Diabetic Kids Are Smoking -- and Docs Aren't Addressing the Issue

Despite the fact that cigarette smoking is widespread among children and young adults with diabetes, few health care providers are counseling children and young adults with diabetes to not smoke or stop smoking, according to a new report published in the Journal of Pediatrics.

Children and young adults with diabetes are already at high risk for heart disease before starting smoking, but few studies have examined the association between cigarette smoking and heart disease risk factors in youth with diabetes.

This study, which was funded by the CDC and the National Institute of Diabetes and Digestive Kidney Diseases, examined tobacco use and heart disease risk factors in a racially and ethnically diverse group of 3,466 children and young adults with diabetes aged 10 to 22 years old across the US. The researchers, led by Kristi Reynolds, PhD, MPH, of the Kaiser Permanente Southern California Department of Research and Evaluation, found that 10% of youth with type 1 diabetes and 16% of youth with type 2 diabetes were currently using some form of tobacco products, such as cigarettes, cigars or smokeless tobacco. Less than half of the youth reported that they had been counseled by their health care provider to not smoke or stop smoking.

“We found a substantial proportion of youth with diabetes are current cigarette smokers, which greatly adds to their already elevated risk for heart disease,” said Reynolds in a statement. “Aggressive smoking prevention and cessation programs are needed to prevent or delay heart disease in youth with diabetes.”

These findings were based on analysis of data from the SEARCH for Diabetes in Youth Study, a large multi-center study of youth diagnosed with diabetes before the age of 20 who were enrolled by six clinical centers in California, Colorado, Hawaii, Ohio, South Carolina and Washington.

The study found the prevalence of current cigarette smoking in youth with type 1 diabetes to be 1.3% of 10- to 14-year-olds, 14.9% of 15- to 19-year-olds, and 27% of those 20 years and older. Among youth with type 2 diabetes, 4.4% of 10- to 14-year-olds were currently cigarette smokers, 12.9% of 15- to 19-year-olds were cigarette smokers, and 37.3% in youth 20 years and older were cigarette smokers.

Researchers also detected early signs of heart disease among those using cigarette products. Youth who were past and current smokers had a higher prevalence of high triglyceride levels, high LDL cholesterol levels, low HDL cholesterol levels and more physical inactivity than non-smokers.

“Cigarette smoking is a completely preventable risk factor for cardiovascular and other diseases. While this is true for all children, it is especially true for children with diabetes because of the increased risk of cardiovascular disease in that population,” said study co-author Stephen R. Daniels, MD, PhD, of the University of Colorado School of Medicine.

In adults with diabetes, the risk of heart disease is greatly increased compared with adults without diabetes, and smoking may increase that risk. About 90% of adult smokers started smoking before age 18. Because of the already increased risk of cardiovascular disease in individuals with diabetes mellitus, the American Diabetes Association emphasizes the importance of smoking cessation for those individuals.

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