Impact of smoking on diabetes complications: a secondary analysis of the Korean National Health Insurance Service-health screening cohort (2002–2019)
- Author:
Seonmi YEOM
1
;
Youngran YANG
Author Information
- Publication Type:Research Paper
- From:Journal of Korean Academy of Nursing 2025;55(2):222-235
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:This study aimed to examine the effects of smoking on the incidence of macrovascular and microvascular complications in patients with type 2 diabetes.
Methods:We analyzed 35,804 patients diagnosed with type 2 diabetes between 2004 and 2017 using the Korean National Health Insurance Service–National Health Screening Cohort (2002–2019). Smoking status was categorized into never, former, and current smoking, with further classification based on duration of smoking and daily smoking amount. We conducted survival analysis using a Cox proportional hazards model.
Results:Both former and current smokers had significantly elevated risks of macrovascular complications compared to non-smokers, with hazard ratios (HRs) of 1.60 (95% confidence interval [CI], 1.49–1.66) and 1.10 (95% CI, 1.08–1.17), respectively. Long-term smokers (over 30 years) had significantly higher risks of both macrovascular (HR, 1.35; 95% CI, 1.29–1.42) and microvascular complications (HR, 1.36; 95% CI, 1.30–1.42). Heavy smokers (over 2 packs/day) more frequently developed macrovascular (HR, 1.46; 95% CI, 1.30–1.64) and microvascular (HR, 1.78; 95% CI, 1.60–1.98) complications than never smokers. Notably, former smokers had increased risks of developing neuropathy (HR, 1.40; 95% CI, 1.31–1.49), nephropathy (HR, 1.27; 95% CI, 1.16–1.39), and retinopathy (HR, 1.49; 95% CI, 1.39–1.60).
Conclusion:Patients with type 2 diabetes and a history of smoking are at higher risk of developing macrovascular and microvascular complications. Smoking cessation, along with reducing smoking duration and amount, is crucial for lowering these risks.
