Cutaneous Complications in Type 1 Diabetes: Influence of Smoking

OBJECTIVE: Type 1 diabetes mellitus (T1DM) often presents with various skin complications, which may be worsened by smoking due to its vascular and metabolic effects. This study aimed to evaluate the influence of smoking on cutaneous manifestations and compare the demographic and clinical characteristics of smokers and non-smokers with T1DM. METHODOLOGY: This cross-sectional study was performed at multiple secondary care hospitals and primary care centers. The duration of the study was about six months from November 1, 2024, to April 30, 2025. This study included 220 patients with confirmed T1DM, categorized into two groups based on smoking status: Group A included current smokers (n = 110), while Group B comprised non-smokers (n = 110). Data were collected through clinical examinations and structured questionnaires, including demographic details, lifestyle factors, physiological parameters, and dermatological findings. Statistical analysis was applied using the chi-square test and a Mann-Whitney test, with p < 0.05 reflecting statistical significance. RESULTS: The findings of the study showed that the smokers had a significantly lower mean height (66.17 ± 10.71 inches), BMI (21.18 ± 5.61 kg/m²), respiratory rate (17.34 ± 5.89 cycles/min), and oral glucose tolerance test (OGTT) values (223.26 ± 75.21 mg/dL) compared to non-smokers (p < 0.05). Most smokers were male, 81 (73.6%), whereas the majority of non-smokers were female, 85 (77.3%) (p < 0.001). Regarding cutaneous manifestations, xerosis fissured skin (59, 53.6%) and bullae (33, 30.0%) were significantly more prevalent in smokers, while ichthyosis (26, 23.6%) and diabetic rubeosis (17, 15.5%) were more frequent among non-smokers (p < 0.05). CONCLUSION: This study concluded that smoking significantly affects the pattern of skin manifestations in patients with type 1 diabetes mellitus. Smokers showed a higher prevalence of xerosis, acanthosis nigricans, and bullae, while non-smokers more often exhibited ichthyosis and diabetic rubeosis.