Type 2 diabetes and cardiovascular disease: Have all risk factors the same strength?

Table 3 Suggested mechanisms for the influence of smoking on risk of type 2 diabetes

Direct effects due to inhalation of smoke from tobacco products

Impaired insulin sensitivity based on influence of haemodynamic dysregulation in capillary vascular bed

Impaired insulin sensitivity due to increase in inflammatory markers secondary to bronchitis and pulmonary infections caused by smoking

Impaired beta-cell function due to toxic effects of tobacco smoke

Lipotoxicity due to influence of increased triglyceride levels

Hypercortisolaemia and increase in abdominal fat tissue

Elevated sympathetic nervous activation

Indirect effects on glucose metabolism

Unhealthy lifestyle in smokers (poor diet, lack of physical activity)

Increased alcohol consumption (toxic effects on beta cells)

Psychosocial stress and impaired sleep associated with smoking

Impaired fetal growth in smoking pregnant women, associated with increased diabetes risk in offspring in adult life