Failure to prevent nicotine addition in young people with diabetes.

The habit of smoking is usually acquired at a young age and it is particularly undesirable in individuals with diabetes. A study was carried out to assess objectively the prevalence of smoking in young patients with diabetes and whether younger age at onset of diabetes (implying exposure to health education) reduced the incidence of smoking. Ninety nine young adults with diabetes attending the routine clinic were studied using a structured interview and assay of a urinary nicotine metabolite (cotinine). Forty eight percent of the cohort were smoking (raised urinary cotinine), although only 31% admitted to smoking. Thirty eight percent of the patients with childhood onset diabetes, 56% of the adolescent onset, and 47% of the young adult onset patients were smoking. Smoking was not related to glycaemic control or body mass index. In conclusion, smoking is common in young patients with diabetes and is often denied. Conventional health education does not appear to prevent children and adolescents with diabetes from starting to smoke. Anti-smoking policies and health education must therefore be reinforced and improved.

How accurate is the smoking history in newly diagnosed diabetic patients?

A smoking history was obtained from 94 consecutive newly diagnosed diabetic patients referred to an adult diabetic clinic. The smoking load was measured using urinary cotinine/creatinine ratios (COT/Cr). Fifty-six patients (60%) claimed to be non-smokers, but COT/Cr suggested active smoking in five of these. The patients who admitted to smoking were given standardised anti-smoking advice. At 3 months, 32 smoking patients were reviewed and 21 (66%) claimed to have reduced or stopped smoking. However, the median COT/Cr in the 32 patients showed no significant reduction (11.15 vs. 9.30 micrograms/mg). Urinary COT/Cr indicated that 6 patients had stopped smoking (median COT/Cr 6.98 fell to 0.97 micrograms/mg), but several patients had a marked rise in COT/Cr, demonstrating that their smoking habit had increased considerably. Therefore the smoking history obtained from new diabetic patients can be very misleading. An objective measure of smoking habits in the initial assessment and follow-up of diabetes may be worthwhile. Anti-smoking counselling at diagnosis of diabetes may persuade some smokers to stop.