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Title: Cigarette smoking and insulin resistance in patients with noninsulin- dependent diabetes mellitus
Authors: Targher, Giovanni
Alberiche, Maria 
Zenere, Marina B.
Bonadonna, Riccardo C.
Muggeo, Michele
Bonora, Enzo
UNESCO Clasification: 32 Ciencias médicas
320502 Endocrinología
320602 Metabolismo energético
Keywords: Cigarettes
Diabetes mellitus
Issue Date: 1997
Journal: Journal of Clinical Endocrinology and Metabolism 
Abstract: To evaluate the effects of chronic cigarette smoking on insulin sensitivity in patients with noninsulin-dependent diabetes mellitus (NIDDM), we examined 28 smokers and 12 nonsmokers with NIDDM, of similar sex, age, body mass index, waist/hip ratio, alcohol consumption, physical activity level, glycometabolic control, diabetes duration, and treatment. Insulin and C-peptide responses to oral glucose load were significantly higher in smokers than nonsmokers, whereas glucose levels were not substantially different. During insulin clamp (20 mU/min.m2), carried out in combination with tritiated glucose infusion and indirect calorimetry, total glucose disposal was markedly reduced in smokers vs. nonsmokers [19 +/- 1.2 vs. 33 +/- 5 mumol/ fat-free mass (FFM); P < 0.001], in a dose-dependent fashion (F = 6.8, P < 0.001 by ANOVA when subjects were categorized for number of cigarettes smoked per day). Oxidative (9 +/- 1 vs. 14 +/- 2 mumol/ FFM; P < 0.01) and nonoxidative (10 +/- 1 vs. 19 +/- 4 mumol/ FFM; P < 0.01) pathways of insulin-mediated intracellular glucose metabolism were similarly reduced in smokers vs. nonsmokers. Plasma free fatty acid levels (240 +/- 33 vs. 130 +/- 23 microEq/L; P < 0.05) and lipid oxidation rate (1.39 +/- 0.1 vs. 0.95 +/- 0.2 mumol/ FFM; P < 0.05) were less suppressed by hyperinsulinemia in smokers than nonsmokers. In conclusion, chronic cigarette smoking seems to markedly aggravate insulin resistance in patients with NIDDM.
ISSN: 0021-972X
DOI: 10.1210/jcem.82.11.4351
Source: Journal of Clinical Endocrinology and Metabolism[ISSN 0021-972X],v. 82(11), p. 3619-3624 (Noviembre 1997)
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