Cigarette smoking and diabetes mellitus: evidence of a positive association from a large prospective cohort study.

OBJECTIVE Only a few prospective studies have examined the relationship between the frequency of cigarette smoking and the incidence of diabetes mellitus. The purpose of this study was to determine whether greater frequency of cigarette smoking accelerated the development of diabetes mellitus, and whether quitting reversed the effect. METHODS Data were collected in the Cancer Prevention Study I, a prospective cohort study conducted from 1959 through 1972 by the American Cancer Society where volunteers recruited more than one million acquaintances in 25 US states. From these over one million original participants, 275,190 men and 434,637 women aged > or = 30 years were selected for the primary analysis using predetermined criteria. RESULTS As smoking increased, the rate of diabetes increased for both men and women. Among those who smoked > or = 2 packs per day at baseline, men had a 45% higher diabetes rate than men who had never smoked; the comparable increase for women was 74%. Quitting smoking reduced the rate of diabetes to that of non-smokers after 5 years in women and after 10 years in men. CONCLUSIONS A dose-response relationship seems likely between smoking and incidence of diabetes. Smokers who quit may derive substantial benefit from doing so. Confirmation of these observations is needed through additional epidemiological and biological research.

[1]  A. Evans.  Causation and Disease: The Henle-Koch Postulates Revisited 1 , 1976, The Yale journal of biology and medicine.

[2]  D. E. Lamphiear,et al.  Diabetes mellitus in Tecumseh, Michigan. Prevalence, incidence, and associated conditions. , 1982, American journal of epidemiology.

[3]  J. Manson,et al.  Cigarette smoking and the risk of diabetes in women. , 1993, American journal of public health.

[4]  E. Barrett-Connor,et al.  Cardiovascular disease risk factors prior to the diagnosis of impaired glucose tolerance and non-insulin-dependent diabetes mellitus in a community of older adults. , 1990, American journal of epidemiology.

[5]  Hammond Ec,et al.  Smoking in relation to the death rates of one million men and women. , 1966 .

[6]  H. Shimizu,et al.  Effects of smoking on the incidence of non-insulin-dependent diabetes mellitus. Replication and extension in a Japanese cohort of male employees. , 1997, American journal of epidemiology.

[7]  H. King,et al.  Factors associated with the development of diabetes in the Micronesian population of Nauru. , 1985, American journal of epidemiology.

[8]  C. Jung,et al.  Glucose transporters and insulin action: Some insights into diabetes management , 1999, Archives of pharmacal research.

[9]  L. Garfinkel.  Selection, follow-up, and analysis in the American Cancer Society prospective studies. , 1985, National Cancer Institute monograph.

[10]  P. Whincup,et al.  Prospective study of risk factors for development of non-insulin dependent diabetes in middle aged British men , 1995, BMJ.

[11]  D Hoffmann,et al.  The changing cigarette, 1950-1995. , 1997, Journal of toxicology and environmental health.

[12]  E. Feskens,et al.  Cardiovascular risk factors and the 25-year incidence of diabetes mellitus in middle-aged men , 1989 .

[13]  E. Feskens,et al.  Cardiovascular risk factors and the 25-year incidence of diabetes mellitus in middle-aged men. The Zutphen Study. , 1989, American journal of epidemiology.

[14]  D. Williamson,et al.  Weight change and diabetes incidence: findings from a national cohort of US adults. , 1997, American journal of epidemiology.

[15]  M. Harris,et al.  Undiagnosed NIDDM: Clinical and Public Health Issues , 1993, Diabetes Care.

[16]  B. Kahn,et al.  Glucose transporters and insulin action--implications for insulin resistance and diabetes mellitus. , 1999, The New England journal of medicine.

[17]  M. Djordjevic,et al.  The changing cigarette. , 1997, Preventive medicine.

[18]  E. Rimm,et al.  Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men , 1995, BMJ.

[19]  P. Vokonas,et al.  Obesity and body fat distribution in relation to the incidence of non-insulin-dependent diabetes mellitus. A prospective cohort study of men in the normative aging study. , 1992, American journal of epidemiology.

[20]  R. Paffenbarger,et al.  Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus. , 1991, The New England journal of medicine.

[21]  J. Medalie,et al.  Major factors in the development of diabetes mellitus in 10,000 men. , 1975, Archives of internal medicine.

[22]  J. Zierath,et al.  Altered skeletal muscle glucose transport and blood lipid levels in habitual cigarette smokers. , 1999, Clinical physiology.

[23]  R. Paffenbarger,et al.  Chronic disease in former college students. XII. Early precursors of adult-onset diabetes mellitus. , 1973, American journal of epidemiology.

[24]  K. Narayan,et al.  Rate of Weight Gain, Weight Fluctuation, and Incidence of NIDDM , 1995, Diabetes.

[25]  K. Anderson,et al.  Epidemiology of diabetes mellitus in the elderly. The Framingham Study. , 1986, The American journal of medicine.

[26]  L. Kuller,et al.  Risk Factors for the Development of Type II Diabetes Among Men Enrolled in the Usual Care Group of the Multiple Risk Factor Intervention Trial , 1993, Diabetes Care.

[27]  P. Bennett,et al.  Prevalence of Diabetes and Impaired Glucose Tolerance and Plasma Glucose Levels in U.S. Population Aged 20–74 Yr , 1987, Diabetes.

[28]  David A. Schoenfeld,et al.  Partial residuals for the proportional hazards regression model , 1982 .