Smoking Makes Diabetes Worse

I can summarize this little article in one quick sentence: Smoking is bad. In the general population, and particularly in patients with diabetes... Smoking is bad.

Cigarette smoking is the leading cause if avoidable death in the United States. Smoking plays a role in one out of every five deaths in the United States per year. Smoking is indeed bad.

Where the health of diabetic smokers is concerned, the statistics are even worse. There is an increased risk of premature death and the development of heart disease in patients who have diabetes and continue to smoke. There is also evidence that links cigarette smoking with microvascular disease (kidney and eye damage) in diabetes. Additionally, there is data that shows that smoking may actually play a role in the development of type 2 diabetes. Smoking is bad.

As a doctor, I think it is extremely important to encourage patients who have diabetes to stop smoking, and certainly not to start this habit. There are certain guidelines set forth by the American Diabetes Association to specifically help doctors deal with the issue of smoking in the diabetic population. The recommendations include:

• A systematic assessment of the patient's smoking history
• Counseling on smoking prevention and cessation
• Assessment of willingness to quit smoking at each visit
• Training on how to effectively deliver smoking cessation systems
• Follow-up to assess and promote quitting

Most doctors I have spoken with agree that encouraging a patient to stop smoking can be frustrating at times. To do it properly, we must constantly nag, remind, and employ various tactics ranging from rationalization (" you know smoking is bad for you, don't you?") to blatant fear (" smoking is clogging up your arteries as we speak"). Patients often take our interest as intrusive and resent being lectured. Unfortunately, many physicians fail to address the issue except in a passing note.

Although I do not have a magic solution for this pervasive problem, I still wanted to highlight this topic in this column because of its serious nature.

If you are a doctor reading this column, I want to encourage you not to give up addressing the smoking issue with your patients. Continue to educate them about the benefits and methods of quitting smoking, especially your patients with diabetes. Arm yourself with material and resources to provide practical answers for your patients and understand that each patient must be approached in a manner based on his or her individual biases and needs.

If you are a patient, I hope that the reality of the danger of smoking is becoming clearer. With diabetes and smoking, 1 plus 1 does not equal 2, but rather 4. The risks for heart disease increase exponentially. Don't be afraid to approach your health care provider for information on quitting and any available resources and/or medications. Your physician is not going to judge you by whether you succeed in quitting or question your motivation for waiting until this particular time to try. Chances are, you will make your doctor's day by inquiring about ways to stop smoking. And, you just might save your life in the process.