Enhanced vulnerability to tobacco use in persons with diabetes: A behavioral and neurobiological framework
Enhanced vulnerability to tobacco use in persons with diabetes: A behavioral and neurobiological framework
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DOI：
10.1016/j.pnpbp.2015.06.005
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发表时间：
2016-02-04
影响因子：
5.6
通讯作者：
Nazarian, Arbi
中科院分区：
文献类型：
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作者：
O'Dell, Laura E.;Nazarian, Arbi
烟草的使用极大地放大了与糖尿病相关的负面健康并发症。尽管强烈反对糖尿病患者使用烟草，但临床证据表明，他们经常继续吸烟，尽管有严重的禁忌症，但戒烟难度更大。在这里，我们认为糖尿病患者对烟草使用的易感性增加的一个潜在原因是尼古丁的更大回报作用。这篇综述总结了临床前的证据，表明尼古丁的奖赏作用在1型和2型糖尿病的啮齿动物模型中得到增强。我们还提供了一个神经生物学机制的框架，这些机制被认为可以促进糖尿病患者的烟草使用。这一框架表明，糖尿病导致胰岛素信号的中断，导致中脑边缘奖赏通路中的多巴胺系统受到抑制。最后，我们考虑了尼古丁增强奖赏效应的临床意义，这可能会促进糖尿病患者的烟草使用。考虑到糖尿病患者可能表现出多巴胺能机制的紊乱，考虑到增强多巴胺的戒烟药物的临床疗效是重要的。未来的工作需要更好地了解多巴胺和胰岛素的复杂相互作用，以便为糖尿病患者开发更好的戒烟药物。(C)2015 Elsevier Inc.保留所有权利。
Tobacco use significantly magnifies the negative health complications associated with diabetes. Although tobacco use is strongly discouraged in persons with diabetes, clinical evidence suggests that they often continue to smoke and have more difficulty quitting despite serious contraindications. Here, we suggest that a potential reason for enhanced vulnerability to tobacco use in persons with diabetes is greater rewarding effects of nicotine. This review summarizes pre-clinical evidence indicating that the rewarding effects of nicotine are enhanced in rodent models of type 1 and type 2 diabetes. We also provide a framework of neurobiological mechanisms that are posited to promote tobacco use in persons with diabetes. This framework suggests that diabetes induces a disruption in insulin signaling that leads to a suppression of dopamine systems in the mesolimbic reward pathway. Lastly, we consider the clinical implications of enhanced rewarding effects of nicotine that may promote tobacco use in persons with diabetes. The clinical efficacy of smoking cessation medications that enhance dopamine are important to consider, given that persons with diabetes may display disrupted dopaminergic mechanisms. Future work is needed to better understand the complex interaction of dopamine and insulin in order to develop better smoking cessation medications for persons with diabetes. (C) 2015 Elsevier Inc. All rights reserved.