Årets Diabetologiska Avhandling utvald av Svensk Förening för Diabetologi 1996 - Thesis of the Year 1996

Avhandlingen baseras på följande delarbeten:

I. Axelsen M, Eliasson B, Joheim T, Lenner R, Taskinen M-R, Smith U. Lipid intolerance in smokers. J Intern Med 1995;237:449-55.

II. Eliasson B, Attvall S, Taskinen MR, Smith U. The insulin resistance syndrome in smokers is related to smoking habits. Arterioscler Thromb 1994;14:1946-50.

III. Eliasson B, Mero N, Taskinen M-R, Smith U. The insulin resistance syndrome and postprandial lipid abnormalities in smokers. Atherosclerosis 1997;129:79-88.

IV. Eliasson B, Attvall S, Taskinen M-R, Smith U. Smoking cessation improves insulin sensitivity in healthy middle-aged men. Eur J Clin Invest 1997;27:450-6.

V. Eliasson B, Taskinen M-R, Smith U. Long-term users of nicotine gum are hyperinsulinemic and insulin resistant. Circulation 1996;94:878-81.

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Abstract

Eliasson B. 1996. The insulin resistance syndrome in smokers. Pages 1-65. The Lundberg Laboratory for Diabetes Research, Department of Medicine, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden

Cigarette smoking is a major risk factor for cardiovascular disease and recent findings have also linked smoking with NIDDM. Since these conditions are associated with insulin resistance and the insulin resistance syndrome (IRS), this study was performed to examine the metabolic effects of smoking and long-term use of smoke-free nicotine.
   Matched groups of healthy, middle-aged men participated (38 non-smokers, 75 habitual smokers and 20 long-term users of nicotine-containing chewing gum, respectively). Anthropometric data, blood pressure, blood glucose, insulin and C-peptide levels were determined as well as lipoproteins, plasminogen activator inhibitor 1 (PAI-1) activity and fibrinogen. Lipoprotein and hepatic lipase activities in plasma were measured before and after an intravenous bolus of heparin. Postprandial triglyceride elimination was examined after a mixed testmeal. The euglycemic hyperinsulinemic clamp technique was utilized to determine degree of insulin sensitivity.
   Smokers were found to exhibit insulin resistance, postprandial lipid intolerance and other manifestations of IRS compared with the non-smoking control subjects. Smoking habits correlated positively with degree of insulin resistance as well as various aspects of IRS. Smoking cessation also improved insulin resistance and IRS in spite of a concomitant increase in body weight. Long-term users of nicotine-containing chewing gum also exhibited insulin resistance and IRS. Again, the degree of insulin resistance was related to the nicotine consumption habits.
   Thus, cigarette smokers are characterized by several aberrations in glucose and lipoprotein metabolism, linking smoking with IRS and the increased risk for cardiovascular disease and NIDDM. The nicotine in cigarette smoke seems to be a major factor for eliciting these abnormalities.

Keywords: smoking, nicotine, insulin resistance, insulin, lipoproteins, PAI-1, fibrinogen

ISBN 91-628-1884-8