Diabetes Metab J.  2021 Jul;45(4):539-546. 10.4093/dmj.2020.0061.

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

• Park SE
• Seo MH
• Cho JH
• Kwon H
• Kim YH
• Han KD
• Jung JH
• Park YG
• Rhee EJ
• Lee WY

• KMID: 2518896
• DOI: http://doi.org/10.4093/dmj.2020.0061

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.

Keyword

Diabetes; Risk factors; Smoking; Smoking cessation; Weight

Figure

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  Fig. 1. Risk of diabetes according to intensity of smoking in packs per day. HR, hazard ratio; CI, confidence interval.

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  Fig. 2. Smoking status and risk of diabetes by subgroup. HR, hazard ratio; CI, confidence interval.

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