Smoking is one of the modifiable risk factors for many chronic diseases, such as cardiovascular disease (CVD), cancer, chronic obstructive lung disease, asthma, and diabetes. However, the adverse effects of smoking on diabetes have been generally under recognized. In the guidelines from the Korean Diabetes Association, smoking cessation is recommended as one of the most important steps in preventing the cardiovascular complications of diabetes [1
]. Many studies have shown that the adverse effects of smoking on diabetes mellitus are not only diabetic macrovascular complications but the causal nature of its association with diabetes and the progression of diabetic microvascular complications has yet to be explored.
Although smoking is known to decrease body weight, it is associated with central obesity [2
]. Smoking also increases inflammation and oxidative stress [3
], to directly damage β-cell function [4
] and to impair endothelial function [5
The prevalence of smoking in Korean men is near 50%, which is the highest smoking rate in the Western Pacific region. In addition to obesity, the high prevalence of smoking is one of the major health problems for Korea's public health.
This review is about the various smoking effects on diabetes mellitus, diabetic complications, and diabetic incidence. Understanding the hazardous effects of smoking on diabetes mellitus may lead to more emphasis on smoking prevention and smoking cessation as important strategies in the management of diabetes mellitus.