Catch 22 For Diabetics Who Stop Smoking To Improve Their Health

It is a proven fact that cigarette smoking is a primary cause of many diseases, including cardiovascular disease and cancer. Smoking is also known to increase the risks associated with insulin resistance, and the possibility of developing diabetes. At the same time, quitting smoking is recognized as an important means of modifying the risk factors for chronic diseases, including diabetes, and is seen as a way to prevent complications from diabetes, and to control diabetes.

Research into the cause, effect, prevention and risk of diabetes is ongoing, and this includes studies that focus on cigarette smoking and its role in the life of diabetic patients. Overall the evidence that those suffering from type 2 diabetes (also called type 2 diabetes mellitus or T2DM) will benefit long-term from not smoking is overwhelming, although a new study warns that there are short-term risks.

New Study On Smoking And Diabetes

One of the most recent studies involving diabetes and smoking was published in The Lancet Diabetes & Endocrinology in June this year (2015). Titled The association between smoking cessation and glycaemic control in patients with type 2 diabetes: a THIN (see below) database cohort study, it found that a variety of health risks were commonly experienced for three to five years after diabetics had quit. 

According to the study that took place over a five-year period from January 1, 2005 to December 31, 2010, diabetics who don’t stop smoking do not face the short-term health risks those who do quit face. Previous studies show that those who do manage to quit take just 10 to 12 years to get to a situation where their health risks are equal to those of diabetics who have never smoked tobacco. So even though there’s a risk, it’s a calculated risk that many, if not most should be willing to take.

The study, which was retrospective, involved 10,692 adult smokers with type 2 diabetes, some of whom had abstained or quit. Data was obtained from a large UK primary care database, The Health Improvement Network (THIN). Researchers examined altered diabetes control in relation to smoking and quitting, taking weight change into account. Their primary finding was that hemoglobin A1c (a pigment in the blood that carries oxygen and is bound to glucose, also referred to as HbA_1c) increased within the first year after a large percentage of smokers with T2DM had quit, and then gradually decreased. After three years, the HbA_1c of smokers and those who had given up was the same. 

Researchers found that weight change did not play a role in the change. More specifically:

• A total of 3,131 (29 percent) of those who quit smoking for at least a year experienced a 0.21 percent increase in HbA_1c. This level decreased gradually over the next two years for those who did not start smoking again.
• A total of 5,831 (55 percent) of those who continued to smoke experienced a very gradual increase in HbA_1c. After three years these levels were equal to those of the quitters.

Principal study researcher from the British Coventry University’s Faculty of Health and Life Studies, Dr Deborah Lycett states that she believes it is crucial for diabetics to stop smoking. If they don’t, she warns, complications of the disease can (and do) lead to “early death.” For this reason, people who suffer from diabetes should do everything possible to quit. But because of the deterioration in control of blood glucose levels when they do give up, it is essential to take extra care to ensure that blood glucose is well controlled. As far as she is concerned, this is an essential way to maximize the benefits of stopping smoking.

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The knowledge that blood glucose control will deteriorate when they stop smoking will help those with diabetes to prepare, and prompt their clinicians to “be proactive in tightening their glycaemic control during this time,” she said. 

Negative Impact Of Smoking For Those with Diabetes

Previous research into smoking and diabetes supports the findings of the newly published study report. Numerous studies indicate that smoking worsens the prognosis of patients and it has been shown to increase the incidence of depression. It also increases the risks of coronary heart disease (CHD), increases the possibility of both microvascular and macrovascular complications, and is associated with inflammation, insulin resistance, and dyslipidemia, a disorder of lipoprotein metabolism that increases bad low-density lipoprotein (LDL) cholesterol and decreases the good high-density lipoprotein (HDL) cholesterol in the blood. 

Ironically though, the proof that smoking is a modifiable risk factor does not appear to have made a major impact on diabetic smokers — yet. Generally research (including the latest study) shows that less than half of smokers with diabetes quit. Worse, there is evidence that a large percentage of clinicians and doctors do not warn their diabetic patients about the advisability of stopping or at least cutting down on smoking. 

What Research Tells Us About Smoking And Diabetes

While research studies over the years have tended to have a different focus to one another, it is clear from overall results that never smoking is the best option in terms of helping to avoid type 2 diabetes. 

A relatively early study (1), published by the British Medical Journal in 2000 looked at the risks for type 2 diabetic patients that are associated with glycaemia. The primary concern of researchers related to macrovascular and microvascular complications, but other complications including stroke, were considered. They found that “any end point or deaths related to diabetes and all cause mortality.” So this is a real concern for diabetics quitting smoking.

Another British study (10) published in 2001 attempted to determine whether smoking accelerated the onset of diabetes mellitus and whether quitting cigarettes could reverse diabetes. Data from 709,827 people older than 30, who had been involved in a cancer prevention study, was used. It found that as these people had increased their smoking habits, the rate of diabetes also increased. When they quit, it took five years (for women) and 10 years (for men) to reduce their diabetes rate to that of people who didn’t smoke.

A US study, Diabetic Patients Who Smoke: Are They Different? Published in 2004 (3) highlighted the importance of encouraging diabetics to quite smoking. While relatively few people (under 2,000) were involved in the study, researchers found that diabetic patients who smoke get more depressed than others.

A study by Arshag D Mooradia on the occurrence of dyslipidemia in T2DM, published in 2009 (4) found this disease to be a major risk factor for CVD in patients with type 2 diabetes. He emphasized the major risks of mortality, though did not discuss smoking.

A nine-year study (5) published in 2010 involved 10,892 middle-aged adults who did not have diabetes, but who did smoke. Researchers found that 1,254 of them developed type 2 diabetes and that the highest risk for those who quit because of this, was in the first three years. This tallies with the new study findings.

Another study (6) that focused specifically on smoking and T2DM was published in the Diabetes & Metabolism Journal (dmj) in 2012. Undertaken by Sang Ah Chang in Korea, it covered a wide range of factors linking diabetes and smoking, and quoted many more studies undertaken in various parts of the world. 

A 10-year study in Japan (7) published in 2012 looked at similar issues to the newly published study quoted earlier, including possible risk factors of quitting as well as weight gain. A total of 59,834 diabetic adults were involved in the study, and again, there was found to be an increased risk when they quit. While weight was not an issue, heavier smokers were found to be more at risk.

Another Japanese study published in 2012 (8) looked at the impact of diabetics quitting smoking, and linked this to weight. The study took more than nine years and involved 2,070 non-smokers, smokers, and men who had previously smoked, none of whom had diabetes. A relatively small number (246) developed diabetes and those who quit were found to be at risk in terms of becoming overweight.  

An American study published in 2013 (9) looked at the association of weight change and smoking cessation in adults with cardiovascular disease (CVD), some of whom had diabetes. A major concern was that while smoking reduces the risk of CVD, it often leads to weight gain that is counter-productive, and can itself increase CVD risks. Data was collected between 1984 and 2011 and analyzed over six-year periods in terms of smoking, non-smoking, and quitting. Even though non-smokers tended to gain more weight, diabetics were at greater risk of CVD “events.”

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As Sang Ah Chang concluded in his research paper (6), it is essential to educate patients attending diabetic clinics about the importance of not smoking cigarettes. It is also vital to encourage programs that help diabetics stop smoking and manage their illness proactively. Forget the Catch 22!