Teen Smoking: Gateway to Kidney Disease

| Jul 1, 1998

In addition to the host of health risks that smoking presents to all people, studies have shown that adult type 1 smokers are at increased risk to develop macrovascular and microvascular diabetic complications, especially retinopathy and nephropathy. A recent study from Germany shows that markers of microvascular complications are also found in teen smokers with type 1 diabetes.

Despite the extra risks of microvascular complications, studies have shown that as many as 27 percent of adults with type 1 diabetes smoke. This could be an underestimate, however, as studies on smoking prevalence have been hampered by the lack of reliable data. Many tend to deny that they smoke or do not adequately report their smoking habits. This failure to report is especially true for adolescents. In a recent study of diabetic teens, only two of seven smoking teens admitted to smoking.

German researchers at the University of Ulm used a measurement of cotinine, a reliable marker of nicotine use found in the urine, to identify teens with type 1 diabetes who smoke. Of the 238 teens studied, 46 fit the definition of a regular smoker based on their cotinine levels, and 26 had cotinine levels indicative of infrequent smoking or environmental exposure to nicotine.

The study, published in the May issue of Diabetes Care, found that "Even if the majority of subjects in our study excreted albumin within the normal range, urinary albumin was significantly higher in smoking compared with nonsmoking subjects." Albumin in the urine is generally accepted as a marker of nephropathy.

The researchers found that smoking status appeared to have no effect on long-term glycemic control as measured by HbA1c. In addition, boys were found to be more likely to be smokers, and smokers tended to be shorter and have higher body mass indexes than nonsmokers. The authors provided no definitive explanation for these differences.

The authors advise that physicians discuss the effects of nicotine on the development of nephropathy in their adolescent type 1 patients in particular because most smokers tend to start during this time period. They also suggest that cotinine testing could help identify regular smokers and those passively exposed to nicotine to better target antismoking information.

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Categories: A1c Test, Adolescent Boys, Adolescent Girls, Diabetes, Kidney Care (Nephropathy), Smoking, Type 1 Issues

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