Cho Nam H, Chan Juliana C N, Jang Hak Chul, Lim Soo, Kim Hyung L, Choi Sung Hee
Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Korea.
Clin Endocrinol (Oxf). 2009 Nov;71(5):679-85. doi: 10.1111/j.1365-2265.2009.03586.x. Epub 2009 Mar 28.
We investigated the association between smoking and its additive effects with insulin resistance and beta-cell function on the incidence of type 2 diabetes in a prospective population-based cohort study.
A total of 10 038 subjects were recruited from rural and urban areas. All subjects underwent 75 g oral glucose tolerance tests and full biochemical assessments at baseline and during 4-year follow-up period. The final analysis was limited to 4041 men due to the low smoking rates in women.
The ex- and heavy current smokers had the highest incidence of diabetes of 12.5% and 11.1% respectively, compared with never-smokers (7.9%) during 4 years. After multivariate adjustment by Cox-proportional hazard model, ex- and current smokers reveal a relative risk of 1.60 (95% CI: 1.07-2.39), 2.06 (1.35-3.16, for <20 cigarettes/day) and 2.41 (1.48-3.93, for > or =20 cigarettes/day) respectively compared with never smokers. The risk of new onset diabetes was the highest in those with low homeostasis model assessment for beta cell function (HOMA-beta) and high homeostasis model assessment for insulin resistance (HOMA-IR) group in both smokers and never smokers.
Smoking is an independent risk factor for type 2 diabetes mellitus and showed synergistic interaction with the status of low insulin secretion and high insulin resistance for developing diabetes. Given the high rates of smoking and growing burden of diabetes in the world, cessation of smoking should be considered as one of the key factors for diabetes prevention and treatment programmes.
在一项基于人群的前瞻性队列研究中，我们调查了吸烟及其与胰岛素抵抗和β细胞功能的相加效应在2型糖尿病发病中的关联。
共招募了10038名来自农村和城市地区的受试者。所有受试者在基线和4年随访期间均接受了75克口服葡萄糖耐量试验和全面的生化评估。由于女性吸烟率较低，最终分析仅限于4041名男性。
在4年期间，既往吸烟者和重度当前吸烟者的糖尿病发病率最高，分别为12.5%和11.1%，而从不吸烟者为7.9%。经Cox比例风险模型进行多变量调整后，既往吸烟者和当前吸烟者与从不吸烟者相比，相对风险分别为1.60（95%CI：1.07 - 2.39）、2.06（1.35 - 3.16，每天<20支香烟）和2.41（1.48 - 3.93，每天≥20支香烟）。在吸烟者和从不吸烟者中，β细胞功能稳态模型评估（HOMA-β）低且胰岛素抵抗稳态模型评估（HOMA-IR）高的组中，新发糖尿病风险最高。
吸烟是2型糖尿病的独立危险因素，并且在发生糖尿病方面与低胰岛素分泌和高胰岛素抵抗状态表现出协同相互作用。鉴于全球吸烟率高且糖尿病负担不断增加，戒烟应被视为糖尿病预防和治疗计划的关键因素之一。
