Cigarette Smoking Is Negatively Associated with the Prevalence of Type 2 Diabetes in Middle-Aged Men with Normal Weight but Positively Associated with Stroke in Men

Abstract

Background. The prevalence of diabetes and potentially related complications, including stroke, is rapidly increasing in China. The long-term effects of lifestyle may affect glucose metabolism in the general population. Although some studies have shown an association between smoking and the risk of type 2 diabetes mellitus (T2DM), the relationship remains unclear. Furthermore, the relationship between smoking and stroke in patients with T2DM has not been fully elucidated. Objective. We investigated the influence of cigarette smoking on T2DM and stroke in China. Detailed questionnaires about smoking status and anthropometric measurement were completed by participants, and oral glucose tolerance testing (OGTT), hemoglobin A1c (HbA1c), homeostasis model assessment of IR (HOMA-IR), and blood lipids were measured. Results. In total, 8196 adults aged 40 years or older were included. We found a reduced risk of impaired glucose regulation (IGR) and T2DM in male smokers with normal weight (body mass index BMI<25 kg/m2 or waist circumference WC<90 cm) compared with nonsmokers after adjusting for age, alcohol intake, physical activity, educational level, family history of diabetes, SBP, DBP, TG, TC, HDL-C, and LDL-C. However, no significant association was detected in male current smokers with overweight/obesity or female smokers. In addition, compared with nonsmokers without T2DM, current smokers with T2DM had a significantly higher risk of stroke (odds ratio: 2.64, 95% confidence interval: 1.25–5.57; P=0.011) after adjusting for confounders. Conclusions. Smoking was negatively associated with T2DM in Chinese men of normal body weight, but no significant association was found for men with overweight/obesity or women. In addition, smoking was positively associated with nonfatal stroke, especially in patients with T2DM. Further prospective studies are needed to examine the association between smoking, diabetes, and stroke in different ethnic groups.

Nationwide Prevalence of Diabetes and Prediabetes and Associated Risk Factors Among Iranian Adults: Analysis of Data from PERSIAN Cohort Study

“…Moreover, the association between cigarette smoking and diabetes and prediabetes is challenging. Although some studies, similar to ours, found protective effects of cigarette smoking on prediabetes and diabetes [23][24][25], a large body of evidence demonstrated a dose-response association between cigarette smoking and diabetes [26,27] as well as prediabetes [28,29]. Moreover, the effect of quitting smoking on diabetes is also conflicting.…”

Establishment of Clinical Prediction Model Based on the Study of Risk Factors of Stroke in Patients With Type 2 Diabetes Mellitus

“…For a cohort including patients with first-ever stroke, higher BMI was confirmed as an independent indicator for long-term survival according to a randomized controlled trial–based study on the effect of interventions targeting risk factors prevention ( 31 ). The study has shown that BMI has an impact on stroke risk in diabetic patients ( 11 ). A study of Chinese patients with T2DM showed that TG is a risk factor for stroke in T2DM patients and that female's elevated TG levels are more likely to be the risk factor to cause strokes than those of males ( 32 ).…”

“…Related studies of T2DM patients with stroke have provided evidence for us to identify corresponding risk factors. Through studies on diabetes and stroke, Wang et al ( 11 ), Li et al ( 12 ), and Bos et al ( 13 ) stated that gender, estimated glomerular filtration rate (eGFR), duration of T2DM (course), postprandial blood glucose (PBG), fasting blood glucose (FBG), glycosylated hemoglobin A 1c (HbA 1c ), systolic blood pressure (SBP), diastolic blood pressure (DBP), age, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), triglyceride (TG), body mass index (BMI), and uric acid (UA) are risk factors for stroke among T2DM patients. Based on the previous studies and community survey in this study, we involved basic information indicators including gender, age, course, BMI, SBP, DBP, and family history of DM; disease record information including hypertension, hyperlipemia, and microvascular disease; lifestyle factors containing smoking and alcohol; and biochemical indicators including FBG, PBG, HbA 1c , TC, TG, HDL-C, LDL-C, blood urea nitrogen (BUN), UA, eGFR, and the ratio of urinary microalbumin to uric creatinine (ACR) in this study.…”

The Role of Alcohol Consumption and Smoking Habits in Increasing the Diabetes Mellitus Risk in Adult Men and Women with Central Obesity in Indonesia

“…Recent research from Wang shows that smoking is negatively associated with the incidence of type 2 diabetes in men of normal weight in China, but not significantly in the obese male or female group (26). A positive relationship from smoking actually appears related to the incidence of central obesity (27,28) and stroke (26) in people with type 2 diabetes.…”

“…Although a lot of epidemiological evidence shows that there is a positive relationship between smoking habits and diabetes mellitus (19,20,21), various studies show insignificant results and even a negative relationship between the two (22,23,24,25). Recent research from Wang shows that smoking is negatively associated with the incidence of type 2 diabetes in men of normal weight in China, but not significantly in the obese male or female group (26). A positive relationship from smoking actually appears related to the incidence of central obesity (27,28) and stroke (26) in people with type 2 diabetes.…”