ADA2013：糖尿病患者戒烟与血糖恶化无关

早期的研究显示吸烟与2型糖尿病（T2D）高风险有关。而且，戒烟可能通过介导体重增加与T2D高风险有关。然而，在2型糖尿病患者，戒烟与体重、血糖控制、血压和血脂水平纵向变化的关系仍不清楚。为此，来自日本全球健康与医学国家中心Atsushi Goto教授及其团队进行了一项研究，该研究发现在2型糖尿病患者中，为期一年期间，戒烟可能与体重增加、血糖控制恶化或血脂水平的升高无关，可能与血压中度升高有关。

该研究为一项在群组随机对照试验中进行的观察性研究，在为期1年期间，在日本2型糖尿病患者中，定期随访协调干预对患者依从性的影响。在2200例受试者中，1169例受试者在基线和随访结束时填写吸烟调查问卷。排除10例新吸烟者，将1159例受试者分为3组：继续吸烟者（328例）、戒烟者（42例）和非吸烟者（789例）。使用混合效应模型校正年龄、性别、干预方式和基线体重、体力活动、糖尿病问题量表和服用降糖药物。

该研究结果表明，戒烟者与继续吸烟者相比，有相似的体重变化（每月平均变化的差异0.00kg；95%可信区间[CI] -0.03–0.04;P=0.61）和HbA1c水平（0.00%；95%CI -0.00–0.02;P=0.11）、LDL（-0.15mg/dl；95%CI -0.57–0.27;P=0.48）、non-HDL（0.03mg/dl；95%CI -0.40–0.46;P=0.91）和总胆固醇（0.04mg/dl；95%CI -0.46–0.54;P=0.87）。然而，戒烟者与继续吸烟者相比，收缩压（0.36mmHg;95%CI 0.08-0.65;P=0.01）和舒张压（0.27mmHg;95%CI 0.04-0.50;P=0.02）抬高更多。

该研究发现，在2型糖尿病患者中，为期一年期间，戒烟可能与体重增加、血糖控制恶化或血脂水平的升高无关，可能与血压中度升高有关。

Earlier studies have associated cigarette smoking with a high risk of type 2 diabetes (T2D). Further smoking cessation has been associated with a high risk of T2D possibly mediated by weight gain. However the associations of smoking cessation with longitudinal changes in weight glycemic control blood pressure (BP) and lipid levels in patients with T2D remain unclear.

To investigate the associations we conducted an observational study in the cluster-randomized controlled trial that examined the effect of a coordinated intervention on patients’ adherence to regular visits over a 1-year period in Japanese patients with T2D. Of the 2 200 participants 1 169 responded to the smoking questionnaire at both baseline and end of follow-up. Excluding 10 new smokers we classified 1 159 patients into 3 groups: continuing smokers (n = 328) quitters (n = 42) and non-smokers (n = 789). To examine the associations we used the mixed-effects model adjusting for age sex intervention arm and baseline weight physical activity the Problem Areas in Diabetes scale and hypoglycemic medication use.

Compared with continuing smokers quitters had similar changes in weight (difference in mean changes per month 0.00 kg; 95% confidence interval [CI] -0.03-0.04; P = 0.61) and levels of HbA1c (0.00 %; 95% CI -0.00-0.02; P = 0.11) LDL (-0.15 mg/dl; 95% CI -0.57-0.27; P = 0.48) non-HDL (0.03mg/dl; 95% CI -0.40-0.46; P = 0.91) and total cholesterol (0.04 mg/dl; 95% CI -0.46-0.54; P = 0.87). However quitters compared with continuing smokers showed greater elevations in systolic BP (0.36 mmHg; 95% CI 0.08-0.65; P = 0.01) and diastolic BP (0.27 mmHg; 95% CI 0.04-0.50; P = 0.02). Thus we conclude that although smoking cessation may not be associated with weight gain worsening of glycemic control or elevations in lipid levels over a 1-year period in patients with T2D it may be associated with modest elevations in BP.

编辑： 葛根    来源：丁香园