International Journal of Epidemiology 2001;30:547-554
© International Epidemiological Association 2001
Diabetes |
Cigarette smoking and glycaemia: the EPIC-Norfolk Study
a Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Robinson Way, Cambridge CB2 2SR, UK.
b MRC Dunn Human Nutrition Unit, Hills Road, Cambridge CB2 2DH, UK.
Dr Nick Wareham, Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Robinson Way, Cambridge CB2 2SR, UK. E-mail: njw1004{at}medschl.cam.ac.uk
Abstract
Background Previous prospective studies have suggested that cigarette smoking may be associated with an increased risk of type 2 diabetes, but the possibility of confounding, particularly by dietary factors has not been fully examined.
Methods Cross-sectional analysis of the association between cigarette smoking and HbA1C, a marker of long-term glucose homeostasis in 2704 men and 3385 women, aged 45–74 years who were recruited to a population-based study of diet and chronic disease.
Results Twelve per cent of men and 11% of women reported being current smokers. Mean HbA1C was lowest in never smokers, intermediate in former smokers and highest in current smokers. There was a dose-response relationship between HbA1C levels and number of cigarettes smoked per day and a positive association with total smoking exposure as measured by pack-years. The unadjusted increase in HbA1C for 20 pack-years of smoking was 0.12% (95% CI : 0.09–0.16) in men and 0.12% (95% CI : 0.08–0.17) in women. After adjustment for possible confounders including dietary variables, the values were 0.08% (95% CI : 0.04– 0.12) and 0.07% (95% CI : 0.02–0.12) for men and women, respectively. Mean HbA1C was inversely related to time since quitting smoking in men.
Conclusions These results add support to the hypothesis that smoking has long-term effects on glucose homeostasis, an association that cannot be explained by confounding by dietary factors as measured in this study.
KEY MESSAGES
- Previous studies have suggested that smoking may be associated with an increased risk of type 2 diabetes.
- In this cross-sectional study, mean HbA1C, a marker of long-term hyperglycaemia was increased in current smokers.
- HbA1C rose by 0.12% for each 20 pack-years of smoking.
- Adjustment for confounding reduced but did not eliminate this association.
- These data add support to the hypothesis that smoking has long-term effects on glucose homeostasis.
Keywords Smoking, glycosylated haemoglobin, diabetes mellitus, epidemiology
Accepted 17 November 2000
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