Medical Association (BÄK), and Novo Nordisk Germany. The authors declare no conflicts of interest.
ABSTRACT