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Original Articles
Metabolic Risk/Epidemiology
Dose-Dependent Effect of Smoking on Risk of Diabetes Remains after Smoking Cessation: A Nationwide Population-Based Cohort Study in Korea
Se Eun Park, Mi Hae Seo, Jung-Hwan Cho, Hyemi Kwon, Yang-Hyun Kim, Kyung-Do Han, Jin-Hyung Jung, Yong-Gyu Park, Eun-Jung Rhee, Won-Young Lee
Diabetes Metab J. 2021;45(4):539-546.   Published online March 4, 2021
DOI: https://doi.org/10.4093/dmj.2020.0061
  • 7,608 View
  • 186 Download
  • 9 Web of Science
  • 12 Crossref
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
This study aimed to evaluate the dose-dependent effects of smoking on risk of diabetes among those quitting smoking.
Methods
We analyzed clinical data from a total of 5,198,792 individuals age 20 years or older who received health care check-up arranged by the national insurance program of Korea between 2009 and 2016 using the Korean National Health Insurance Service database. Cumulative smoking was estimated by pack-years. Smokers were classified into four categories according to the amount of smoking: light smokers (0.025 to 5 smoking pack-years), medium smokers (5 to 14 smoking pack-years), heavy smokers (14 to 26 smoking pack-years), and extreme smokers (more than 26 smoking pack-years).
Results
During the study period, 164,335 individuals (3.2% of the total population) developed diabetes. Compared to sustained smokers, the risk of diabetes was significantly reduced in both quitters (hazard ratio [HR], 0.858; 95% confidence interval [CI], 0.838 to 0.878) and nonsmokers (HR, 0.616; 95% CI, 0.606 to 0.625) after adjustment for multiple risk factors. The risk of diabetes gradually increased with amount of smoking in both quitters and current smokers. The risk of diabetes in heavy (HR, 1.119; 95% CI, 1.057 to 1.185) and extreme smokers (HR, 1.348; 95% CI, 1.275 to 1.425) among quitters was much higher compared to light smokers among current smokers.
Conclusion
Smoking cessation was effective in reducing the risk of diabetes regardless of weight change. However, there was a potential dose-dependent association between smoking amount and the development of diabetes. Diabetes risk still remained in heavy and extreme smokers even after smoking cessation.

Citations

Citations to this article as recorded by  
  • Dietary and other lifestyle factors and their influence on non-communicable diseases in the Western Pacific region
    Xiaomin Sun, Dong Keon Yon, Tuan Thanh Nguyen, Kumpei Tanisawa, Kumhee Son, Ling Zhang, Jing Shu, Wen Peng, Yuexin Yang, Francesco Branca, Mark L. Wahlqvist, Hyunjung Lim, Youfa Wang
    The Lancet Regional Health - Western Pacific.2024; 43: 100842.     CrossRef
  • The Concentrations of Interleukin-6, Insulin, and Glucagon in the Context of Obesity and Type 2 Diabetes and Single Nucleotide Polymorphisms in IL6 and INS Genes
    Magdalena Król-Kulikowska, Iwona Urbanowicz, Marta Kepinska, Mayank Choubey
    Journal of Obesity.2024; 2024: 1.     CrossRef
  • Chronic cigarette smoking is associated with increased arterial stiffness in men and women: evidence from a large population-based cohort
    Omar Hahad, Volker H. Schmitt, Natalie Arnold, Karsten Keller, Jürgen H. Prochaska, Philipp S. Wild, Andreas Schulz, Karl J. Lackner, Norbert Pfeiffer, Irene Schmidtmann, Matthias Michal, Jörn M. Schattenberg, Oliver Tüscher, Andreas Daiber, Thomas Münzel
    Clinical Research in Cardiology.2023; 112(2): 270.     CrossRef
  • Association between Meal Frequency and Type 2 Diabetes Mellitus in Rural Adults: A Large-Scale Cross-Sectional Study
    Bota Baheti, Xiaotian Liu, Mu Wang, Caiyun Zhang, Xiaokang Dong, Ning Kang, Linlin Li, Xing Li, Songcheng Yu, Jian Hou, Zhenxing Mao, Chongjian Wang
    Nutrients.2023; 15(6): 1348.     CrossRef
  • Impaired Lung Function and Lung Cancer Incidence: A Nationwide Population-Based Cohort Study
    Hye Seon Kang, Yong-Moon Park, Seung-Hyun Ko, Seung Hoon Kim, Shin Young Kim, Chi Hong Kim, Kyungdo Han, Sung Kyoung Kim
    Journal of Clinical Medicine.2022; 11(4): 1077.     CrossRef
  • Smoking cessation and risk of type 2 diabetes
    Jana Malinovská, Jana Urbanová, Veronika Vejtasová, Alexandra Romanová, Sabina Pálová, Syed Taha Naeem, Jan Brož
    Vnitřní lékařství.2022; 68(1): E04.     CrossRef
  • Association between lung function and the risk of atrial fibrillation in a nationwide population cohort study
    Su Nam Lee, Seung-Hyun Ko, Sung-Ho Her, Kyungdo Han, Donggyu Moon, Sung Kyoung Kim, Ki-Dong Yoo, Yu-Bae Ahn
    Scientific Reports.2022;[Epub]     CrossRef
  • Sex differences in factors associated with prediabetes in Korean adults
    Jin Suk Ra
    Osong Public Health and Research Perspectives.2022; 13(2): 142.     CrossRef
  • Smoking and diabetes interplay: A comprehensive review and joint statement
    Vincent Durlach, Bruno Vergès, Abdallah Al-Salameh, Thibault Bahougne, Farid Benzerouk, Ivan Berlin, Carole Clair, Jacques Mansourati, Alexia Rouland, Daniel Thomas, Philippe Thuillier, Blandine Tramunt, Anne-Laurence Le Faou
    Diabetes & Metabolism.2022; 48(6): 101370.     CrossRef
  • Impact of healthy lifestyle on the risk of type 2 diabetes mellitus in southwest China: A prospective cohort study
    Yanli Wu, Xi He, Jie Zhou, Yiying Wang, Lisha Yu, Xuejiao Li, Tao Liu, Jianhua Luo
    Journal of Diabetes Investigation.2022; 13(12): 2091.     CrossRef
  • Current status of health promotion in Korea
    Soo Young Kim
    Journal of the Korean Medical Association.2022; 65(12): 776.     CrossRef
  • Smoking Cessation after Diagnosis of New-Onset Atrial Fibrillation and the Risk of Stroke and Death
    So-Ryoung Lee, Eue-Keun Choi, Jin-Hyung Jung, Kyung-Do Han, Seil Oh, Gregory Y. H. Lip
    Journal of Clinical Medicine.2021; 10(11): 2238.     CrossRef
Clinical Care/Education
Patient Understanding of Hypoglycemia in Tertiary Referral Centers
Nan Hee Cho, Nam Kyung Kim, Eugene Han, Jun Hwa Hong, Eon Ju Jeon, Jun Sung Moon, Mi Hae Seo, Ji Eun Lee, Hyun-Ae Seo, Mi-Kyung Kim, Hye Soon Kim
Diabetes Metab J. 2018;42(1):43-52.   Published online February 23, 2018
DOI: https://doi.org/10.4093/dmj.2018.42.1.43
  • 4,537 View
  • 54 Download
  • 5 Web of Science
  • 5 Crossref
AbstractAbstract PDFPubReader   
Background

Hypoglycemia is an important complication in the treatment of patients with diabetes. We surveyed the insight by patients with diabetes into hypoglycemia, their hypoglycemia avoidance behavior, and their level of worry regarding hypoglycemia.

Methods

A survey of patients with diabetes, who had visited seven tertiary referral centers in Daegu or Gyeongsangbuk-do, Korea, between June 2014 and June 2015, was conducted. The survey contained questions about personal history, symptoms, educational experience, self-management, and attitudes about hypoglycemia.

Results

Of 758 participants, 471 (62.1%) had experienced hypoglycemia, and 250 (32.9%) had experienced hypoglycemia at least once in the month immediately preceding the study. Two hundred and forty-two (31.8%) of the participants had received hypoglycemia education at least once, but only 148 (19.4%) knew the exact definition of hypoglycemia. Hypoglycemic symptoms identified by the participants were dizziness (55.0%), sweating (53.8%), and tremor (40.8%). They mostly chose candy (62.1%), chocolate (37.7%), or juice (36.8%) as food for recovering hypoglycemia. Participants who had experienced hypoglycemia had longer duration of diabetes and a higher proportion of insulin usage. The mean scores for hypoglycemia avoidance behavior and worry about hypoglycemia were 21.2±10.71 and 23.38±13.19, respectively. These scores tended to be higher for participants with higher than 8% of glycosylated hemoglobin, insulin use, and experience of emergency room visits.

Conclusion

Many patients had experienced hypoglycemia and worried about it. We recommend identifying patients that are anxious about hypoglycemia and educating them about what to do when they develop hypoglycemic symptoms, especially those who have a high risk of hypoglycemia.

Citations

Citations to this article as recorded by  
  • Severe Hypoglycemia Increases Dementia Risk and Related Mortality: A Nationwide, Population-based Cohort Study
    Eugene Han, Kyung-do Han, Byung-Wan Lee, Eun Seok Kang, Bong-Soo Cha, Seung-Hyun Ko, Yong-ho Lee
    The Journal of Clinical Endocrinology & Metabolism.2022; 107(5): e1976.     CrossRef
  • Severe hypoglycemia as a preventable risk factor for cardiovascular disease in patients with type 2 diabetes mellitus
    Soo-Yeon Choi, Seung-Hyun Ko
    The Korean Journal of Internal Medicine.2021; 36(2): 263.     CrossRef
  • Severe hypoglycemia and the risk of end stage renal disease in type 2 diabetes
    Jae-Seung Yun, Yong-Moon Park, Kyungdo Han, Hyung-Wook Kim, Seon-Ah Cha, Yu-Bae Ahn, Seung-Hyun Ko
    Scientific Reports.2021;[Epub]     CrossRef
  • Response: Patient Understanding of Hypoglycemia in Tertiary Referral Centers (Diabetes Metab J 2018;42:43-52)
    Nan Hee Cho, Hye Soon Kim
    Diabetes & Metabolism Journal.2018; 42(2): 175.     CrossRef
  • Letter: Patient Understanding of Hypoglycemia in Tertiary Referral Centers (Diabetes Metab J 2018;42:43-52)
    Jae-Han Jeon
    Diabetes & Metabolism Journal.2018; 42(2): 173.     CrossRef
Management of Blood Pressure in Patients with Type 2 Diabetes Mellitus: A Nationwide Survey in Korean
Mi Hae Seo, Woo Je Lee, Cheol Young Park, Sung Rae Kim, Joong Yeol Park, Kun-Ho Yoon, Moon Kyu Lee, Sung Woo Park
Diabetes Metab J. 2011;35(4):348-353.   Published online August 31, 2011
DOI: https://doi.org/10.4093/dmj.2011.35.4.348
  • 3,788 View
  • 33 Download
  • 5 Crossref
AbstractAbstract PDFPubReader   
Background

Hypertension is common in patients with type 2 diabetes, affecting up to 60% of patients. The Korean Diabetes Association performed a nationwide survey about prevalence, awareness and control of hypertension among diabetic Koreans.

Methods

The current survey included 3,859 diabetic patients recruited from 43 hospitals in Korea. Age, gender, height, weight and blood pressure (BP) were measured by standard methods. Data on fasting plasma glucose, glycosylated hemoglobin (HbA1c), awareness of hypertension, and compliance of antihypertensive medication were collected via interview and reviewed using patient medical records.

Results

A total of 57.5% of all patients were >60 years old. Their mean HbA1c was 7.6±1.5%. Among antihypertensive medication users, 39.9% had <130 mm Hg and <80 mm Hg, whereas 60.1% had ≥130 mm Hg or ≥80 mm Hg. The answer "BP is under good control" was given by 75.1% of the antihypertensive medication users. Out of these patients, 26.4% had <130 mm Hg and <80 mm Hg, whereas 73.6% had ≥130 mm Hg or ≥80 mm Hg. A total of 75.5% of antihypertensive medication users answered that they had taken their antihypertensive medication every day for the past 2 weeks. "Forgetfulness" was most frequently the reason of non-compliance for patients that did not take their antihypertensive medication regularly.

Conclusion

Approximately one third of the patients with diabetes were found to reach target blood pressure control in the 43 hospitals across Korea. Stricter control is needed to reduce severe complications of diabetes in Korea.

Citations

Citations to this article as recorded by  
  • Value of ambulatory blood pressure measurement in diagnosing hypotension in hypertensive diabetic patients with medication-controlled BP
    Kamal Alghalayini
    JRSM Cardiovascular Disease.2020; 9: 204800402093088.     CrossRef
  • Association between blood pressure and target organ damage in patients with chronic kidney disease and hypertension: results of the APrODiTe study
    Ran-hui Cha, Sejoong Kim, Sun Ae Yoon, Dong-Ryeol Ryu, Ji Eun Oh, Sang-Youb Han, Eun Young Lee, Dong Ki Kim, Yon Su Kim
    Hypertension Research.2014; 37(2): 172.     CrossRef
  • Blood Pressure Control According to the Prevalence of Diabetes in Renal Transplant Recipients
    E. Zbroch, J. Malyszko, I. Glowinska, D. Maciorkowska, G. Kobus, M. Mysliwiec
    Transplantation Proceedings.2013; 45(1): 200.     CrossRef
  • Prevalence, awareness, treatment and control of hypertension in adults with diagnosed diabetes: The Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV)
    H-S Lee, S-S Lee, I-Y Hwang, Y-J Park, S-H Yoon, K Han, J-W Son, S-H Ko, Y G Park, H W Yim, W-C Lee, Y-M Park
    Journal of Human Hypertension.2013; 27(6): 381.     CrossRef
  • Multi-Institutional Analysis of Localized Renal Cell Carcinoma that Demonstrates the Impact of Diabetic Status on Prognosis After Nephrectomy
    Yun-Sok Ha, Won Tae Kim, Seok-Joong Yun, Sang-Cheol Lee, Wun-Jae Kim, Yong Hyun Park, Seok Ho Kang, Sung-Hoo Hong, Seok-Soo Byun, Yong-June Kim
    Annals of Surgical Oncology.2013; 20(11): 3662.     CrossRef

Diabetes Metab J : Diabetes & Metabolism Journal