[Diabetes and tobacco--a double health hazard]

Smoking is a serious risk factor for cardiovascular disease, retinopathy, and nephropathy in patients with diabetes. Furthermore, epidemiological studies have shown that heavy smokers run an increased prospective risk of developing type 2 diabetes, probably due both to the fact that smoking is a marker for an unhealthy lifestyle and that smoking via nicotine may deteriorate glucose metabolism by negatively influencing insulin sensitivity. In Sweden, data from the National Diabetes Register (NDR) has shown that the prevalence of smoking in type 2 diabetes patients followed in primary health care is almost as high as in the non-diabetic population, at least in middle-aged subjects (about 20%). This alarming situation must be dealt with by using new and effective methods to promote anti-smoking. If support by group sessions can be organised for patients with type 2 diabetes who are smokers, in combination with pharmacological approaches (nicotine, bupropion) it is hoped that the rate of smoking cessation can substantially increase. Such projects are currently under-way within the primary health care in southern Sweden.