The smoker with diabetes: a difficult challenge.

Over the past 40 years the serious damage to health associated with smoking has become clear.' Cigarette smoking has been identified as the main avoidable cause of death and disability in the United States. The overall mortality ratio for adult cigarette smokers versus non-smokers is about 1.7; it increases with the amount smoked and is directly proportional to the duration of smoking. In the United States there are approximately 400,000 excess deaths each year from smoking and tobacco use, with smoking accounting for one in every 6 deaths in the United States and remaining as the single most preventable cause ofdeath in American society (chronic obstructive lung disease, cancer deaths particularly lung cancer, and coronary heart disease). Other disease risks include atherosclerotic and occlusive peripheral vascular disease and cerebral vascular disease and stroke. In addition, cigarette smoking causes substantial morbidity, smokers reporting more acute and chronic symptoms than people who have never smoked. It is estimated that about one quarter of all regular cigarette smokers are killed early by their smoking, losing on average 10 to 15 years of their life. The health costs and loss of productivity due to cigarette smoking are staggering.