Altan Onat, MD
Potential Conflicts of Interest: None disclosed.
Onat A. Smoking Cessation and the Risk for Type 2 Diabetes Mellitus. Ann Intern Med. 2010;152:754-755. doi: 10.7326/0003-4819-152-11-201006010-00019
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Published: Ann Intern Med. 2010;152(11):754-755.
TO THE EDITOR:
Yeh and colleagues (1) prospectively examined the association of smoking status with development of incident type 2 diabetes in the ARIC (Atherosclerosis Risk in Communities) cohort (1) and concluded that predicts incident diabetes and that cessation leads to higher short-term risk. The first part of the conclusion was not convincing for several reasons.
First, excess risk did not emerge in one third of the smokers (mild smokers). Second, the study does not clarify whether this risk is valid only for men or for both sexes, because sex-stratified analyses are missing. In the regression analyses, the referent never-smokers and the top tertile comprised men and women who differed substantially in risk. Sex adjustment may not disclose the situation for women who may have been unaffected by the habit, although adjusted combined analyses have yielded excess risk. Third, adjustment for body mass index (BMI) may be biased depending on whether smoking led to a reduction in obesity in this cohort. If it did, which seems likely on the basis of the significantly lower BMIs in increasing categories of smoking, this would conceal a possible beneficial BMI-mediated effect of smoking on diabetes risk. This adjustment might introduce bias to male smokers as well. Finally, the adjusted hazard ratio was slightly increased at least a decade after smoking cessation and was increased 1.54-fold in ex-smokers who quit 3 to 5 years previously compared with never-smokers.
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