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Date of Graduation


Degree Type

Capstone Project (On-Campus Access Only)

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Judy Ortiz PA-C

Second Advisor

Jonathan W. Gietzen, MS PA-C


Context: Type II Diabetes is a prevalent multisystem chronic disease that is seen frequently by many healthcare providers. It is important that all providers are aware and following specific guidelines for the management of these patients. Management of Diabetes includes addressing modifiable and nonmodifiable risk factors for complications of this disease. By close monitoring of modifiable behaviors it has been shown that complications from DM II are much lower than in those patients who continue with their lifestyle of smoking, alcohol consumption, poor diet and lack of exercise. Of these modifiable behaviors tobacco use has been shown to increase the occurrence of secondary complications among type II diabetics. Some of these secondary complications include hyperglycemia, nephropathy, neuropathy, and vascular disease both micro and macro leading to increased risk of complicated foot ulcers. It is crucial that healthcare providers are addressing this risk factor at each visit with their diabetic patients and offering appropriate cessation.

Objective: To compare diabetic control, using HbAlc, Microalbumin/Creatinine ratio, and foot risk, between tobacco and non-tobacco using type II diabetics.

Design: This study is a retrospective diabetic registry review of two Family Medicine Physicians at Group Health Cooperative.

Setting: The study took place at Group Health Cooperative of Olympia, Washington.

Subjects: Male and Female type II diabetics over the age of 45, both tobacco and non-tobacco users.

Results: There were a total of 194 type II diabetic patients between the two Family Medicine Physicians, 13 of which are current tobacco users and 184 which are not. The mean HbAlc among the tobacco users is 7.8% (SD 1.2% with CI 95% 7.1-8.5%) and among non-tobacco users is 7.8% (SD 1.6% with CI 95% 7.6-8.0%) with a p-value of 1.00. The mean Microalbumin/Creatinine ratio among tobacco users is 314.8 ug/mg (SD 618.4 ug/mg with CI 95% -21.4-651 ug/mg) and among non-tobacco users is 192.6 ug/mg (SD 846.9 ug/mg with CI 95% 70.6-315 ug/mg) with a p-value of 0.61. The foot risk among tobacco users is 6(46.2%) have been classified as having high risk feet and 7(53.8%) have normal risk feet and among nontobacco users 115(62.5%) have high risk feet and 69(37.5%) have normal risk feet.

Conclusions: Tobacco use among type II diabetics increases the amount of albuminuria secondary to nephropathy, but not to a statistically significant amount. No significant difference was shown in glycemic control as measured by HbA1c or foot risk when compared to nontobacco using type II diabetics.


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