Smoking, smoking cessation, and risk for type 2 diabetes mellitus: a cohort study.
Smoking, smoking cessation, and risk for type 2 diabetes mellitus: a cohort study.
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DOI：
10.7326/0003-4819-152-1-201001050-00005
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发表时间：
2010-01-05
影响因子：
39.2
通讯作者：
Brancati FL
中科院分区：
文献类型：
--
作者：
Yeh HC;Duncan BB;Schmidt MI;Wang NY;Brancati FL
吸烟是 2 型糖尿病发生的既定预测因素，但戒烟对糖尿病风险的影响尚不清楚。检验戒烟会在短期内增加糖尿病风险的假设，这可能是由于戒烟相关的体重增加所致。前瞻性队列研究。社区动脉粥样硬化风险 (ARIC) 研究。 1987 年至 1989 年间，共有 10,892 名最初没有患糖尿病的中年人。我们通过访谈在基线和随后的随访中评估了吸烟情况。糖尿病的发生是通过 1998 年的空腹血糖测定和 2004 年的医生诊断或糖尿病药物使用情况的自我报告来确定的。在 9 年的随访期间，1,254 名成年人患上了 2 型糖尿病。与从不吸烟的成年人相比，最高三分位包年发生糖尿病的调整后风险比为 1.42（95% CI，1.20 至 1.67）。在随访的前 3 年中，380 名成年人戒烟了。调整年龄、种族、性别、教育程度、肥胖程度、体力活动、血脂、血压和 ARIC 中心后，与从不吸烟的成年人相比，前吸烟者、新戒烟者和继续吸烟者患糖尿病的风险比分别为 1.22（CI，0.99 至 1.50）、1.73（CI，1.19 至 2.53）和 1.31（CI，1.04 至 2.53）。 1.65），分别。对体重变化和白细胞计数的进一步调整大大降低了这些风险。在对戒烟后长期风险的分析中，最高风险发生在前 3 年（风险比，1.91 [CI，1.19 至 3.05]），然后在 12 年逐渐降至 0。即使对已确定的糖尿病危险因素进行最细致的调整，仍有可能出现残留的混杂因素。吸烟可预测 2 型糖尿病的发生，但戒烟会导致更高的短期风险。对于有糖尿病风险的吸烟者，戒烟应与糖尿病预防和早期发现策略相结合。
Cigarette smoking is an established predictor of incident type 2 diabetes mellitus, but the effects of smoking cessation on diabetes risk are unknown. To test the hypothesis that smoking cessation increases diabetes risk in the short term, possibly due to cessation-related weight gain. Prospective cohort study. The Atherosclerosis Risk in Communities (ARIC) study. 10,892 middle-aged adults who initially did not have diabetes in 1987 to 1989. We assessed smoking by interview at baseline and at subsequent follow-ups. Incident diabetes was ascertained by fasting glucose assays through 1998 and self-report of physician diagnosis or use of diabetes medications through 2004. During 9 years of follow-up, 1,254 adults developed type 2 diabetes. Compared with adults who never smoked, the adjusted hazard ratio of incident diabetes in the highest tertile of pack-years was 1.42 (95% CI, 1.20 to 1.67). In the first 3 years of follow-up, 380 adults quit smoking. After adjustment for age, race, sex, education, adiposity, physical activity, lipids, blood pressure, and ARIC center, compared with adults who never smoked the hazard ratio of diabetes among former smokers, new quitters, and continuing smokers were 1.22 (CI, 0.99 to 1.50), 1.73 (CI, 1.19 to 2.53), and 1.31 (CI, 1.04 to 1.65), respectively. Further adjustment for weight change and leukocyte count attenuated these risks substantially. In an analysis of long-term risk after quitting, the highest risk occurred in the first 3 years (hazard ratio, 1.91 [CI, 1.19 to 3.05]), then gradually decreased to 0 at 12 years. Residual confounding is possible even with the most meticulous adjustment for established diabetes risk factors. Cigarette smoking predicts incident type 2 diabetes, but smoking cessation leads to higher short-term risk. For smokers at risk for diabetes, smoking cessation should be coupled with strategies for diabetes prevention and early detection.
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