Study links quitting smoking with deterioration in diabetes control

Sufferers of type 2 diabetes mellitus (T2DM) who quit smoking are likely to see a temporary deterioration in their glycaemic control which could last up to three years, according to new research published today in The Lancet Diabetes & Endocrinology.

The research team¹, led by Dr Deborah Lycett of Coventry University and funded by the NIHR School for Primary Care Research (SPCR) examined the primary care records of 10,692 adult smokers with T2DM over six years to investigate whether or not quitting was associated with altered diabetes control.

The study found that in the 3,131 (29%) people who quit and remained abstinent for at least one year, HbA1c – which is an average measurement indicating how well the body is controlling blood glucose levels² – increased by 2.3mmol/mol (0.21%) before decreasing gradually as abstinence continued (the higher the HbA1c level, the greater the risk of developing diabetes-related complications).

In the same period, 5,831 (55%) continual smokers – who did not change their smoking status during the study – experienced a more gradual increase in HbA1c, such that HbA1c levels in quitters became comparable with the levels seen in continual smokers three years after quitting.

The researchers used a regression model which examined each cohort with and without weight change data, concluding that weight changes often associated with quitting smoking did not significantly alter the association between smoking cessation and HbA1c levels.

Previous research³ has shown that a 1% (11mmol/mol) reduction in the HbA1c level of someone with diabetes will result in them being 16% less likely to suffer heart failure and 37% less likely to experience microvascular complications – indicating the significance of small percentage changes in HbA1c levels.

Principal investigator Dr Deborah Lycett from Coventry University's Faculty of Health and Life Sciences said:

Knowing that deterioration in blood glucose control occurs around the time of stopping smoking helps to prepare those with diabetes and their clinicians to be proactive in tightening their glycaemic control during this time.

Stopping smoking is crucial for preventing complications that lead to early death in those with diabetes. So people with diabetes should continue to make every effort to stop smoking, and at the same time they should expect to take extra care to keep their blood glucose well controlled and maximise the benefits of smoking cessation.

The study, entitled 'The Association between Smoking Cessation and HbA1c Control of Type 2 Diabetes Mellitus: A THIN database cohort study', is published today online and can be viewed here.

For further information, please contact Alex Roache, external press and media relations officer, Coventry University, on +44 (0)24 7765 5050 or email alex.roache@coventry.ac.uk.

NOTES TO EDITORS

¹ The research team comprised academics from Coventry University (principal investigator); University of Birmingham; University of Bradford; University of Nottingham; University of Bristol; and the University of Oxford.

² HbA1c (Haemoglobin A1c) refers to glycated haemoglobin, and develops when the protein haemoglobin in red blood cells joins with glucose. It is reflective of blood glucose levels over the last two to three months. The higher the HbA1c level, the greater the risk of developing diabetes-related complications. Someone without diabetes would expect their HbA1c to be in the range of 20-41mmol/mol (4%–5.9%), while an HbA1c level of 48mmol/mol (6.5%) is considered good control in someone who has diabetes.

³ Association of glycaemia with macrovascular and microvascular complications of Type 2 diabetes: prospective observational study, British Medical Journal 2000; 321: 405.

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