High Risk Pregnancy: Diabetes
Risk of Type 2 Diabetes High for Smokers, Decreases With Quitting
12 percent of diabetes cases in men may be attributable to smoking.
By Parker Brown, MedPage Today
Medically Reviewed byHenry A. Soloman, MD, FACP, FACC
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Active and passive smoking are associated with a significantly higher risk of incident type 2 diabetes, but the risk for those who quit smoking decreases over time, according to a large meta-analysis.
Researchers looked at 88 studies with nearly 6 million participants and found that the risk ratio of developing type 2 diabetes was 1.37 for current smokers, 1.22 for never smokers both with and without exposure to second-hand smoke, and 1.14 for former smokers when compared to non-smokers.
The risk was dose-dependent for smokers, added the authors, who were led by An Pan, PhD, at Huazhong University of Science and Technology in China. The authors published their findings in The Lancet Diabetes & Endocrinology.
"In view of the high prevalence of smoking in many countries and the increasing burden of diabetes worldwide, reducing tobacco use should be prioritized as a key public health strategy," wrote Pan and colleagues, "which could potentially contribute to prevention and control of diabetes."
The link between smoking and risk of type 2 diabetes has been known for at least a decade. But in this latest study, researchers wanted to know how the risk changed with different smoking behavior. For new quitters -- who stopped smoking within the last five years -- the pooled risk ratio from 10 studies was 1.54 compared to those who have never smoked. And it was 1.18 for those who'd stopped from 5-9 years and 1.11 for those who stopped 10 years ago or more.
The researchers also estimated, under the assumption of causation, that 11.7 percent of cases of diabetes among men, and 2.4 percent in women, was attributable to active smoking, totalling about 27.8 million cases worldwide.
RELATED: 8 Surprising Risk Factors for Type 2 Diabetes
In an accompanying comment, Naveed Sattar, PhD, of the University of Glasgow, along with four colleagues, wrote that doctors should talk to their patients about this particular risk of smoking. "They should mention that, as well as being a risk factor for cardiovascular disease and many cancers, smoking should also be regarded as a risk factor for diabetes (albeit with a small effect relative to, for example, lung cancer)," he wrote.
"Patients who smoke should also be informed that stopping smoking and maintaining long-term abstinence will not only lessen their cardiovascular and cancer risks, but over time, might also lessen their diabetes risk."
He added that convincing patients to not take up smoking would be the best option, however. "Public health messages should perhaps now include diabetes on the list of smoking-related harms," he wrote.
The risk ratios were 1.21 for light smokers, 1.34 for moderate smokers, and 1.57 for heavy smokers, reported the authors. Light smokers were defined as those who smoked fewer than 10 cigarettes per day, and heavy smokers as those who smoked 20 or more per day. The associations persisted in all subgroups that the researchers looked at.
All included studies in the meta-analysis were peer-reviewed, original, prospective, and reported risk estimates of type 2 diabetes from smoking. All participants did not have type 2 diabetes at baseline and were not living in an institution. Studies with very few reported cases of type 2 diabetes or with more than 50 percent of the cohort lost to follow-up were excluded.
All but four of the studies focused on active smokers, but some included results for second-hand smoke, and more than half of all studies reported on smoking cessation. Four of the studies looked at second-hand smoke among never smokers. Smoking status was self-reported in nearly all of the studies. Most of the studies were done in Europe, but studies from the U.S., Asia, Australia, Israel, and Turkey were also included.
A significant limitation of the study was the heterogeneity across studies. In addition, there may have been residual confounding or misclassification due to self-reporting. None of the studies directly compared recent quitters with those who continued to smoke, so it's unclear how the two statuses related to each other in terms of risk of developing diabetes.
The authors noted that more research is needed to understand the possible causal mechanisms underlying the relationship between type 2 diabetes and smoking. "An improved understanding of this effect could contribute to the development of targeted pharmaceutical and lifestyle interventions that could be used to aid smoking cessation and prevent the occurrence of type 2 diabetes," they wrote.
The authors disclosed no relevant relationships with industry.
The study was supported by the Chinese National Thousand Talents Program for Distinguished Young Scholars, the U.S. National Institutes of Health, and the Program for Changjiang Scholars and Innovative Research Team.
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