Sweet Drag

T.V. Jayan on a new study that confirms that nicotine worsens diabetes-related complications

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If you are diabetic and also enjoy your smoke, it’s a double whammy for you. Diabetic smokers will find it difficult to stave off complications associated with rising blood sugar levels, new research has shown.

The study — by Xian-Chuan Liu, a researcher at the California State Polytechnic University in the US — is the first to establish a strong link between smoking and diabetes-related complications. The work was presented at the 241st annual meeting of the American Chemical Society in Anaheim yesterday. “If you’re a smoker and have diabetes, you should be concerned and make every effort to quit smoking,” says Liu.

Though cigarette smoking is a major health risk factor that significantly increases your chances of heart disease, cancer, and acute and chronic respiratory tract infection, it was hardly implicated in the development of diabetes till very recently. One study in the recent past, however, showed that smokers may be nearly 50 per cent more vulnerable to developing type 2 diabetes than non-smokers. Similarly, children born to smoking mothers will have impaired production of insulin, the hormone required to regulate glucose uptake by cells, and thus may develop type 1 diabetes.

The new study has gone a step further to show that smoking worsens the complications associated with diabetes and how this really happens. Some of the complications linked to diabetes are heart attack, stroke, kidney failure and nerve damage.

According to the Brussels-based International Diabetes Federation, more than 300 million people around the world suffer from diabetes. The figure is expected to reach close to 500 million by 2030.

The study is particularly significant for India, where a large number of diabetics are also smokers. It is estimated that there are more than 50 million diabetics in the country. A study published in the New England Journal of Medicine in 2008 showed that India is home to more than 120 million smokers.

Though doctors have known for years that smoking increases the risk of developing diabetes-related complications, they haven’t been able to pinpoint the exact substance in cigarette smoke responsible for this. Liu and his colleagues suspected it may be nicotine, the chemical that makes smoking addictive.

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As diabetes has no cure yet, the only way to ward off complications is to maintain the required blood sugar levels through medicine and lifestyle modification. The gold standard for monitoring long-term blood sugar levels in diabetics is a blood test called the haemoglobin A1c (HbA1c).

The premise for the HbA1c test is as follows. The haemoglobin in red blood cells reacts with glucose molecules to form what is called glycated haemoglobin. In individuals with poorly controlled diabetes, the quantities of these glycated haemoglobins are much higher than in healthy people. Hence, the number of glycated haemoglobins in one’s blood gives a fairly accurate measure of glucose levels in blood.

Used often in conjunction with regular blood sugar monitoring, the HbA1c test reveals the average amount of sugar in blood during a period of up to three months. High HbA1c test results mean that the condition is not well controlled and there is an increased risk of chronic complications.

To explore their theory that nicotine has a role, the scientists set out to check how the chemical influences HbA1c. Using human blood samples, they showed that concentrations of nicotine similar to those found in the blood of smokers did, indeed, raise levels of HbA1c.

Nicotine caused HbA1c levels to rise by as much as 34 per cent,” Liu told Knowhow. In moderate smokers, the increase was about 10 per cent.

“This looks like an important finding. We had so far thought that nicotine had no influence on diabetes-related complications,” says Balbir Singh, cardiologist at Medanta, a private hospital in Gurgaon.

High blood sugar or not, it doesn’t matter. Stub out that cigarette in any case.

Source: The Telegraph ( Kolkata, India)

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