| Sumario: | Purpose: This study aimed to examine the effects of smoking on the incidence of macrovascular and microvascular complications in patients with type 2 diabetes. Methods: We analyzed 35,804 patients diagnosed with type 2 diabetes between 2004 and 2017 using the Korean National Health Insurance Service-National Health Screening Cohort (2002-2019). Smoking status was categorized into never, former, and current smokers, with further classification based on duration of smoking and daily smoking amount. We conducted survival analysis using a Cox proportional hazards model. Results: Both former and current smokers had significantly elevated risks of macrovascular complications compared to non-smokers, with hazard ratios (HRs) of 1.60 (95% confidence interval [CI], 1.49- 1.66) and 1.10 (95% CI, 1.08-1.17), respectively. Long-term smokers (over 30 years) had significantly higher risks of both macrovascular (HR, 1.35; 95% CI, 1.29-1.42) and microvascular complications (HR, 1.36; 95% CI, 1.30-1.42). Heavy smokers (over 2 packs/day) had a higher risk of developing macrovascular (HR, 1.46; 95% CI, 1.30-1.64) and microvascular (HR, 1.78; 95% CI, 1.60-1.98) complications than never smokers. Notably, former smokers had increased risks of developing neuropathy (HR, 1.40; 95% CI, 1.31-1.49), nephropathy (HR, 1.27; 95% CI, 1.16-1.39), and retinopathy (HR, 1.49; 95% CI, 1.39-1.60). Conclusion: Patients with type 2 diabetes and a history of smoking are at higher risk of developing macrovascular and microvascular complications. Smoking cessation, along with reducing smoking duration and amount, is crucial for lowering these risks.
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