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Smoking and the risk of type 2 diabetes in Japan: A systematic review and meta-analysis - PubMed

Review

Smoking and the risk of type 2 diabetes in Japan: A systematic review and meta-analysis

Shamima Akter et al. J Epidemiol. 2017 Dec.

Abstract

Cigarette smoking is the leading avoidable cause of disease burden. Observational studies have suggested an association between smoking and risk of type 2 diabetes mellitus (T2DM). We conducted a meta-analysis of prospective observational studies to investigate the association of smoking status, smoking intensity, and smoking cessation with the risk of T2DM in Japan, where the prevalence of smoking has been decreasing but remains high. We systematically searched MEDLINE and the Ichushi database to December 2015 and identified 22 eligible articles, representing 343,573 subjects and 16,383 patients with T2DM. We estimated pooled relative risks (RRs) using a random-effects model and conducted subgroup analyses by participant and study characteristics. Compared with nonsmoking, the pooled RR of T2DM was 1.38 (95% confidence interval [CI], 1.28-1.49) for current smoking (19 studies) and 1.19 (95% CI, 1.09-1.31) for former smoking (15 studies). These associations persisted in all subgroup and sensitivity analyses. We found a linear dose-response relationship between cigarette consumption and T2DM risk; the risk of T2DM increased by 16% for each increment of 10 cigarettes smoked per day. The risk of T2DM remained high among those who quit during the preceding 5 years but decreased steadily with increasing duration of cessation, reaching a risk level comparable to that of never smokers after 10 years of smoking cessation. We estimated that 18.8% of T2DM cases in men and 5.4% of T2DM cases in women were attributable to smoking. The present findings suggest that cigarette smoking is associated with an increased risk of T2DM, so tobacco control programs to reduce smoking could have a substantial effect to decrease the burden of T2DM in Japan.

Keywords: Japanese; Meta-analysis; Smoking; Smoking cessation; Systematic review; Type 2 diabetes.

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Figures

Fig. 1
Fig. 1

Flowchart of the selection of studies included in meta-analysis.

Fig. 2
Fig. 2

Adjusted relative risk for current smokers compared with non-smokers. CI, confidence interval; RR, relative risk.

Fig. 3
Fig. 3

Adjusted relative risk for past smokers compared with nonsmokers. CI, confidence interval; RR, relative risk.

Fig. 4
Fig. 4

Linear dose-response relationship between cigarette smokes per day and relative risk of diabetes among total subjects (P for non-linearity = 0.08). Data were modeled with random-effects restricted cubic spline models with three knots placed at 10th, 50th, and 90th percentiles of cigarette smokes per day. Lines with long dashes represent the pointwise 95% confidence intervals for the fitted linear trend (solid line). Line with short dashes represents the linear trend.

Fig. 5
Fig. 5

Relationship between duration of smoking cessation and relative risk of diabetes. Data were pooled using random-effects meta-analysis from three studies that presented data for duration of smoking cessation. Error bars show 95% confidence intervals.

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