Smoking Cessation Leads to Higher Short-Term Risk for Diabetes
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Smoking cessation increases a person’s risk of developing diabetes in the short term, based on longitudinal data from the Atherosclerosis Risk in Communities (ARIC) study.
ARIC is an ongoing, prospective cohort study involving more than 15,000 American adults who were 45 to 64 years of age at the time of enrollment. The current analysis was based on follow-up data through 2004 for 9,398 participants who did not have diabetes either at baseline or at an initial follow-up clinic visit 3 years later.
A total of 1,254 study participants developed type 2 diabetes during 9 years of follow-up. The incidence of diabetes increased from 13.3 per 1,000 person-years for participants who never smoked to 18.5 per 1,000 person-years in the highest tertile of pack-years; the adjusted hazard ratio of incident diabetes in the highest tertile of pack-years was 1.42 (95% CI, 1.20 to 1.67).
From baseline to the 3-year clinic visit, 380 participants quit smoking, and 2,018 participants continued to smoke. Compared with participants who never smoked, the adjusted hazard ratios of diabetes among former smokers, new quitters, and continuing smokers were 1.22 (95% CI, 0.99 to 1.50), 1.73 (95% CI, 1.19 to 2.53), and 1.31 (95% CI, 1.04 to 1.65), respectively. An analysis of long-term risk after quitting showed that the highest risk occurred during the first 3 years (hazard ratio, 1.91 [CI, 1.19 to 3.05]), then decreased gradually to zero at 12 years. The increased risk seemed to be mediated partially by weight gain and systemic inflammation.
The authors concluded that smoking cessation for individuals at risk for diabetes (especially heavy smokers) should be coupled with strategies for diabetes prevention (e.g., aggressive weight management) and early detection.
Ann Intern Med. 2010;152:10-17.