July 2003
Tobacco is harmful to health and is of particular danger to people with diabetes. All late complications of diabetes such as cardiovascular disease, foot problems, kidney and eye disease are worsened by smoking. Smoking cessation has immediate positive effects, however it is made difficult by tobacco dependence and by all forms of advertising and promotion used by the tobacco industry.
IDF’s position is that
- People with diabetes should not smoke.
- Smoking cessation should be included in all diabetes management and educational programmes. Discussion of the dangers of smoking should be done in consultations, in all educational programmes, and by diabetes organizations.
- Tobacco control should be included in all health programmes at national, regional and international levels.
When diabetes is already present, smoking increases the incidence, mortality and morbidity from cardio and cerebrovascular complications (myocardial infarction and stroke), diabetic foot problems, diabetic eye disease and diabetic kidney disease. Studies show that smoking shortens life on an average by 5 to 10 years, however this could be even more in people with diabetes. The importance of passive smoking for health has been emphasized, particularly for children.
Although smoking cessation has immediate positive effects and reduces the risks of cardio and cerebrovascular disease even more than the risk of cancer, smoking cessation is made difficult by a number of factors.
- Cigarettes and some other products containing tobacco are highly engineered so as to create and maintain dependence to nicotine. It is not nicotine itself which is the most dangerous agent of smoking, but the many compounds that these products contain and the smoke they produce that cause most of the damage: they are pharmacologically active, toxic, mutagenic and carcinogenic.
- The tobacco industry’s artful marketing, advertising and promotion, particularly towards adolescents, are another obstacle to worldwide smoking cessation. In fact, we even witness an escalation in smoking and other forms of tobacco consumption by children and adolescents worldwide, and particularly smoking at increasingly early ages. Furthermore in many cultures smoking is not common among women. However strong marketing forces are trying with success to change this, as there is an increase in smoking and other forms of tobacco consumption by women and young girls worldwide.
- The large economic interest in tobacco cultivation and cigarettes production, due to the increase in the worldwide consumption, particularly in developing countries is another main obstacle to worldwide smoking cessation.
IDF recommends that
- Non-Smoking should be recognized as an important part of diabetes management, and be included in all diabetes management and educational programmes. Discussion of smoking dangers should be done in healthcare facilities, in all educational institutions, in workplaces and sporting environments, and by diabetes organizations. The many educational methods developed for smoking cessation should be used, in addition pharmacological support may be useful (nicotine, psychotropic drugs).
- National and international efforts to limit tobacco utilization should be fully supported. In this respect, IDF welcomes the World Health Organization (WHO) Framework Convention on Tobacco Control, which was ratified by the World Health Assembly in May 2003.
- Particular emphasis should be given to efforts to prevent young people from starting to smoke. IDF welcomes all initiatives at all levels that oppose the existing marketing forces, which address particularly new consumers such as children, adolescents, and women in certain cultures.
WHO Framework Convention on Tobacco Control, WHO, May 2003.
• Haire-Joshu D, Glasgow RE, Tibbs TL. Smoking and Diabetes. Diabetes Care 1999, 22 :1887-98.
Source: International Diabetes Federation