title: The Association Between Smoking Tobacco After a Diagnosis of Diabetes and the Prevalence of Diabetic Nephropathy in the Korean Male Population.
abstract: OBJECTIVE
  Smoking is known to be associated with nephropathy in patients with diabetes. The distinct effects of smoking before and after diabetes has been diagnosed, however, are not well characterized. We evaluated the association of cigarette smoking before and after a diagnosis of diabetes with the presence of diabetic nephropathy.
  
  
  METHODS
  We analyzed data from the 2011-2013 editions of the Korea National Health and Nutrition Examination Survey. A total of 629 male patients diagnosed with diabetes were classified as non-smokers (90 patients), former smokers (225 patients), or continuing smokers (314 patients). A "former smoker" was a patient who smoked only before receiving his diagnosis of diabetes. A "continuing smoker" was a patient who smoked at any time after his diabetes had been diagnosed. Diabetic nephropathy was defined as the presence of albuminuria (spot urine albumin/creatinine ratio ≥30 mg/g) or low estimated glomerular filtration rate (<60 mL/min/1.73 m(2)). Multiple logistic regression models were used to assess the independent association after adjusting for age, duration of diabetes, hemoglobin A1c, body mass index, systolic blood pressure, medication for hypertension, and medication for dyslipidemia. Female patients were excluded from the study due to the small proportion of females in the survey who smoked.
  
  
  RESULTS
  Compared to non-smokers, continuing smokers had significantly higher odds ratio ([OR], 2.17; 95% confidence interval [CI], 1.23 to 3.83) of suffering from diabetic nephropathy. The corresponding OR (95% CI) for former smokers was 1.26 (0.70 to 2.29).
  
  
  CONCLUSIONS
  Smoking after diagnosis of diabetes is significantly associated with the presence of diabetic nephropathy in the Korean male population.
authors.affiliation: Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hyungseon
authors.identifier: 0000-0002-8004-8244
authors.initials: H
authors.lastname: Yeom
authors.affiliation: Department of Preventive Medicine, Graduate School of Public Health, Yonsei University, Seoul, Korea.
authors.forename: Jung Hyun
authors.identifier: 0000-0001-7141-4532
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hyeon Chang
authors.identifier: 0000-0001-7867-1240
authors.initials: HC
authors.lastname: Kim
authors.affiliation: Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Il
authors.identifier: 0000-0002-9689-7849
authors.initials: I
authors.lastname: Suh
mesh_terms: D000368:Aged; D000418:Albumins / Q000032:analysis; D044466:Asian People; D001794:Blood Pressure; D015992:Body Mass Index; D003404:Creatinine / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis*; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D016017:Odds Ratio; D015995:Prevalence; D056910:Republic of Korea; D012907:Smoking / Q000009:adverse effects*
chemical_list: D000418:Albumins; D003404:Creatinine; D006442:Glycated Hemoglobin
keywords: Diabetes mellitus; Diabetic nephropathies; Diagnosis; Smoking