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Question #828

Mr. Carlson is a 52-year-old Caucasian grocery store manager you saw last week for a new patient visit. His labs from that visit were significant for elevated random plasma glucose 166 mg/dL, A1C 7.4% and elevated lipids (TG=175 mg/dL, LDL 148 mg/dL, HDL 38 mg/dL, total cholesterol 221 mg/dL). He has returned to your clinic for a follow-up appointment. His physical exam is notable for central abdominal obesity (waist circumference 42”), left eyelid xanthelasma, BP 147/91, HR 72, RR 18, BMI 36 kg/m2, but otherwise normal. A repeat A1C test shows A1C 7.6%. Mr. Carlson smokes between 1 and 1.5 packs of cigarettes daily. After discussing the labs and your findings with Mr. Carlson, you begin collaborating on a management plan. You write prescriptions for metformin, a statin and ACE inhibitor. Mr. Carlson doesn’t think “taking medication will be too tough,” but expresses skepticism about your recommendations for a change in his diet, exercise and smoking programs because he has tried them, without success, in the past.

You are concerned about Mr. Carlson’s cigarette use because cigarette smoking has been shown to have multiple physiological impacts on health. Which one of the following statements regarding smoking and type 2 diabetes is true?

Correct

Answer. B. In individuals with diabetes, it causes more rapid progression to micro- and macroalbuminuria.

Smoking cessation support for patients with diabetes is important and should be given high priority. In patients with diabetes, smoking is an independent risk factor for developing macrovascular and microvascular complications. In addition to being an independent risk factor, smoking causes more rapid progression to micro- and macroalbuminuria. Overall mortality is higher in smokers who have diabetes when compared to the non-diabetic smoking population. Studies suggest that smoking may induce diabetes and smoking has been shown to worsen glycemic control and insulin resistance. There are a variety of medications that can be used to help patients with diabetes stop smoking. Bupropion is one of them.

Reference(s):
Sherman J. The impact of smoking and quitting smoking on patients with diabetes. Diabetes Spectrum. Oct. 2005; 18(4):202-208.

Incorrect