The association of smoking status with glycemic control, metabolic profile and diabetic complications- Results of the Australian National Diabetes Audit (ANDA)

N Szwarcbard; M Villani; A Earnest; J Flack; S Andrikopoulos; N Wischer; G Soldatos; D Gasevic; S Zoungas

doi:10.1016/j.jdiacomp.2020.107626

The association of smoking status with glycemic control, metabolic profile and diabetic complications- Results of the Australian National Diabetes Audit (ANDA)

J Diabetes Complications. 2020 Sep;34(9):107626. doi: 10.1016/j.jdiacomp.2020.107626. Epub 2020 May 20.

Authors

N Szwarcbard¹, M Villani², A Earnest¹, J Flack³, S Andrikopoulos⁴, N Wischer⁵, G Soldatos⁶, D Gasevic⁷, S Zoungas⁸

Affiliations

¹ School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
² School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia; Research and Evaluation, Ambulance Victoria, Blackburn, VIC 3130, Australia.
³ Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, Bankstown, NSW 2200, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW,Australia; School of Medicine, Western Sydney University, Sydney, NSW,Australia.
⁴ Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia; Australian Diabetes Society, Sydney, NSW 2000, Australia.
⁵ National Association of Diabetes Centres, Sydney, NSW, 2000, Australia.
⁶ School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia; Diabetes and Vascular Medicine Unit, Monash Health, Clayton, VIC,Australia, 3168.
⁷ School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia; Usher Institute, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, United Kingdom.
⁸ School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia; Diabetes and Vascular Medicine Unit, Monash Health, Clayton, VIC,Australia, 3168. Electronic address: sophia.zoungas@monash.edu.

PMID: 32527672
DOI: 10.1016/j.jdiacomp.2020.107626

Abstract

Background: Tobacco smoking and diabetes mellitus contribute significantly to the overall health burden and mortality of Australians. We aimed to assess the relationship of smoking with glycemic control, metabolic profile and complications in Australian patients living with diabetes.

Methods: We analysed the 2011-2017 biennial Australian National Diabetes Audit cross-sectional data. Patients were classified as current, past or never smokers. Linear (or quantile) and logistic regression models were used to assess for associations.

Results: Data from 15,352 patients were analysed, including 72.2% with type 2 diabetes. Current smokers comprised 13.5% of the study population. Current and past smokers had a median HbA_1c that was 0.49% and 0.14% higher than never smokers, respectively, as well as higher triglyceride and lower HDL levels (all p values < .0001). Compared to never smokers, current smokers had higher odds of severe hypoglycemia and current and past smokers had higher odds of myocardial infarction, stroke, peripheral vascular disease, lower limb amputation, erectile dysfunction and peripheral neuropathy (all p values ≤.001), with no significant change over time.

Conclusion: When compared to never smokers, current and past smokers had poorer glycemic and lipid control and higher odds of macrovascular and microvascular complications. Despite this, current smoking remains prevalent among Australians with diabetes.

Keywords: Complications; Diabetes; HbA(1c); Macrovascular; Microvascular; Smoking.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia / epidemiology
Cross-Sectional Studies
Diabetes Complications* / epidemiology
Diabetes Mellitus, Type 2* / epidemiology
Glycemic Control
Humans
Metabolome
Risk Factors
Smoking* / epidemiology