Empowering patients living with diabetes mellitus to cease smoking will improve lower limb perfusion

Abstract

Background: To evaluate the effect of smoking on arterial perfusion and to determine whether smoking cessation would result in a significant improvement on the circulation of persons living with type 2 diabetes mellitus (T2DM). Methods: A nonexperimental comparative quantitative research was conducted amongst 32 participants with type 2 diabetes mellitus (T2DM) and controlled hyperlipidemia [smokers (n 1⁄4 11), past smokers (n 1⁄4 11), and non-smokers (n 1⁄4 10); aged 40 & 85 years]. Participants were matched for age, body mass index, estimated glomerular filtration rate, packet years, duration of diabetes mellitus, and glycated hemoglobin levels (HbA1c, %) utilizing frequency distribution matching. Peripheral arterial disease (PAD) was assessed utilizing the toe brachial pressure index (TBPI). TBPI value of 0.7 was suggestive of PAD while >0.7 was considered normal. Results: Sixty-four limbs were included for analyses. One-way ANOVA showed significant difference in the TBPI scores between the three categories (p < 0.05), with the current smokers demonstrating the lowest TBPI means (0.544), followed by past smokers (0.649) and non-smokers having the highest TBPI (0.781). Tukey’s post-hoc analysis confirmed significant difference in TBPI between current and nonsmokers (p 1⁄4 0.024). Linear regression of risk predictors identified packet years as the best predictor (p 1⁄4 0.004), followed by HbA1c (0.019). Conclusions: Results suggest that smoking has a significant effect on PAD in T2DM and that improved perfusion is found in past smokers. Empowering patients to cease smoking will result in better limb perfusion.