Hsin-Chieh Yeh, PhD; Frederick L. Brancati, MD, MHS
Potential Conflicts of Interest: None disclosed.
Yeh H, Brancati FL. Smoking Cessation and the Risk for Type 2 Diabetes Mellitus. Ann Intern Med. 2010;152:755-756. doi: 10.7326/0003-4819-152-11-201006010-00021
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Published: Ann Intern Med. 2010;152(11):755-756.
We agree with Dr. Ziegelstein that smoking cessation may trigger depression, which could in turn increase the risk for type 2 diabetes because of unhealthy behaviors, decreased insulin sensitivity, or increased systemic inflammation. Unfortunately, the ARIC study did not include a specific assessment for depression. At the 3-year follow-up visit, ARIC participants were asked to complete a survey of vital exhaustion (1) to measure feelings of fatigue and exhaustion that might precede myocardial infarction. As Dr. Ziegelstein suspected, vital exhaustion was greater in quitters than in never-smokers (mean score adjusted for age, sex, race, and ARIC center, 11.3 [SD, 9.3] vs. 9.1 [SD, 8.3], respectively), but adjustment for vital exhaustion did not seem to explain the higher risk for incident diabetes in quitters in the fully adjusted regression model.
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