| Cigarette smoking is implicated as a major risk factor for several serious and life-threatening diseases and conditions. It increases the risk of heart disease, lung cancer and emphysema, for example. Some studies, but not all, have indicated that smoking also increases the risk of type 2 diabetes, the type most common in the United States. A new study by a team of Japanese investigators, in the August 1 issue of the Annals of Internal Medicine lends further support to the evidence that implicates smoking as a risk factor for diabetes in middle-aged Japanese men.
Type 2 diabetes is typically seen in overweight or obese adults. People with type 2 diabetes typically have normal or higher than normal amounts of the hormone insulin in their blood. But their insulin does not lower blood sugar levels as well as it should. The levels of blood sugar thus rise, and, if chronically elevated, lead to a number of serious complications. These can include kidney failure, blindness, nerve and blood vessel disorders in the legs and feet, and heart disease.
While type 2 diabetes accounts for the great majority of diabetes in the United States, it had not been as common in Japan. It has, however, been much more frequently diagnosed there during the last 10 years, according to the study authors. These investigators, from Osaka and Tokyo, wanted to determine if smoking cigarettes was a risk factor for diabetes in Japanese men, as it is thought to be for American and other Western men.
In Japan, employers are required to conduct annual employee health examinations. The investigators followed the health status of 1,266 men who were 35 to 59 years old at the start of the study in 1994. The study lasted until 1999, so the subjects’ blood sugar levels were measured six times. The participants also completed a questionnaire on health-related behaviors at each health examination. These included queries about smoking, alcohol consumption and physical activity, plus medical history, family history of disease, and use of prescription medications. Body weight and height, as well as blood pressure were measured each year.
The authors found that as the number of cigarettes smoked per day and the subject’s length of time as a smoker increased, so did the risk of developing impaired fasting blood glucose, which is an early indicator of diabetes. Compared to people who had never smoked, even former smokers had an increased risk of both impaired fasting glucose and type 2 diabetes (by 62 percent and 8 percent, respectively). For current smokers, the risk of diabetes increased — by more than threefold for those who smoked 21 to 30 cigarettes per day, and more than fourfold for those who smoked more than 31 cigarettes per day.
Ex-smokers were heavier than people who had never smoked; the authors noted that this might in part account for their increased risk of diabetes, since being overweight is a known risk factor for diabetes.
The authors concluded: “Our findings support the conclusion that the number of cigarettes smoked daily and the number of pack-years of exposure are closely associated with the risk for impaired fasting glucose and type 2 diabetes.” They continued, “Our findings provide evidence that cigarette smoking is a modifiable risk factor that could be targeted for prevention of diabetes.”
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