Data from a prospective study of 87,938 subjects indicated that low to moderate consumption of alcohol is associated with decreased risk of coronary vascular disease in men with diabetes comparable to those without diabetes (52).
There are several prospective cohort studies that suggest smoking is associated with the etiology of diabetes (53). In one study, the relative risk of type 2 diabetes in women smoking > 25 cigarettes per year versus women who never smoked was 1.42 (95 percent CI, 1.18-1.72) (53). It was concluded that this suggested a moderate association between smoking and subsequent development of diabetes (53). In a similar study, the relative risk of type 2 diabetes in men smoking > 25 cigarettes per year versus men who never smoked was 1.94 (95 percent CI, 1.25-3.03) (53). Furthermore, cigarette smoking has been associated with insulin resistance, larger upper-body fat distribution (a marker of insulin resistance), and raised plasma-glucose concentration (53). It has also been associated with blunting the rise of HbA1c (53). Cigarette smoking has been shown to be a significant risk factor for death by coronary artery disease in type 2 diabetes in several studies, including the Multiple Risk Factor Intervention Trial, The Finnish Prospective Study, and the Paris Prospective Study (53). Former smokers are 1.54 times (95 percent CI, 1.49-1.58) more likely to be diagnosed with coronary artery disease (53). Cigarette smoking has also been shown to be an independent predictor for stroke (53). It also appears to heighten the development of macrovascular and microvascular complications, including nephropathy and neuropathy (53). Its association with the development of retinopathy is not well-defined (53).
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