Diabetes Research Centre, Univerisity of Leicester, Leicester, UK.
Academic Unit of Diabetes and Endocrinology, University of Sheffield, Sheffield, UK.
Acta Diabetol. 2019 Aug;56(8):839-850. doi: 10.1007/s00592-019-01293-x. Epub 2019 Feb 24.
Smoking is a strong risk factor for albuminuria in people with type 2 diabetes mellitus (T2DM). However, it is unclear whether this sequela of smoking is brought about by its action on cardiometabolic parameters or the relationship is independent. The aim of this systematic review is to explore this relationship.
Electronic databases on cross-sectional and prospective studies in Medline and Embase were searched from January 1946 to May 2018. Adult smokers with T2DM were included, and other types of diabetes were excluded.
A random effects meta-analysis of 20,056 participants from 13 studies found that the odds ratio (OR) of smokers developing albuminuria compared to non-smokers was 2.13 (95% CI 1.32, 3.45). Apart from smoking, the odds ratio of other risk factors associated with albuminuria were: age 1.24 (95% CI 0.84, 1.64), male sex 1.39 (95% CI 1.16, 1.67), duration of diabetes 1.78 (95% CI 1.32, 2.23), HbA1c 0.63 (95% CI 0.45, 0.81), SBP 6.03 (95% CI 4.10, 7.97), DBP 1.85 (95% CI 1.08, 2.62), total cholesterol 0.06 (95% CI - 0.05, 0.17) and HDL cholesterol - 0.01 (95% CI - 0.04, 0.02), triglyceride 0.22 (95% CI 0.12, 0.33) and BMI 0.40 (95% CI 0.00-0.80). When the smoking status was adjusted in a mixed effect meta-regression model, the duration of diabetes was the only statistically significant factor that influenced the prevalence of albuminuria. In smokers, each year's increase in the duration of T2DM was associated with an increased risk of albuminuria of 0.19 units (95% CI 0.07, 0.31) on the log odds scale or increased the odds approximately by 23%, compared to non-smokers. Prediction from the meta-regression model also suggested that the odds ratios of albuminuria in smokers after a diabetes duration of 9 years and 16 years were 1.53 (95% CI 1.10, 2.13) and 5.94 (95% CI 2.53, 13.95), respectively.
Continuing to smoke and the duration of diabetes are two strong predictors of albuminuria in smokers with T2DM. With a global surge in younger smokers developing T2DM, smoking cessation interventions at an early stage of disease trajectory should be promoted.
吸烟是 2 型糖尿病（T2DM）患者发生白蛋白尿的一个重要危险因素。然而，目前尚不清楚这种吸烟的后遗症是由其对心血管代谢参数的作用引起的，还是这种关系是独立的。本系统评价的目的是探讨这种关系。
检索 Medline 和 Embase 数据库中 1946 年 1 月至 2018 年 5 月的横断面和前瞻性研究的电子数据库。纳入成年 T2DM 吸烟者，排除其他类型的糖尿病。
对来自 13 项研究的 20056 名参与者进行随机效应荟萃分析发现，与不吸烟者相比，吸烟者发生白蛋白尿的优势比（OR）为 2.13（95%置信区间 1.32，3.45）。除吸烟外，与白蛋白尿相关的其他危险因素的 OR 分别为：年龄 1.24（95%置信区间 0.84，1.64）、男性 1.39（95%置信区间 1.16，1.67）、糖尿病病程 1.78（95%置信区间 1.32，2.23）、HbA1c 0.63（95%置信区间 0.45，0.81）、SBP 6.03（95%置信区间 4.10，7.97）、DBP 1.85（95%置信区间 1.08，2.62）、总胆固醇 0.06（95%置信区间-0.05，0.17）和 HDL 胆固醇-0.01（95%置信区间-0.04，0.02）、甘油三酯 0.22（95%置信区间 0.12，0.33）和 BMI 0.40（95%置信区间 0.00-0.80）。在混合效应荟萃回归模型中调整吸烟状况后，糖尿病病程是唯一具有统计学意义的影响白蛋白尿患病率的因素。在吸烟者中，T2DM 病程每年增加，与非吸烟者相比，白蛋白尿的风险增加 0.19 个单位（95%置信区间 0.07，0.31），或风险增加约 23%。荟萃回归模型的预测还表明，吸烟者在糖尿病病程 9 年和 16 年后发生白蛋白尿的优势比分别为 1.53（95%置信区间 1.10，2.13）和 5.94（95%置信区间 2.53，13.95）。
持续吸烟和糖尿病病程是 T2DM 吸烟者发生白蛋白尿的两个重要预测因素。随着全球年轻吸烟者中 T2DM 的发病率上升，应在疾病轨迹的早期阶段开展戒烟干预。
