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.
Hsu
C C
CC
Division of Health Policy Research and Development, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.
Hwang
S J
SJ
Tai
T Y
TY
Chen
T
T
Huang
M C
MC
Shin
S J
SJ
Wen
C P
CP
Shih
Y T
YT
Yang
H J
HJ
Chang
C T
CT
Chang
C J
CJ
Loh
C H
CH
Fuh
M T
MT
Li
Y S
YS
Chang
H-Y
HY
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