Cigarette smoking is an independent risk factor for type 2 diabetes: a four-year community-based prospective study
Cigarette smoking is an independent risk factor for type 2 diabetes: a four-year community-based prospective study
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DOI：
10.1111/j.1365-2265.2009.03586.x
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发表时间：
2009-11-01
影响因子：
3.2
通讯作者：
Choi, Sung Hee
中科院分区：
文献类型：
--
作者：
Cho, Nam H.;Chan, Juliana C. N.;Choi, Sung Hee
目的在一项基于人群的前瞻性队列研究中，我们研究了吸烟及其与胰岛素抵抗和β细胞功能的累加效应与2型糖尿病发病率之间的关系。设计与方法从城乡地区共招募10038名受试者。所有受试者在基线和4年随访期间进行75克口服葡萄糖耐量试验和全面生化评估。由于女性吸烟率较低，最终的分析仅限于4041名男性。结果4年间，既往吸烟者和重度吸烟者的糖尿病发病率分别为12.5%和11.1%，高于不吸烟者（7.9%）。经Cox-proportional hazard model多变量调整后，与从不吸烟者相比，前吸烟者和当前吸烟者的相对危险度分别为1中心点60 （95% CI: 1中心点07-2中心点39）、2中心点06（1中心点35-3中心点16，< 20支/天）和2中心点41（1中心点48-3中心点93，>= 20支/天）。在吸烟者和从不吸烟者中，β细胞功能稳态模型评估（homa - β）低和胰岛素抵抗稳态模型评估（HOMA-IR）高组中新发糖尿病的风险最高。结论吸烟是2型糖尿病的独立危险因素，与胰岛素分泌低、胰岛素抵抗高的状态存在协同作用。鉴于世界上的高吸烟率和日益增加的糖尿病负担，戒烟应被视为糖尿病预防和治疗规划的关键因素之一。
P>ObjectivesWe investigated the association between smoking and its additive effects with insulin resistance and beta-cell function on the incidence of type 2 diabetes in a prospective population-based cohort study.Design and methodA total of 10 038 subjects were recruited from rural and urban areas. All subjects underwent 75 g oral glucose tolerance tests and full biochemical assessments at baseline and during 4-year follow-up period. The final analysis was limited to 4041 men due to the low smoking rates in women.ResultsThe ex- and heavy current smokers had the highest incidence of diabetes of 12 center dot 5% and 11 center dot 1% respectively, compared with never-smokers (7 center dot 9%) during 4 years. After multivariate adjustment by Cox-proportional hazard model, ex- and current smokers reveal a relative risk of 1 center dot 60 (95% CI: 1 center dot 07-2 center dot 39), 2 center dot 06 (1 center dot 35-3 center dot 16, for < 20 cigarettes/day) and 2 center dot 41 (1 center dot 48-3 center dot 93, for >= 20 cigarettes/day) respectively compared with never smokers. The risk of new onset diabetes was the highest in those with low homeostasis model assessment for beta cell function (HOMA-beta) and high homeostasis model assessment for insulin resistance (HOMA-IR) group in both smokers and never smokers.ConclusionsSmoking is an independent risk factor for type 2 diabetes mellitus and showed synergistic interaction with the status of low insulin secretion and high insulin resistance for developing diabetes. Given the high rates of smoking and growing burden of diabetes in the world, cessation of smoking should be considered as one of the key factors for diabetes prevention and treatment programmes.