The association between smoking cessation and glycaemic control in patients with type 2 diabetes: a THIN database cohort study

Deborah Lycett, Linda Nichols, Ronan Ryan, Amanda Farley, Andrea Roalfe, Mohammed A Mohammed, Lisa Szatkowski, Tim Coleman, Richard Morris, Andrew Farmer, Paul Aveyard

Research output: Contribution to journalArticle (Academic Journal)peer-review

46 Citations (Scopus)

Abstract

BACKGROUND: Smoking increases the risk of developing type 2 diabetes. However, several population studies also show a higher risk in people 3-5 years after smoking cessation than in continuing smokers. After 10-12 years the risk equates to that of never-smokers. Small cohort studies suggest diabetes control deteriorates temporarily during the first year after quitting. We examined whether or not quitting smoking was associated with altered diabetes control in a population study, for how long this association persisted, and whether or not this association was mediated by weight change.

METHODS: We did a retrospective cohort study (Jan 1, 2005, to Dec 31, 2010) of adult smokers with type 2 diabetes using The Health Improvement Network (THIN), a large UK primary care database. We developed adjusted multilevel regression models to investigate the association between a quit event, smoking abstinence duration, change in HbA1c, and the mediating effect of weight change.

FINDINGS: 10 692 adult smokers with type 2 diabetes were included. 3131 (29%) quit smoking and remained abstinent for at least 1 year. After adjustment for potential confounders, HbA1c increased by 0·21% (95% CI 0·17-0·25; p<0·001; [2·34 mmol/mol (95% CI 1·91-2·77)]) within the first year after quitting. HbA1c decreased as abstinence continued and became comparable to that of continual smokers after 3 years. This increase in HbA1c was not mediated by weight change.

INTERPRETATION: In type 2 diabetes, smoking cessation is associated with deterioration in glycaemic control that lasts for 3 years and is unrelated to weight gain. At a population level, this temporary rise could increase microvascular complications.

FUNDING: National Institute for Health Research School for Primary Care Research.

Original languageEnglish
Pages (from-to)423-430
Number of pages8
JournalLancet Diabetes and Endocrinology
Volume3
Issue number6
Early online date29 Apr 2015
DOIs
Publication statusPublished - 1 Jun 2015

Bibliographical note

Copyright © 2015 Elsevier Ltd. All rights reserved.

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