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zoom RSS 禁煙後の糖尿病発症増加

<<   作成日時 : 2010/01/06 20:07   >>

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画像 新たな研究で、喫煙を止めるとその後の数年で糖尿病を発症するリスクが増加するという。体重増加するので糖尿病発症と関連するのは驚くことではない。喫煙しないことの利点の方がリスクに勝るので、喫煙継続の弁解に使われるべきではない。
 中年の人の11,000人の9年間の追跡調査によれば、1,254人がU型糖尿病を発症した。380人は喫煙を中止した人であり、糖尿病発症リスクは70%高かった。喫煙継続者は30%リスクが高かった。喫煙中止者の発症リスク増加は約6年間認められ、約10年で消失した。
 喫煙中止者は3年後にウエストが平均1.25インチ増加し、体重は8.4ポンド増加した。
----------------------------------------------------
Quitting Smoking Can Raise Diabetes Risk
But interventions can keep the illness at bay, experts say
By Ed EdelsonHealthDay Reporter
http://health.msn.com/health-topics/diabetes/articlepage.aspx?cp-documentid=100252074

MONDAY, Jan. 4 (HealthDay News) -- Smokers who give up the habit have an increased risk of developing diabetes over the next few years, a new study finds.

The finding wasn't a surprise, since smokers typically gain weight when they quit, and weight gain is associated with diabetes, noted study author Hsin-Chieh Yeh, an assistant professor of general internal medicine and epidemiology at the Johns Hopkins University School of Medicine in Baltimore.

And the finding should not be used as excuse to keep smoking, Yeh said, since the benefits of not smoking far outweigh the risk seen in the study and there are simple measures to cut the odds for diabetes.

"The main message we would like to convey is that quitting smoking is good," she said. However, "when a person quits, the physician should pay additional attention in terms of weight measurement and counseling."

The study is published in the Jan. 5 issue of the Annals of Internal Medicine.

Yeh and her colleagues studied almost 11,000 middle-aged people who were not diabetic when the study began. Over nine years, 1,254 of them developed type 2 diabetes, in which the body gradually loses the ability to maintain proper levels of blood sugar.

Among the 380 participants who gave up smoking, the incidence of newly developed diabetes was 70 percent higher than among those who never smoked. Continuing smokers also had a greater risk of developing diabetes in that period, 30 percent higher than for nonsmokers.

"The higher risk for smokers who quit was seen for about six years out," Yeh said. "It became attenuated and disappeared after about 10 years."

The increased risk was directly related to the amount of weight gain seen in the former smokers, Yeh said. In the first three years after quitting, the average weight gain for former smokers was 8.4 pounds, with an average 1.25-inch increase in waist circumference.

In addition to paying attention to weight, "we would suggest that physicians seeing former smokers check on glucose levels more frequently as a means of early detection of diabetes," Yeh said.

Of course, it's better to have never smoked at all, since smoking is also an established risk factor for diabetes, said Dr. Richard Bergenstal, executive director of the International Diabetes Center in Minneapolis, and newly appointed president of medicine and science at the American Diabetes Association. He added that for someone who already smokes, "stopping is critically important."

"Someone at risk for diabetes who stops smoking should have blood sugars checked on a regular basis and should have counseling on weight gain," Bergenstal said. "If diabetes is detected, it should be treated in an effective way, according to American Diabetes Association guidelines."

Effective treatment starts with lifestyle measures such as proper diet and physical activity to prevent obesity, with medication if necessary, he said.

"Lets get rid of the known risk factors," including smoking, Bergenstal said. "If blood sugar levels become elevated, we do have treatments for that."

More information

There's more on preventing diabetes at the American Diabetes Association.
SOURCES: Hsin-Chieh Yeh, Ph.D, assistant professor, general internal medicine, epidemiology, Johns Hopkins University School of Medicine, Baltimore; Richard Bergenstal, M.D., exeutive director, International Diabetes Center, Minneapolis, president, medicine and science, American Diabetes Association; Jan 5, 2010, Annals of Internal Medicine

Copyright (c) 2009 ScoutNews, LLC. All rights reserved.

--------------------------------------------------
Smoking, Smoking Cessation, and Risk for Type 2 Diabetes Mellitus
A Cohort Study

1. Hsin-Chieh Yeh, PhD;
2. Bruce B. Duncan, MD, PhD;
3. Maria Ine^s Schmidt, PhD;
4. Nae-Yuh Wang, PhD; and
5. Frederick L. Brancati, MD, MHS

+ Author Affiliations
1. From The Johns Hopkins University, Baltimore, Maryland; Federal University of Rio Grande do Sul, Porto Alegre, Brazil; and University of North Carolina, Chapel Hill, North Carolina.

Abstract

Background: Cigarette smoking is an established predictor of incident type 2 diabetes mellitus, but the effects of smoking cessation on diabetes risk are unknown.

Objective: To test the hypothesis that smoking cessation increases diabetes risk in the short term, possibly owing to cessation-related weight gain.

Design: Prospective cohort study.

Setting: The ARIC (Atherosclerosis Risk in Communities) Study.

Patients: 10 892 middle-aged adults who initially did not have diabetes in 1987 to 1989.

Measurements: Smoking was assessed by interview at baseline and at subsequent follow-up. Incident diabetes was ascertained by fasting glucose assays through 1998 and self-report of physician diagnosis or use of diabetes medications through 2004.

Results: During 9 years of follow-up, 1254 adults developed type 2 diabetes. Compared with adults who never smoked, the adjusted hazard ratio of incident diabetes in the highest tertile of pack-years was 1.42 (95% CI, 1.20 to 1.67). In the first 3 years of follow-up, 380 adults quit smoking. After adjustment for age, race, sex, education, adiposity, physical activity, lipid levels, blood pressure, and ARIC Study center, compared with adults who never smoked, the hazard ratios of diabetes among former smokers, new quitters, and continuing smokers were 1.22 (CI, 0.99 to 1.50), 1.73 (CI, 1.19 to 2.53), and 1.31 (CI, 1.04 to 1.65), respectively. Further adjustment for weight change and leukocyte count attenuated these risks substantially. In an analysis of long-term risk after quitting, the highest risk occurred in the first 3 years (hazard ratio, 1.91 [CI, 1.19 to 3.05]), then gradually decreased to 0 at 12 years.

Limitation: Residual confounding is possible even with meticulous adjustment for established diabetes risk factors.

Conclusion: Cigarette smoking predicts incident type 2 diabetes, but smoking cessation leads to higher short-term risk. For smokers at risk for diabetes, smoking cessation should be coupled with strategies for diabetes prevention and early detection.

Primary Funding Source: National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases.


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