Cigarette smoking and proteinuria in Taiwanese men with Type 2 diabetes mellitus.
OBJECTIVE
Cigarette smoking is a well-known risk factor associated with diabetic nephropathy. The objective of this study was to further investigate the dose-response effect of tobacco exposure on proteinuria in males with Type 2 diabetes.


METHODS
Five hundred and nine males with Type 2 diabetes were selected from a cohort participating in a glucose control study in Taiwan. Pack-years of cigarette smoking were calculated to define tobacco exposure. Proteinuria was identified if albumin-to-creatinine ratio was > or = 30 mg/g in at least two of three consecutive urine tests. Logistic regression and trend tests were used to delineate the association between smoking status and proteinuria.


RESULTS
Compared with non-smokers, those who had smoked 15-30 or more than 30 pack-years were respectively 2.78 (95% CI 1.34-5.76, P < 0.01) and 3.20 (95% CI 1.74-5.86, P < 0.001) times more likely to develop proteinuria. The dose-response effect of tobacco exposure on the development of proteinuria is highly significant in all subjects (P = 0.001) and in subgroups with relatively short duration of diabetes mellitus (P < 0.001), good blood pressure control (P = 0.001) and those of young age (P = 0.007).


CONCLUSIONS
The current study shows a clear dose-response effect of cigarette smoking on development of proteinuria in male Type 2 diabetic patients. These findings reinforce the urgent need to encourage diabetic patients to stop smoking regardless of age, duration of diabetes mellitus or status of blood pressure control.
Division of Health Policy Research and Development, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.
C C
CC
Hsu
S J
SJ
Hwang
T Y
TY
Tai
T
T
Chen
M C
MC
Huang
S J
SJ
Shin
C P
CP
Wen
Y T
YT
Shih
H J
HJ
Yang
C T
CT
Chang
C J
CJ
Chang
C H
CH
Loh
M T
MT
Fuh
Y S
YS
Li
H-Y
HY
Chang
D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D004305:Dose-Response Relationship, Drug; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000209:etiology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D013624:Taiwan
D006442:Glycated Hemoglobin