Abstract
Post-cessation weight gain (PCWG) facilitates short-term type 2 diabetes (T2D) risk in prediabetic smokers in the absence of complementary measures. In this shared decision-making-based non-randomized controlled trial, prediabetic smokers joined the Fight Tobacco and Stay Fit (FIT2) program or received usual care. The 16-week FIT2 program combined smoking cessation therapy with individualized coaching in diet and physical activity strategies for PCWG restriction (NCT01926041 at ClinicalTrials.gov). During a mean follow-up period of 1316 days, 217 participants (36.8%) developed T2D, and 68 (11.5%) regressed to normoglycemia. In the intention-to-treat analysis (n = 589), the FIT2 program was associated with a reduced T2D risk (HR, 0.58; 95% CI, 0.40–0.84) and a higher probability of regression to normoglycemia (HR, 1.91; 95% CI, 1.04–3.53) compared with usual care. The post-program quitters were at lower T2D risk (HR, 0.63; 95% CI, 0.44–0.92) and were more likely to regress to normoglycemia (HR, 1.83; 95% CI, 1.01–3.30) compared with the controls in the time-varying analysis (n = 532). We demonstrated that the FIT2 program was negatively associated with long-term T2D risk and positively associated with the probability of regression to normoglycemia compared with usual care. To prevent T2D development, we recommend simultaneously promoting smoking abstinence and lifestyle coaching for PCWG restriction.
Highlights
Type 2 diabetes (T2D) has been linked to cardiovascular comorbidities, malignancy, and high mortality [1–3]
The intentionto-treat analysis demonstrated that the FIT2 program was negatively associated with long-term T2D risk and positively associated with the probability of regression to normoglycemia compared with usual care
The time-varying analysis consistently revealed that the post-program quitters had a lower long-term T2D risk and were more likely to regress to normoglycemia compared with the controls
Summary
Type 2 diabetes (T2D) has been linked to cardiovascular comorbidities, malignancy, and high mortality [1–3]. An early cohort study involving non-diabetic middle-aged adults reported that quitters had the highest risk of T2D in the first three years [11]. Findings from another 9.2-year cohort of 2070 overweight Japanese men indicated that T2D occurrence peaked within three years of quitting [10]. The intervention combining smoking cessation and PCWG restriction has been proposed to minimize obesity and diabetes but has not yet been experimentally elucidated for prediabetic smokers [13,14]. In this non-randomized controlled trial, we introduced a shared decision-making-based Fight Tobacco and Stay Fit (FIT2) program combining smoking cessation therapy with individualized lifestyle coaching for restricting
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