From the Guidelines
Smoking cigarettes does impact the progression from prediabetes to diabetes, and quitting smoking is essential for diabetes prevention. According to the standards of medical care in diabetes-2021 1, people with prediabetes often have other cardiovascular risk factors, including hypertension and dyslipidemia, and are at increased risk for cardiovascular disease. Evaluation for tobacco use and referral for tobacco cessation, if indicated, should be part of routine care for those at risk for diabetes.
Key Points to Consider
- The years immediately following smoking cessation may represent a time of increased risk for diabetes 1, highlighting the need for monitoring and evidence-based lifestyle behavior change for diabetes prevention.
- Lifestyle interventions for weight loss in study populations at risk for type 2 diabetes have shown a reduction in cardiovascular risk factors and the need for medications used to treat these cardiovascular risk factors 1.
- Quitting smoking can significantly reduce the risk of developing type 2 diabetes, with former smokers showing progressively lower diabetes risk as years since quitting increase.
Recommendations for Clinical Practice
- Smoking cessation should be considered an essential part of diabetes prevention alongside other interventions like weight management, regular physical activity, and healthy eating patterns.
- Healthcare providers should evaluate tobacco use and refer patients to tobacco cessation programs as part of routine care for those at risk for diabetes.
- Patients who have quit smoking should be monitored for diabetes development and receive concurrent evidence-based lifestyle behavior change for diabetes prevention.
From the Research
Impact of Smoking on Progression from Prediabetes to Diabetes
- Smoking cigarettes has been shown to increase the risk of developing type 2 diabetes, with studies indicating a 50% increased risk for diabetes in smoking men and women 2.
- The relationship between smoking and prediabetes has been assessed in several studies, with one analysis finding that current smokers had an odds ratio of pre-diabetes of 1.82 (95% CI 1.39; 2.38, p <0.0001) compared to never smokers 3.
- Smoking is also associated with an increased risk of macrovascular and microvascular complications in patients with diabetes, and may contribute to the pathogenesis of type 2 diabetes 4.
- The mechanisms explaining the relationship between smoking and the development of diabetes are not fully understood, although several hypotheses have been put forward, including insulin resistance, inflammation, and endothelial dysfunction 2, 4.
- Quitting smoking has been shown to have benefits in terms of reducing or slowing the risk of cardiovascular morbidity and mortality in people with diabetes, but its role in preventing the onset of diabetes and delaying the development of its complications is less clear 5, 6.
Key Findings
- Smoking is strongly associated with pre-diabetes in young adults with a low burden of smoking exposure 3.
- Nicotine dependence could be a potential mechanism of the relationship between smoking and pre-diabetes 3.
- Smoking cessation is important to prevent macrovascular complications in diabetes, and may also have a role in limiting microvascular disease and facilitating glycaemic management 4.
- The current evidence does not seem to unequivocally suggest a positive role for quitting in patients with diabetes, with some studies finding that quitting smoking can have a negative impact on body weight, glycemic control, and subsequent increased risk of new-onset diabetes 5.