Cigarette Smoking and Risk of Type 2 Diabetes Mellitus among Middle-aged and Elderly Japanese Men and Women

¹ Ibaraki Health Service Association, Ibaraki-ken, Japan.
² Department of Public Health Medicine, Institute of Community Medicine, University of Tsukuba, Ibaraki-ken, Japan.
³ Young Leaders’ Program, Graduate School of Medicine, Nagoya University, Aichi-ken, Japan.
⁴ Ibaraki Health Science Center, Ibaraki-ken, Japan.
⁵ Ibaraki Prefectural Hokota Health Center, Ibaraki-ken, Japan.

For examination of sex- and age-specific relations between smoking and risk of type 2 diabetes mellitus, 39,528 nondiabetic men and 88,613 nondiabetic women aged 40–79 years who underwent health checkups in Ibaraki-ken, Japan, in 1993 were followed through 2002. Risk ratios for diabetes according to smoking habits were calculated using a Cox proportional hazards model. Compared with never smokers, the risk ratio for diabetes among current smokers, after adjustment for age, systolic blood pressure, antihypertensive mediation use, alcohol intake, parental history of diabetes, body mass index, fasting status, blood glucose concentration, total and high density lipoprotein cholesterol levels, and log-transformed triglyceride level, was 1.27 (95% confidence interval (CI): 1.16, 1.38) in men and 1.39 (95% CI: 1.20, 1.61) in women. The excess risk was more pronounced among men with a parental history of diabetes than among men without one. The excess risk among current smokers was observed in both age subgroups (40–59 and 60–79 years). Respective multivariate risk ratios for the age subgroups were 1.37 (95% CI: 1.18, 1.60) and 1.20 (95% CI: 1.08, 1.34) in men and 1.45 (95% CI: 1.18, 1.79) and 1.34 (95% CI: 1.09, 1.66) in women. Smoking was independently associated with increased risk of type 2 diabetes among both middle-aged and elderly men and women.

Key Words: diabetes mellitus; follow-up studies; risk factors; smoking

２型糖尿病の発症は、喫煙男性では非喫煙者の約２倍になる。女性は1.5倍程度。

Association of cigarette smoking and tar and nicotine intake with 
development of type 2 diabetes mellitus in men and women from the 
general population: the MONICA/KORA Augsburg Cohort Study
Meisinger C, Doring A, Thorand B, Lowel H.
  Diabetologia. 2006 Aug;49(8):1770-1776

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 We examined sex-specific associations between cigarette smoking and incident type 2 diabetes mellitus in Germany.

Subjects, materials and methods  

The study was based on 5,470 men and 5,422 women (aged 25–74 years) without diabetes who participated in one of the three population-based MONICA Augsburg surveys between 1984 and 1995. Incident cases of type 2 diabetes were assessed using follow-up questionnaires. Hazard ratios (HRs) were estimated from Cox proportional hazard models.Results  Up to 31 December 2002 a total of 409 cases of incident type 2 diabetes among men and 263 among women were registered. 

The number of cigarettes and the nicotine and tar consumption per day were associated with a significantly increased risk of type 2 diabetes among men, but not among women; this could be due to the low power of the study in women. After multivariable adjustment, the HRs for type 2 diabetes compared with never-smokers were 1.48, 2.03 and 2.10 for men smoking 1 to 14, 15 to 19 and ≥20 cigarettes/day (p for trend <0.0001) and 1.25, 1.34 and 1.37 for women smoking 1 to 9, 10 to 19 and ≥20 cigarettes/day (p for trend 0.0985). Compared with never-smokers, the HRs for increasing tar intake in men (1–167, 168–259 and ≥260 mg/day) were 1.45, 2.32 and 2.07 (p for trend <0.0001); the respective HRs in women (1–89, 90–194 and ≥195 mg/day) were 1.18, 1.57 and 1.24 (p for trend 0.1159).

Conclusions/interpretation  Cigarette smoking is an important modifiable risk factor of type 2 diabetes particularly in men from the general population

.Keywords  Lifestyle - Population - Risk - Smoking - Type 2 diabetes