Smoking and Diabetes Control in Adults With Type 1 and Type 2 Diabetes: A Nationwide Study From the 2018 National Program for Prevention and Control of Diabetes of Iran

Objectives: Smoking is among the top leading causes of morbidity and mortality worldwide. To date, studies on the association between smoking and diabetes complications and metabolic control have shown conflicting results. In this study, we aimed to assess the association of smoking with micro- and macrovascular complications of diabetes and lipid and glycemic indices. Methods: We used the National Program for Prevention and Control of Diabetes of Iran database of 99,651 adult patients with diabetes across Iran. Multiple logistic regression models were used to examine the association between smoking and diabetes complications including cardiovascular disease, neuropathy, nephropathy and retinopathy. This association was adjusted for age, sex, duration of diabetes, glycated hemoglobin (A1C), hypertension, hyperlipidemia, medication, obesity and type of diabetes. Results: Smoking was associated with cardiovascular disease, nephropathy, retinopathy and neuropathy (odds ratios ORs for patients with type 1 diabetes were 1.51, 2.29, 2.70 and 2.40, respectively; for patients with type 2 diabetes, ORs were 1.27, 1.21, 1.51 and 1.70, respectively; all with p values <0.001). Among patients with type 1 diabetes, smoking was significantly (p<0.05) associated with A1C (OR, 2.12), 2-h postglucose level (OR, 1.30), triglycerides (OR, 1.48) and high-density lipoprotein (HDL) control (OR, 1.34). Among patients with type 2 diabetes, smoking was significantly associated with A1C (OR, 1.09) and HDL control (OR, 1.21). Conclusions: Smoking was associated with multiple diabetes complications including cardiovascular disease, neuropathy, nephropathy and retinopathy and worse A1C and HDL control in both patients with type 1 and type 2 diabetes. It was also associated with worse 2-h postglucose level and triglyceride control among patients with type 1 diabetes. Our findings signify that national programs for smoking prevention and cessation may be beneficial to diabetes control in Iran. © 2019 Canadian Diabetes Associatio

Determinants of glycemic control: Phase 2 analysis from nationwide diabetes report of National Program for Prevention and Control of Diabetes (NPPCD-2018)

Background: Diabetes is one of the leading causes of morbidity and mortality worldwide, especially among middle and low income nations. Many diabetic complications and comorbidities are attributable to poor glycemic control. The aim of this study was to update and extend the national diabetes reports on the status of comorbidities, diabetes care and complications in Iran. Moreover, we investigated the risk factors of poor glycemic control in the Iranian population. Methods: National database of 99,651 patients with diabetes who attended university-affiliated clinics between April 1, 2017 and February 30, 2018 was used to carry out a cross-sectional study. Stepwise backward selection logistic regression model was used to examine the associated factors of glycemic control. Results: In this study 73.0 and 56.5 of the enrolled population with diabetes, had hypertension and hyperlipidemia, respectively. The prevalence of patients who received education for nutrition therapy or diabetes self-management was 16.3 and 23.3 respectively. Poor glycemic control was associated with male gender (OR = 1.06, p = 0.001), obesity (OR = 1.03, p = 0.05), duration of diabetes (OR = 1.018, p < 0.001), smoking (OR = 1.08, p = 0.041), hypertension (OR = 1.53, p < 0.001), hyperlipidemia (OR = 1.15, p < 0.001), insulin therapy (OR = 1.26, p < 0.001) and combination of insulin and oral anti-diabetic agents compared to oral anti-diabetic agents alone (OR = 2.36, p < 0.001). Conclusion: We demonstrated that the prevalence of diabetes comorbidities is high in Iranian population and that a great proportion of Iranian patients with diabetes had not reached the goal of glycemic control. Our findings provide a starting point from which to investigate the obstacles that prevent patients with diabetes from reaching metabolic targets. © 2019 Primary Care Diabetes Europ