Dose-Dependent Effect of Smoking on Risk of Diabetes Remains after Smoking Cessation: A Nationwide Population-Based Cohort Study in Korea

다국어 초록 (Multilingual Abstract)

Background This study aimed to evaluate the dose-dependent effects of smoking on risk of diabetes among those quitting smoking.
Methods We analyzed clinical data from a total of 5,198,792 individuals age 20 years or older who received health care check-up arranged by the national insurance program of Korea between 2009 and 2016 using the Korean National Health Insurance Service database. Cumulative smoking was estimated by pack-years. Smokers were classified into four categories according to the amount of smoking: light smokers (0.025 to 5 smoking pack-years), medium smokers (5 to 14 smoking pack-years), heavy smokers (14 to 26 smoking pack-years), and extreme smokers (more than 26 smoking pack-years).
Results During the study period, 164,335 individuals (3.2% of the total population) developed diabetes. Compared to sustained smokers, the risk of diabetes was significantly reduced in both quitters (hazard ratio [HR], 0.858; 95% confidence interval [CI], 0.838 to 0.878) and nonsmokers (HR, 0.616; 95% CI, 0.606 to 0.625) after adjustment for multiple risk factors. The risk of diabetes gradually increased with amount of smoking in both quitters and current smokers. The risk of diabetes in heavy (HR, 1.119; 95% CI, 1.057 to 1.185) and extreme smokers (HR, 1.348; 95% CI, 1.275 to 1.425) among quitters was much higher compared to light smokers among current smokers.
Conclusion Smoking cessation was effective in reducing the risk of diabetes regardless of weight change. However, there was a potential dose-dependent association between smoking amount and the development of diabetes. Diabetes risk still remained in heavy and extreme smokers even after smoking cessation.

참고문헌 (Reference)

1 Aubin HJ, "Weight gain in smokers after quitting cigarettes: meta-analysis" 345 : e4439-, 2012

2 Li G, "The association between smoking and blood pressure in men : a cross-sectional study" 17 : 797-, 2017

3 Berlin I, "Smoking-induced metabolic disorders : a review" 34 (34): 307-314, 2008

4 Yeh HC, "Smoking, smoking cessation, and risk for type 2 diabetes mellitus : a cohort study" 152 : 10-17, 2010

5 Kong C, "Smoking is associated with increased hepatic lipase activity, insulin resistance, dyslipidaemia and early atherosclerosis in type 2 diabetes" 156 : 373-378, 2001

6 Hu Y, "Smoking cessation, weight change, type 2 diabetes, and mortality" 379 : 623-632, 2018

7 Jee SH, "Smoking and risk for diabetes incidence and mortality in Korean men and women" 33 : 2567-2572, 2010

8 장상아, "Smoking and Type 2 Diabetes Mellitus" 대한당뇨병학회 36 (36): 399-403, 2012

9 Shin DY, "Relationship with smoking and dyslipidemia in Korean adults" 8 : 73-79, 2017

10 곽수헌, "Pathophysiology of Type 2 Diabetes in Koreans" 대한내분비학회 33 (33): 9-16, 2018

11 Taylor R, "Pathogenesis of type 2 diabetes : tracing the reverse route from cure to cause" 51 : 1781-1789, 2008

12 Morimoto A, "Impact of cigarette smoking on impaired insulin secretion and insulin resistance in Japanese men : The Saku Study" 4 : 274-280, 2013

13 이은정, "Diabetes in Asians" 대한내분비학회 30 (30): 263-269, 2015

14 이용호, "Data Analytic Process of a Nationwide Population-Based Study Using National Health Information Database Established by National Health Insurance Service" 대한당뇨병학회 40 (40): 79-82, 2016

15 Chiolero A, "Consequences of smoking for body weight, body fat distribution, and insulin resistance" 87 : 801-809, 2008

16 Tamura U, "Changes in weight, cardiovascular risk factors and estimated risk of coronary heart disease following smoking cessation in Japanese male workers : HIPOP-OHP study" 17 : 12-20, 2010

17 송선옥, "Background and Data Configuration Process of a Nationwide Population-Based Study Using the Korean National Health Insurance System" 대한당뇨병학회 38 (38): 395-403, 2014

18 Ostgren CJ, "Associations between smoking and beta-cell function in a non-hypertensive and non-diabetic population. Skaraborg Hypertension and Diabetes Project" 17 : 445-450, 2000

19 Corrada MM, "Association of body mass index and weight change with all-cause mortality in the elderly" 163 : 938-949, 2006

20 김은하, "Association between Weight Changes after Smoking Cessation and Cardiovascular Disease among the Korean Population" 대한가정의학회 38 (38): 122-129, 2017

21 Willi C, "Active smoking and the risk of type 2 diabetes : a systematic review and meta-analysis" 298 : 2654-2664, 2007

22 Jha P, "21st-Century hazards of smoking and benefits of cessation in the United States" 368 : 341-350, 2013