Should diabetics be advised not to smoke? A review of the epidemiological evidence

Doxazosin therapy in the treatment of diabetic hypertension

The incidence of cardiovascular disease in non-insulin-dependent diabetes mellitus (NIDDM) has not been reduced by the control of hyperglycemia alone. Hypertension and dyslipidemia may be the major determinants of macrovascular disease in these patients. With the high prevalence of hypertension in NIDDM, antihypertensive drugs are likely to be important determinants of an atherogenic lipid profile. To date, there is no completed major randomized controlled trial of antihypertensive treatment outcome in a diabetic population, and as such, drug choice for the treatment of diabetic hypertension is often based on evidence extrapolated from studies in nondiabetic groups. However, two short-term studies have assessed the effects of doxazosin antihypertensive therapy in subjects with NIDDM. Both studies showed that the significant reduction in blood pressure with doxazosin treatment was associated with favorable effects on the serum lipid profile. In one study, contrasting adverse effects of atenolol treatment on glycemic control, lipids, and lipoproteins were observed. Doxazosin therapy was associated with a trend toward correcting the disturbances of lipoprotein metabolism characteristic of NIDDM. These metabolic effects, combined with effective lowering of blood pressure by doxazosin, may be important determinants of cardiovascular disease in the long term.

Association between connective tissue changes and smoking habit in type 2 diabetes and in non-diabetic humans

Two hundred type 2 (non-insulin-dependent) diabetic patients and 170 non-diabetic age- and sex-matched normotensive controls were examined for limited joint mobility (LJM) and Dupuytren's contracture (DC), and their smoking history was documented. The prevalences of LJM and DC were not significantly different in diabetic and control subjects (LJM: odds ratio 1.58, 95% CI 0.99 to 2.50; DC: odds ratio 1.34, CI 0.81 to 2.23). Cigarette smoking was positively associated with both LJM and DC in the diabetic patients (LJM: relative risk (R) = 1.96, 95% CI 1.10 to 3.49; DC: R = 2.88, CI 1.29 to 6.43) and in the control group (LJM: R = 2.22, CI 1.70 to 5.86; DC: R = 2.71, CI 1.23 to 5.89). Limited joint mobility and Dupuytren's contracture are both associated with cigarette smoking in type 2 diabetic patients and in age-matched non-diabetic subjects. This suggests that type 2 diabetes is only one of a number of factors which promote the development of these connective tissue changes.