Cigarette smoking is a serious hazard to health. Yet, although as a group people with diabetes are at increased risk of developing cardiovascular disease, this does not appear to influence smoking habits among them. Tobacco use among people with diabetes is strongly associated with a further increase in the risk of developing cardiovascular complications. Furthermore, research has indicated that smoking has negative effects on the metabolism of glucose and lipids (fat), leading to the deterioration of metabolic control in diabetes. Effects on the blood vessels of the body, inflammation, and other possible factors may also contribute to the very serious negative consequences of cigarette smoking for people with diabetes. Björn Eliasson reports.