RESEARCH · October 21, 2014
TAKE-HOME MESSAGE
- This multinational prospective case-cohort study examined the relationship between smoking and incident type 2 diabetes. The hazard ratios of type 2 diabetes among men were 1.40 for former smokers and 1.43 for current smokers, irrespective of age, education, center, physical activity, and ingestion of alcohol, coffee, and meat. Correlations among women were not as strong, with hazard ratios of 1.18 for former smokers and 1.13 for current smokers.
- Smoking may be considered as a modifiable risk factor for type 2 diabetes in both men and women.
ABSTRACT
OBJECTIVE
The aims of this study were to investigate the association between smoking and incident type 2 diabetes, accounting for a large number of potential confounding factors, and to explore potential effect modifiers and intermediate factors.
RESEARCH DESIGN AND METHODS
The European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct is a prospective case-cohort study within eight European countries, including 12,403 cases of incident type 2 diabetes and a random subcohort of 16,835 individuals. After exclusion of individuals with missing data, the analyses included 10,327 cases and 13,863 subcohort individuals. Smoking status was used (never, former, current), with never smokers as the reference. Country-specific Prentice-weighted Cox regression models and random-effects meta-analysis were used to estimate hazard ratios (HRs) for type 2 diabetes.
RESULTS
In men, the HRs (95% CI) of type 2 diabetes were 1.40 (1.26, 1.55) for former smokers and 1.43 (1.27, 1.61) for current smokers, independent of age, education, center, physical activity, and alcohol, coffee, and meat consumption. In women, associations were weaker, with HRs (95% CI) of 1.18 (1.07, 1.30) and 1.13 (1.03, 1.25) for former and current smokers, respectively. There was some evidence of effect modification by BMI. The association tended to be slightly stronger in normal weight men compared with those with overall adiposity.
CONCLUSIONS
Former and current smoking was associated with a higher risk of incident type 2 diabetes compared with never smoking in men and women, independent of educational level, physical activity, alcohol consumption, and diet. Smoking may be regarded as a modifiable risk factor for type 2 diabetes, and smoking cessation should be encouraged for diabetes prevention.
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