Diabetes and tobacco: fatal combination

There is no doubt that smoking is very harmful for our health. Or as the warnings on the cigarette packets say, smoking kills. In fact, smoking is, as many studies have shown, the first risk factor for premature death. A risk that is even greater in people who, as a result of a chronic disease, already have depleted their health. This is the case, among other pathologies, of HIV infection, in which smoking shortens life expectancy more than the virus itself. And also, diabetes. Not surprisingly, a study conducted by researchers at University of Colorado Denver shows that the risk of dying from any cause in the already high smoking population even doubles in The case of diabetes.

As explained by Kavita Garg, director of this research presented at the 2016 Annual Meeting of the Radiological Society of North America (RSNA) in Chicago, “in our work we have found a statistically significant association between diabetes and all-cause mortality, deaths from non-localized lung tumors, and deaths from lung cancer among the female population”.

The study aimed to evaluate possible impact of smoking on all-cause mortality, lung cancer or any other type of cancer disease in the population with diabetes. To that end, the authors analyzed the medical records of 53,454 adults, 5,137 of them diagnosed with diabetes, who had participated in the National Lung Screening Trial (NLST), a study performed to compare the efficacy of computed tomography low dose and chest radiography in the early detection of lung cancer in smoking and ex-smoker population.

During the follow-up period of the study, a total of 3,963 deaths were recorded – 680 among participants with diabetes – of which 1,021 were caused by lung cancer and 826 by tumors located in other organs.

The results showed that diabetes by itself is associated with a risk of up to two increased mortality from any cause, as well as a tumor not located in the lung, in the smoking population. An increase in risk is also independent of, among other factors, age, sex, body mass index (BMI) and number of cigarettes smoked per year.

As Kavita Garg points out, “the results show that diabetes doubles the risk of death from any cause or cancer other than lung cancer in the smoking population. We also found that women with diabetes have an increased risk of dying from lung cancer. An effect associated with diabetes which, however, was not observed in the case of males”.

In short, it seems that the smoking habit is a greater harm, if possible, for the diabetic population. A harmful effect, if not fatal, that seemed to ignore the participants in the study. Not surprisingly, the average number of packs smoked per year was higher in patients with diabetes than in those who did not have this metabolic disease.

Then, given that they were older and smoked more, is the increased mortality associated with diabetes explained by increased cumulative consumption of cigarettes by participants with the disease? The truth is that, as the authors themselves acknowledge, it is not yet known. In any case, Kavita Garg concludes, “it is critical that patients take part in controlling their diabetes and that they undergo lung screening if they are smokers”.