Cigarette smoking is associated with conversion from normoglycemia to impaired fasting glucose: the Western New York Health Study

Tobacco Smoking and Survival Following a Diagnosis with Ovarian Cancer

BACKGROUND

Little is known about the influence of smoking on ovarian cancer survival. We investigated this relationship in a hospital-based study.

METHODS

Analyses included 519 women with ovarian cancer. We used multivariable adjusted Cox proportional hazards regression models to estimate HRs and 95% confidence intervals (CI).

RESULTS

Risk of all-cause mortality was increased for current smokers (HR = 1.70; 95% CI: 1.09-2.63) versus never smokers, especially for those with ≥15 cigarettes per day (HR = 1.92; 95% CI: 1.15-3.20). Results were largely similar after additional adjustment for debulking status (current vs. never smokers, HR = 2.96; 95% CI: 1.07-8.21) or neoadjuvant chemotherapy (comparable HR = 2.87; 95% CI: 1.02-8.06). Compared with never smokers, smoking duration ≥20 years (HR = 1.38; 95% CI: 0.94-2.03) and ≥20 pack-years (HR = 1.35; 95% CI: 0.92-1.99) were suggestively associated with worse outcomes. Current smoking was also positively associated with the risk of mortality among patients with ovarian cancer recurrence (current vs. never/past smokers, HR = 2.79; 95% CI: 1.44-5.41), despite the null association between smoking and recurrence (HR = 1.46; 95% CI: 0.86-2.48). Furthermore, no association was observed for smoking initiation before age 18 (HR = 1.22; 95% CI: 0.80-1.85), or either environmental smoke exposure at home (HR = 1.16; 95% CI: 0.76-1.78) or at work (HR = 1.10; 95% CI: 0.75-1.60).

CONCLUSIONS

Our results suggest active tobacco smoking is associated with worse ovarian cancer outcomes, particularly after a recurrence.

IMPACT

Our findings support structured smoking cessation programs for patients with ovarian cancer, especially in recurrent settings. Further research to confirm these findings and examine the interplay between smoking and the tumor immune microenvironment may help provide insight into ovarian cancer etiology.

Lifestyle Modifies the Diabetes-Related Metabolic Risk, Conditional on Individual Genetic Differences

Metabolic syndrome is a group of heritable metabolic traits that are highly associated with type 2 diabetes (T2DM). Classical interventions to T2DM include individual self-management of environmental risk factors, such as improving diet quality, increasing physical activity, and reducing smoking and alcohol consumption, which decreases the risk of developing metabolic syndrome. However, it is poorly understood how the phenotypes of diabetes-related metabolic traits change with respect to lifestyle modifications at the individual level. In the analysis, we used 12 diabetes-related metabolic traits and eight lifestyle covariates from the UK Biobank comprising 288,837 white British participants genotyped for 1,133,273 genome-wide single nucleotide polymorphisms. We found 16 GxE interactions. Modulation of genetic effects by physical activity was seen for four traits (glucose, HbA1c, C-reactive protein, systolic blood pressure) and by alcohol and smoking for three (BMI, glucose, waist-hip ratio and BMI and diastolic and systolic blood pressure, respectively). We also found a number of significant phenotypic modulations by the lifestyle covariates, which were not attributed to the genetic effects in the model. Overall, modulation in the metabolic risk in response to the level of lifestyle covariates was clearly observed, and its direction and magnitude were varied depending on individual differences. We also showed that the metabolic risk inferred by our model was notably higher in T2DM prospective cases than controls. Our findings highlight the importance of individual genetic differences in the prevention and management of diabetes and suggest that the one-size-fits-all approach may not benefit all.

Smoking-by-genotype interaction in type 2 diabetes risk and fasting glucose

Smoking is a potentially causal behavioral risk factor for type 2 diabetes (T2D), but not all smokers develop T2D. It is unknown whether genetic factors partially explain this variation. We performed genome-environment-wide interaction studies to identify loci exhibiting potential interaction with baseline smoking status (ever vs. never) on incident T2D and fasting glucose (FG). Analyses were performed in participants of European (EA) and African ancestry (AA) separately. Discovery analyses were conducted using genotype data from the 50,000-single-nucleotide polymorphism (SNP) ITMAT-Broad-CARe (IBC) array in 5 cohorts from from the Candidate Gene Association Resource Consortium (n = 23,189). Replication was performed in up to 16 studies from the Cohorts for Heart Aging Research in Genomic Epidemiology Consortium (n = 74,584). In meta-analysis of discovery and replication estimates, 5 SNPs met at least one criterion for potential interaction with smoking on incident T2D at p<1x10-7 (adjusted for multiple hypothesis-testing with the IBC array). Two SNPs had significant joint effects in the overall model and significant main effects only in one smoking stratum: rs140637 (FBN1) in AA individuals had a significant main effect only among smokers, and rs1444261 (closest gene C2orf63) in EA individuals had a significant main effect only among nonsmokers. Three additional SNPs were identified as having potential interaction by exhibiting a significant main effects only in smokers: rs1801232 (CUBN) in AA individuals, rs12243326 (TCF7L2) in EA individuals, and rs4132670 (TCF7L2) in EA individuals. No SNP met significance for potential interaction with smoking on baseline FG. The identification of these loci provides evidence for genetic interactions with smoking exposure that may explain some of the heterogeneity in the association between smoking and T2D.

Health risks and interventions in prediabetes: A review

Prediabetes is a condition which appears prior to the development of diabetes in which blood glucose is abnormally high but do not reach the diagnostic threshold of type 2 diabetes mellitus. It is characterized by a cluster of metabolic abnormalities viz. dysglycemia, dyslipidemia, hypertension, physical inactivity, obesity, insulin resistance, procoagulant state, endothelial dysfunction, oxidative stress and inflammation, placing prediabetic subjects to an increased risk for diabetes and its complications. Recent studies demonstrate that complications of diabetes i.e. microvascular and macrovascular complications may manifest in some prediabetic subjects. This article reviews prediabetes-related risk factors and health issues. In addition, this article also highlights the interventions to prevent the development of diabetes in prediabetic subjects.

Occupational metal exposures, smoking and risk of diabetes and prediabetes

BACKGROUND

Metal exposure and tobacco smoking have been independently associated with diabetes, but no study has been conducted to investigate the interaction between them on the risk of diabetes.

AIMS

To investigate the effect of occupational exposure to metals, and potential effect modification by smoking, on the risk of diabetes and prediabetes in a cohort of Chinese male workers.

METHODS

We assessed metal exposure and tobacco smoking at baseline in the Jinchang Cohort of male workers. We used Poisson regression analyses to estimate the interaction between smoking and metal exposures based on occupations, which we grouped according to the measured urinary metal levels.

RESULTS

Among the 26008 study subjects, compared with non-smokers, the adjusted prevalence ratio (PR) for diabetes was 1.8 [95% confidence interval (CI) 1.3-2.4] for smokers of >40 pack-years. The adjusted PRs were 1.2 (95% CI 1.1-1.4) among mining/production workers and 2.7 (95% CI 2.4-3.0) among smelting/refining workers, both compared with office workers. There was significant effect modification under the additive model between smoking and metal exposure on the prevalence of diabetes (Pinteraction = 0.001), with an adjusted PR of 3.6 (95% CI 2.4-5.4) for those with >40 pack-years of smoking who had the highest metal exposures, whereas no significant interaction was observed for prediabetes.

CONCLUSIONS

Both exposure to metals and heavy smoking were associated with an increased prevalence of diabetes in this large cohort of male workers. There was also strong interaction between these two exposures in affecting diabetes risk that should be confirmed in future studies.

Awareness and intervention status of prediabetes among Chinese adults: implications from a community-based investigation

With the rapid changes in lifestyle of China, the prevalence of diabetes and prediabetes is increasing. This study aims to evaluate the prevalence of prediabetes and study the disease awareness of prediabetes in a Southern China community. Furthermore, it also aimed to investigate the intervention status of lifestyle changes for pre-diabetes prevention. 881 adults without diabetes mellitus were recruited from the Suzhou community of China in 2012-2013. Self-report questionnaires including demographics, Disease Awareness Scale, Willingness on Lifestyle Changes for Prediabetes Cure Scale were collected. The results showed that 16.8% were in prediabetes, and 38.5% of them knew they had it. Young age, non-smoking, high education level, low BMI, and receiving provider advice were found with less possibility to have prediabetes in Chinese adults. Less than a third of those reported with the knowledge of that pre-diabetes is a risk factor of developing Type 2 diabetes mellitus (T2DM) and cardiovascular disease. Less a half of the population with prediabetes may take steps in lifestyle changes for pre-diabetes prevention. It is necessary to call for action on the improvement of disease awareness and promotion of healthy behaviors to prevent the prevalence of prediabetes and diabetes in Chinese adults.

Smoking and long-term risk of type 2 diabetes: the EPIC-InterAct study in European populations

OBJECTIVE

The aims of this study were to investigate the association between smoking and incident type 2 diabetes, accounting for a large number of potential confounding factors, and to explore potential effect modifiers and intermediate factors.

RESEARCH DESIGN AND METHODS

The European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct is a prospective case-cohort study within eight European countries, including 12,403 cases of incident type 2 diabetes and a random subcohort of 16,835 individuals. After exclusion of individuals with missing data, the analyses included 10,327 cases and 13,863 subcohort individuals. Smoking status was used (never, former, current), with never smokers as the reference. Country-specific Prentice-weighted Cox regression models and random-effects meta-analysis were used to estimate hazard ratios (HRs) for type 2 diabetes.

RESULTS

In men, the HRs (95% CI) of type 2 diabetes were 1.40 (1.26, 1.55) for former smokers and 1.43 (1.27, 1.61) for current smokers, independent of age, education, center, physical activity, and alcohol, coffee, and meat consumption. In women, associations were weaker, with HRs (95% CI) of 1.18 (1.07, 1.30) and 1.13 (1.03, 1.25) for former and current smokers, respectively. There was some evidence of effect modification by BMI. The association tended to be slightly stronger in normal weight men compared with those with overall adiposity.

CONCLUSIONS

Former and current smoking was associated with a higher risk of incident type 2 diabetes compared with never smoking in men and women, independent of educational level, physical activity, alcohol consumption, and diet. Smoking may be regarded as a modifiable risk factor for type 2 diabetes, and smoking cessation should be encouraged for diabetes prevention.

Smoking is associated with impaired glucose regulation and a decrease in insulin sensitivity and the disposition index in first-degree relatives of type 2 diabetes subjects independently of the presence of metabolic syndrome

The aim of this study was to investigate glucose tolerance, insulin secretion and insulin resistance according to smoking habits in first-degree relatives of type 2 diabetes patients, a population at high risk for developing diabetes. One thousand three hundred (646 females and 654 males) subjects underwent an oral glucose tolerance test (OGTT) to investigate their glucose metabolism and answered questionnaires about their lifestyle habits. Smoker subjects showed significant impairment compared with non-smoker subjects in 2-h post-oral glucose tolerance test (2hOGTT, 129.3 ± 40.2 vs. 117.7 ± 37.6 mg/dl, p < 0.001), the OGTT insulin sensitivity (386.3 ± 54.9 vs. 400.5 ± 53.4 ml min(-1) m(2), p < 0.01) method and the insulin sensitivity and secretion index-2 (ISSI-2, 1.7 ± 0.8 vs. 2.0 ± 1.0, p < 0.005). Metabolic syndrome (MS) was higher in the smoker than in the non-smoker group (46.5 vs. 29.7 %, p < 0001), and smokers were more sedentary than non-smokers (3.94 ± 3.77 vs. 4.86 ± 4.41 h/week, p < 0.001). Smokers showed an increased risk of impaired glucose regulation (IGR: impaired glucose tolerance or diabetes mellitus) with a hazard ratio (HR) adjusted by gender, metabolic syndrome and physical activity of 1.78, 95 % CI 1.27-2.47 (p < 0.001). The association between smoking and MS conferred a risk of IGR that was five times higher (HR 5.495, 95 % CI 4.07-7.41, p < 0.001). Smoking habit was a significant explanatory variable in a multiple forward stepwise regression analysis performed using 2hOGTT and ISSI-2 as dependent variables (p < 0.0001, R = 0.313 and p < 0.0001, R = 0.347, respectively). In conclusions, our results show that tobacco smoking is tightly associated with impairments in glucose metabolism and insulin sensitivity and insulin secretion.

Differences by sex in the prevalence of diabetes mellitus, impaired fasting glycaemia and impaired glucose tolerance in sub-Saharan Africa: a systematic review and meta-analysis

OBJECTIVE

To assess differences between men and women in the prevalence of diabetes mellitus, impaired fasting glycaemia and impaired glucose tolerance in sub-Saharan Africa.

METHODS

In September 2011, the PubMed and Web of Science databases were searched for community-based, cross-sectional studies providing sex-specific prevalences of any of the three study conditions among adults living in parts of sub-Saharan Africa (i.e. in Eastern, Middle and Southern Africa according to the United Nations subregional classification for African countries). A random-effects model was then used to calculate and compare the odds of men and women having each condition.

FINDINGS

In a meta-analysis of the 36 relevant, cross-sectional data sets that were identified, impaired fasting glycaemia was found to be more common in men than in women (OR: 1.56; 95% confidence interval, CI: 1.20-2.03), whereas impaired glucose tolerance was found to be less common in men than in women (OR: 0.84; 95% CI: 0.72-0.98). The prevalence of diabetes mellitus - which was generally similar in both sexes (OR: 1.01; 95% CI: 0.91-1.11) - was higher among the women in Southern Africa than among the men from the same subregion and lower among the women from Eastern and Middle Africa and from low-income countries of sub-Saharan Africa than among the corresponding men.

CONCLUSION

Compared with women in the same subregions, men in Eastern, Middle and Southern Africa were found to have a similar overall prevalence of diabetes mellitus but were more likely to have impaired fasting glycaemia and less likely to have impaired glucose tolerance.

Do early onset and pack-years of smoking increase risk of type II diabetes?

Background

Type II diabetes is not only major public health problem but also heavy fiscal burden to each nation’s health care system around the world. This study aimed to investigate the effect of early onset and pack-years of smoking on type II diabetes risk.

Methods

We used the most recent cross-sectional National Health and Nutrition Examination Survey set of South Korea (2010) and the United States (2009–2010). Participants who were diagnosed with diabetes after age 20 were included (South Korea: n = 7273, 44% male; U.S.: n = 3271, 52% male). Cox proportional models, stratified by sex and country, were used to estimate hazard ratios.

Results

7.1% of South Korean men, 5.5% of South Korean women, 15.5% of U.S. men, and 12.4% of U.S. women had type II diabetes; 40% of South Korean men, 34% of U.S. men, and 21% of U.S. women began smoking before age 20 (57%, 49%, 36% of those who had type II diabetes, respectively). Type II diabetic participants were older and married; have a higher BMI, low income, and less education; lack moderate physical activity, smoked more and earlier compared to those without type II diabetes. Differences in risk factors including life-style behaviors and SES were found in both diabetic and non-diabetic populations. Men who began smoking before age 16 had a higher type II diabetes risk than who never smoked (South Korea: hazard ratio [HR] 2.46, 95% confidence interval [CI] 1.04–5.79; U.S.: HR 1.64, 95% CI 1.01–2.67), as did U.S. men who began smoking between 16 and 20 years (HR 1.58, 95% CI 1.05–2.37). Smoking pack-years were also associated with type II diabetes in U.S. men (HR 1.07, 95% CI 1.01–1.12). In women population, however, associations were not found.

Conclusions

Early onset of smoking increases type II diabetic risk among men in South Korea and the U.S., and type II diabetic risk increases with higher pack-years in U.S. men, however, no associations were found in women population. Underage tobacco policy and education programs are strongly needed in both countries.

Lifestyle change in Kerala, India: needs assessment and planning for a community-based diabetes prevention trial

Background

Type 2 Diabetes Mellitus (T2DM) has become a major public health challenge in India. Factors relevant to the development and implementation of diabetes prevention programmes in resource-constrained countries, such as India, have been under-studied. The purpose of this study is to describe the findings from research aimed at informing the development and evaluation of a Diabetes Prevention Programme in Kerala, India (K-DPP).

Methods

Data were collected from three main sources: (1) a systematic review of key research literature; (2) a review of relevant policy documents; and (3) focus groups conducted among individuals with a high risk of progressing to diabetes. The key findings were then triangulated and synthesised.

Results

Prevalence of risk factors for diabetes is very high and increasing in Kerala. This situation is largely attributable to rapid changes in the lifestyle of people living in this state of India. The findings from the systematic review and focus groups identified many environmental and personal determinants of these unhealthy lifestyle changes, including: less than ideal accessibility to and availability of health services; cultural values and norms; optimistic bias and other misconceptions related to risk; and low expectations regarding one’s ability to make lifestyle changes in order to influence health and disease outcomes. On the other hand, there are existing intervention trials conducted in India which suggests that risk reduction is possible. These programmes utilize multi-level strategies including mass media, as well as strategies to enhance community and individual empowerment. India’s national programme for the prevention and control of major non-communicable diseases (NCD) also provide a supportive environment for further community-based efforts to prevent diabetes.

Conclusion

These findings provide strong support for undertaking more research into the conduct of community-based diabetes prevention in the rural areas of Kerala. We aim to develop, implement and evaluate a group-based peer support programme that will address cultural and family determinants of lifestyle risks, including family decision-making regarding adoption of healthy dietary and physical activity patterns. Furthermore, we believe that this approach will be feasible, acceptable and effective in these communities; with the potential for scale-up in other parts of India.

Medication non-adherence and poor glycaemic control in patients with type 2 diabetes mellitus

AIMS

Our main aim was to analyse gender differences in the association of adherence and poor glycaemic control (PGC) in a cohort of patients with type 2 diabetes mellitus in Germany.

METHODS

Baseline data of the DIANA-study, a prospective cohort study of type 2 diabetes mellitus patients in South-West Germany, were analysed. Information on medication adherence and factors related to PGC was obtained by self-administered questionnaire. PGC was defined as HbA(1c)≥7.5%. Bivariate and multivariate analyses using log-binomial regression were employed to assess overall and gender-specific associations of non-adherence and PGC.

RESULTS

624 men and 518 women were included in the analyses. In total, 147 men (24%) and 114 women (23%) reported non-adherence to medication. In men, PGC was found in 37% of the participants reporting non-adherence and in 19% reporting adherence (adjusted prevalence ratio (PR)=1.90, 95%-CI: 1.46-2.49). In women, PGC was found in 19% of the participants reporting non-adherence and in 18% reporting adherence (adjusted PR=0.97, 95%-CI: 0.65-1.46).

CONCLUSIONS

Our results show gender-specific differences in the association of adherence and PGC. This underlines the need for efforts to improve glycaemic control in patients with type 2 diabetes mellitus with a particular focus on men.

Effects of cigarette smoking, metabolic syndrome and dehydroepiandrosterone deficiency on intima-media thickness and endothelial function in hypertensive postmenopausal women

Background

Cigarette smoking is a major risk factor of atherosclerosis. The aim of this study was to assess the relationship between smoking and arterial hypertension as well as endothelial dysfunction in postmenopausal women without clinically manifested symptoms of atherosclerosis.

Material/Methods

The study groups consisted of 35 current smokers and 45 nonsmokers. The thickness of intima-media complex (IMT), a marker of atherosclerosis, was measured in carotid arteries. Plasma concentrations of fasting glucose, insulin, lipoproteins, inflammatory markers (tumor necrosis factor-alpha, intercellular adhesion molecule-1), matrix metalloproteinases (metalloproteinase-9, tissue inhibitor of metalloproteinase-1), insulin, and dehydroepiandrosterone sulfate (DHEA-S) were measured.

Results

Smokers compared with nonsmokers showed lower fasting glucose levels in blood (87.0±10.9 and 93.2±13.6 mg/dl, p<0.05), higher mean systolic (131.1±15.9 vs. 123.0±10.9 mm Hg, p<0.05) and diastolic (81.7±11.4 vs. 75.2±9.2 mm Hg, p<0.05) blood pressure during daytime, and higher average heart rate during the daytime (78.2±9.3/min vs. 71.5±9.5/min, p<0.01) and at night (67.2±10.6/min vs. 61.7±7.7/min, p<0.05), respectively. The IMT in the right carotid artery was significantly higher in smokers than in nonsmokers (0.96±0.16 mm vs. 0.82±0.21, p<0.05) and was positively correlated with smoking intensity (R=0.36) and habit duration (R=0.35). The comparison of inflammatory markers, metalloproteinases, and DHEA-S concentrations in plasma did not reveal significant differences between the 2 groups. A significant negative correlation between DHEA-S concentration in plasma and IMT in right carotid artery was found in smokers.

Conclusions

Smoking in hypertensive postmenopausal women is associated with lower fasting blood glucose and BMI values, but higher arterial pressure and heart rate, and increases in IMT in right carotid artery.

Childhood risk factors predict cardiovascular disease, impaired fasting glucose plus type 2 diabetes mellitus, and high blood pressure 26 years later at a mean age of 38 years: the Princeton-lipid research clinics follow-up study

The objective was to assess whether pediatric risk factors predict cardiovascular disease (CVD), impaired fasting glucose (IFG) + type 2 diabetes mellitus (T2DM), and high blood pressure (HBP) in young adulthood. We performed a prospective follow-up of 909 public-parochial suburban schoolchildren first studied at ages 6 to 18 years and 26 years later at a mean age of 38 years. Pediatric triglycerides (TGs), blood pressure, low-density lipoprotein cholesterol, body mass index, and glucose above and high-density lipoprotein cholesterol below established pediatric cutoffs, along with race, cigarette smoking, family history of CVD, T2DM, and HBP, were assessed as determinants of young adult CVD, a composite variable including IFG + T2DM and HBP. By stepwise logistic regression, adult CVD (19 yes, 862 no) was associated with pediatric high TG (odds ratio [OR], 5.85; 95% confidence interval [CI], 2.3-14.7). High TG in pediatric probands with young adult CVD was familial and was associated with early CVD in their high-TG parents. Adult IFG + T2DM (114 yes, 535 no) was associated with parental T2DM (OR, 2.2; 95% CI, 1.38-3.6), high childhood glucose (OR, 4.43; 95% CI, 2-9.7), and childhood cigarette smoking (OR, 1.64; 95% CI, 1.03-2.61). Adult HBP (133 yes, 475 no) was associated with pediatric high body mass index (OR, 2.7; 95% CI, 1.7-4.3) and HBP (OR, 2.5; 95% CI, 1.5-4.3). Pediatric risk factors are significantly, independently related to young adult CVD, IFG + T2DM, and HBP. Identification of pediatric risk factors for CVD, IFG + T2DM, and HBP facilitates initiation of primary prevention programs to reduce development of adult CVD, IFG + T2DM, and HBP.

Clinicodemographic factors influencing outcomes in patients with low-grade serous ovarian carcinoma

BACKGROUND

Low-grade serous carcinoma (LGSC) of the ovary is a rare tumor that is distinct from its high-grade counterpart. The objective of this study was to determine whether patient demographic factors and clinical treatment histories affected survival in a population of women with LGSC.

METHODS

A review of patients who had pathologically confirmed LGSC of the ovary diagnosed between 1977 and 2009 was performed. Abstracted data included medical and social histories, anthropometric measurements, and details about diagnosis, treatment, and follow-up. Statistical analyses included Fisher exact tests, Cox proportional hazards models, and the Kaplan-Meier method.

RESULTS

The study sample included 194 patients who had a median follow-up of 60.9 months (range, 1-383 months). In multivariate analyses, smoking had a negative association with both overall survival (OS) (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.03-2.92; P = .04) and progression-free survival (PFS) (HR, 1.72; 95% CI, 1.00-2.96; P = .05). The median OS was shorter in current smokers than in former/never smokers (48.0 months vs 79.9 months; P = .002). PFS also was predicted by year of diagnosis >1994 (HR, 1.74; P = .01). Although the difference was not statistically significant, hormone consolidation appeared to be associated with better OS (HR, 0.15; P = .06) and better PFS (HR, 0.44; P = .07). A smaller proportion of the patients who received hormone consolidation experienced disease recurrence compared with the patients who did not receive hormone consolidation (66.7% vs 87.6%; P = .07).

CONCLUSIONS

Smoking was associated negatively with survival outcomes in women with LGSC of the ovary, whereas consolidation treatment with hormone antagonists demonstrated a protective associative trend with survival. Both lifestyle modification and innovative treatment plans should be considered in this group of patients.

Smoking and risk for diabetes incidence and mortality in Korean men and women

OBJECTIVE

Mounting evidence suggests that smoking is a cause of type 2 diabetes. We explored the association of cigarette smoking with diabetes incidence and mortality in a large cohort of Koreans.

RESEARCH DESIGN AND METHODS

A 14-year prospective cohort study was performed on 1,236,443 Korean men and women, aged 30-95 years at baseline, who underwent standardized biennial medical examinations provided by the National Health Insurance Corporation (NHIC). Incident diabetes was identified on the basis of outpatient visits, hospitalization, or prescription medication treatment for diabetes, as captured in the NHIC database. Diabetes mortality was obtained through the national statistical office. Cox proportional hazards models were used to investigate associations of smoking with indicators of diabetes and diabetes mortality.

RESULTS

Smoking was significantly associated with increased risk for diabetic outpatient treatment, hospitalization, and mortality among both men and women, and the risk among current smokers increased modestly with the number of cigarettes smoked daily (P(trend) < 0.0001 for all associations). Compared with never smokers, current male smokers who smoked ≥ 20 cigarettes/day had increased risk for incident diabetes defined by outpatient treatment (adjusted hazard ratio 1.55 [1.51-1.60]), incident diabetes defined by ≥ 3 prescription medications for diabetes (1.71 [1.63-1.80]), and death from diabetes (1.60 [1.25-2.06]). The risks for outpatient treatment among smokers were higher in men than in women with evidence for effect modification by sex and age (P(interaction) < 0.0001).

CONCLUSIONS

Our study provides longitudinal evidence that smoking increases the risk of incident diabetes and mortality.

Differences in tobacco use between Canada and the United States

OBJECTIVES

This study explores differences in who smokes (smoker type) and exposure to smoking (pack-years) between Canada and the US. Both countries have policies to limit the number of smokers and smoking-related deaths.

METHODS

This research uses The Joint Canada/United States Survey of Health (JCUSH) and employs multinomial logistic regression and ordinary least squares regression.

RESULTS

In Canada, native-born, young, White males without a degree, with poor health and who had been previously married predominate in smoking. This profile is the same for the US. However, different characteristics predict exposure to smoking for the two countries. Native-born males without a degree, with poor health and who had been previously married smoked more cigarettes per day in Canada. For the US, younger individuals smoked more cigarettes per day.

CONCLUSIONS

If countries want to focus on limiting the number of new cases of smokers, the target population is different from the target population that should be used if countries are interested in converting smokers into non-smokers, based on the demographic analyses presented.

Smoking and diabetes--the double health hazard!

Smoking is a predictor of the transition from normoglycaemia to impaired fasting glucose and increases the risk of type 2 diabetes, independent from possible confounders. In patients with diabetes as in non-diabetics, smoking is a significant and independent risk factor for all-cause mortality and for mortality from cardiovascular disease and corononary heart disease, as well as for aggregates of fatal and non-fatal cardiovascular events. There is little doubt that smoking is a risk factor for coronary heart disease, but this risk appears to be stronger than the risk for stroke in diabetics. Pathophysiological mechanisms by which smoking causes glucose intolerance and worsens clinical outcomes in established diabetes include greater insulin resistance, impaired beta-cell function and insulin secretion, chronic low-grade inflammation, endothelial dysfunction, as well as interacting indirectly with other factors known to aggravate diabetes and lifestyle factors. Smoking cessation programs are of great importance for primary care specialists dealing with diabetes.