Link Found Between Smoking and Diabetic Neuropathy
Researchers have found a link between smoking and diabetic neuropathy. A study found that 62 percent of patients with diabetic neuropathy smoked cigarettes compared with 33 percent of patients who didn’t smoke.
Patients were entered into the study if they scored greater than 12 on the self-completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale, self-reported nerve pain, or were treated at hospitals with neuropathic pain as noted in hospital charts.
The participants in the study then underwent a clinical evaluation to determine whether their pain was truly part of the neuropathic pain complex. Their current smoking habits were also determined; about 13% of the patients smoked. The researchers found that the 13% of smokers in the study made up 21% of the patients who were suffering from neuropathic pain.
“When a smoker comes into your office and complains of diabetic neuropathy, it may be a good teaching moment,” commented Rollin Gallagher, M.D., a clinical professor of psychiatry and anesthesiology at the University of Pennsylvania.
He said it is a good time to outline for the patient how smoking and diabetes both cause insult to the nerves, especially the long nerves of the legs and arms.
“It is not clear exactly why smoking appears to increase the risk of diabetic neuropathy,” said Toby Weingarten, M.D., a co-author of the study with Todd Call, M.D. and a Mayo colleague. He said some doctors believe that smoking causes some sort of ischemic injury secondary to diabetes in exacerbating the pain.
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Did the good doctors ask the simple question of which came first, the diabetes or the smoking? Did they account for weight, diet and exercise history? This seems like a very cheap association…
This is almost the medical equivalent of announcing the fall of Fort Sumter or the signing of the Declaration of Independence. That is not to say that it is unimportant information, but only that it was “news” a very long time ago. In “the good doctors”’s defense, however, they did contribute something useful, in that they performed tests to discriminate between pains that were due to neuropathy and symptoms that might be confused with neuropathy.
Argus Panoply raises some very important questions and one that is minor.
Starting with the latter, most people who smoke start early, whereas most people who have diabetes developed it later. Hence, on average, smoking begins well before diabetes. Since diabetes does not cause smoking, and smoking is not strongly associated with development of diabetes, this criticism is fairly weak. On the other hand, there is a strong association between smoking and other unhealthy lifestyles and between unhealthy lifestyles and the development of the (overwhelmingly) most common form of diabetes (type 2), which is more important than the question of “which came first?” Diet and exercise histories are, of course, major components of lifestyle. There is some evidence that exercise may prevent or reverse neuropathy. For diet, even small amounts of alcohol seem to greatly increase the risk of neuropathy, and the association between tobacco and ethanol use is well-known, both popularly and in the medical literature.