Abstract
Weight gain after smoking cessation may increase diabetes mellitus and impaired fasting glucose (IFG) risk. This study evaluated associations between smoking cessation and continued smoking with incident diabetes and IFG three years after a quit attempt. The 1504 smokers (58% female) were mean (standard deviation) 44.7 (11.1) years old and smoked 21.4 (8.9) cigarettes/day. Of 914 participants with year 3 data, the 238 abstainers had greater weight gain, increase in waist circumference, and increase in fasting glucose levels than the 676 continuing smokers (p≤0.008). In univariate analyses, Year 3 abstinence was associated with incident diabetes (OR = 2.60, 95% CI 1.44–4.67, p = .002; 4.3% absolute excess) and IFG (OR = 2.43, 95% CI 1.74–3.41, p<0.0001; 15.6% absolute excess). In multivariate analyses, incident diabetes was associated independently with older age (p = 0.0002), higher baseline body weight (p = 0.021), weight gain (p = 0.023), baseline smoking rate (p = 0.008), baseline IFG (p<0.0001), and baseline hemoglobin A1C (all p<0.0001). Smoking more at baseline predicted incident diabetes among eventual abstainers (p<0.0001); weighing more at baseline predicted incident diabetes among continuing smokers (p = 0.0004). Quitting smoking is associated with increased diabetes and IFG risk. Independent risk factors include older age, baseline body weight, baseline glycemic status, and heavier pre-quit smoking. These findings may help target smokers for interventions to prevent dysglycemia.Trial RegistrationClinicaltrials.gov NCT00332644
Highlights
Quitting smoking is the most important behavioral change individuals can make to reduce their risk of cardiovascular disease (CVD), pulmonary disease, and cancer [1]
Cigarette smoking is a risk factor for developing diabetes mellitus and impaired fasting glucose (IFG); smoking cessation should be associated with a decrease in the risk of type II diabetes mellitus [2,3,4,5,6]
The purpose of this study was to examine the effects of smoking cessation and continued smoking on incident diabetes mellitus and IFG 3 years after a quit attempt in a large, contemporary cohort of active smokers who volunteered for a smoking cessation clinical trial
Summary
Quitting smoking is the most important behavioral change individuals can make to reduce their risk of cardiovascular disease (CVD), pulmonary disease, and cancer [1]. Smoking cessation can lead to weight gain, with various studies reporting average increases of 4–8 kg [7,8,9]. Reports of weight gain after smoking cessation raise concern that increases in adiposity could blunt or counter the proven health benefits of smoking cessation [2,7,9,10] and might paradoxically increase risk for developing diabetes mellitus and IFG [2,10,11]. Some studies have suggested that smoking cessation leads to increased short-term risk of diabetes mellitus; most of these studies involved individuals from older cohorts who smoked more heavily and weighed less than contemporary smokers [2,10,11,12,13,14]. In observational cohort studies, abstainers may be motivated to quit as a result of disease exacerbation, so the association between quitting and disease outcomes may reflect worsening disease status prior to a quit attempt [15]
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