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Smoking by patients with diabetes discussed by Maggie Diebolt Public Relations An acclaimed researcher discussed the health implications of smoking for African-Americans who suffer from type 2 diabetes mellitus (DM2) and other diseases during MUSC’s 2007 Medicine Grand Rounds in the Institute of Psychiatry auditorium Feb. 6.   Donald Wesson, M.D., vice dean for Texas A & M University, College of Medicine and Chief Academic Office, Scott & White Clinic and Hospital, discussed cigarette smoking and the progression of type 2 diabetic nephropathy, an issue that affects more than 30 million African-Americans nationwide.   DM2 is the most common form of diabetes that is linked to obesity and other factors in both young and older patients. Diabetic nephropathy is a kidney disease that occurs as a result of diabetes and is the leading cause of kidney failure in the nation. Patients with both DM2 and type 1 diabetes (which generally afflicts children) often develop chronic kidney disease (CKD). Complications from CKD also begets cardiovascular disease, which is the leading cause of death for people with diabetes.   During his investigation, Wesson discovered through monitoring the urine albumin excretion and TGF-beta in non-smokers that cigarette smoking augments the progression of early to advanced DM2 nephropathy in smokers and former smokers who have DM2. (Albumins are important in regulating blood volume by maintaining the osmotic pressure of the blood compartment and for transporting fatty acids, thyroid hormones, some steroid hormones, and other substances in the bloodstream.)   Wesson stressed the importance of helping patients with diabetes to monitor and manage the disease. “Intervene as early as possible,” he told the assembly of MUSC physicians and other health professionals. “Most importantly, primary care doctors should have the greatest opportunity to  prevent the progression in patients toward end-stage kidney disease.”   Through his study, Wesson learned that smokers had progressive kidney injury as measured by increasing urine albumin and TGF-beta excretion despite angiotensin-converting enzyme (ACE) inhibitors. (ACE inhibitors are a group of pharmaceuticals used primarily in treatment of hypertension and congestive heart failure, in most cases as the drugs of first choice.)   Former smokers received ACE inhibitors and had no progression of kidney injury, which was similar to non-smokers. But smokers had a greater progression rate from early to advanced nephropathy despite ACE inhibitors.   Wesson emphasized that the progression of advanced DM2 nephropathy is slowed, but not stopped, by ACE inhibition, and smoking cessation ameliorates the progression from early to advanced DM2 nephropathy with the presence of ACE inhibitors. Focus on African-American Health Care Issues Sessions are open to all students, house staff, faculty, research and nursing staff. All lectures will be held at 8 a.m. in the Institute of Psychiatry's Auditorium. Feb. 20 Cancer Disparities: Scope and Steps Toward a Solution in South Carolina Speakers: Marvella E. Ford, Ph.D., associate director, Cancer Disparities Program, Hollings Cancer Center, associate professor, Biostatistics, Bioinformatics and Epidemiology, MUSC; and Anthony Alberg, Ph.D., associate professor, associate director of Cancer Prevention and Control and Blass Ness Chair in Oncology, MUSC. Feb. 27 Recruitment of African-Americans into Clinical Trials Speaker: Crystal A. Gadegbeku, M.D., assistant professor of medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Mich.     Friday, Feb. 16, 2007 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.