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The association between smoking cessation and glycaemic control in patients with type 2 diabetes: a THIN database cohort study
Lycett, D. Ryan, R. Farley, A. Roalfe, A. Mohammed, Mohammed A. Szatkowski, L. Coleman, T. Morris, R. Farmer, A. Aveyard, P.
Lycett, D.
Ryan, R.
Farley, A.
Roalfe, A.
Mohammed, Mohammed A.
Szatkowski, L.
Coleman, T.
Morris, R.
Farmer, A.
Aveyard, P.
Publication Date
2015-06
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© 2015 Elsevier Ltd. All rights reserved. Reproduced in accordance with the publisher's self-archiving policy. This manuscript version is made available under the CC-BY-NC-ND 4.0 license (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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Abstract
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.
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Accepted manuscript
Citation
Lycett D, Nichols L, Ryan R et al (2015) The association between smoking cessation and glycaemic control in patients with type 2 diabetes: a THIN database cohort study. The Lancet Diabetes & Endocrinology. 3(6): 423-430.
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Article