Journal Club 埼玉医科大学 総合医療センター 内分泌・糖尿病内科 Department of Endocrinology and Diabetes, Saitama Medical Center, Saitama Medical University 松田 昌文 Matsuda, Masafumi 2010 年 1 月 7 日 8:30-8:55 ８階 医局 Yeh HC, Duncan BB, Schmidt MI, Wang NY, Brancati FL. Smoking, smoking cessation, and risk for type 2 diabetes mellitus: a cohort study. Ann Intern Med Jan 5;152(1):10-7. Carson AP, Reynolds K, Fonseca VA, Muntner P. Comparison of A1C and fasting glucose criteria to diagnose diabetes among U.S. adults. Diabetes Care Jan;33(1):95-7. Epub 2009 Oct 6.

Ann Intern Med. 2010;152: Study protocol: ARIC protocols are available in the public domain through the ARIC Web site ( Statistical code: Not available. Data set: ARIC data are available through request from the NHLBI data repository. Drs. Yeh and Brancati: Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, 2024 East Monument Street, Suite 2-600, Baltimore, MD Drs. Duncan and Schmidt: Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Avenida Luiz Manoel Gonzaga, 630/8, Porto Alegre, RS , Brazil. Dr. Wang: Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, 2024 East Monument Street, Suite Baltimore, MD

Background and Objective Cigarette smoking is an established predictor of incident type 2 diabetes mellitus, but the effects of smoking cessation on diabetes risk are unknown. Objective is to test the hypothesis that smoking cessation increases diabetes risk in the short term, possibly owing to cessation- related weight gain.

Method Prospective cohort study. Setting: The ARIC (Atherosclerosis Risk in Communities) Study. Patients: middle- aged adults who initially did not have diabetes in 1987 to 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.

Figure 1. Study flow diagram.

Table 1. Characteristics of Middle-Aged Adults Without Diabetes at Baseline

Figure 2. Nine-year adjusted hazard ratio (1990–1998) for incident diabetes in middle-aged adults, by years since quitting before baseline (1987–1989).

Diabetes incidence increased from 13.3 per 1000 person-years in persons who never smoked to 18.5 per 1000 person-years in the highest tertile of pack-years, corresponding to an age- and race-adjusted relative risk for 1.40 (95% CI, 1.20 to 1.64).

Figure 3. Adjusted hazard ratios for incident self-reported diabetes during 12 years in middle-aged adults without diabetes at baseline and 3-year follow- up.

Appendix Figure. Nine-year adjusted hazard ratio for incident diabetes in middle- aged adults, by tertile of pack- years of smoking at baseline.

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.

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

Message 喫煙者では やはり２型糖尿病が増加する！ しかし、禁煙した場合に 体重増加に伴い かえって糖尿病が増加する可能性もあるので注 意が必要！（特に禁煙して３年まで） （禁煙した場合に体重管理と血糖測定が必要）

Diabetes Care 33:95–97, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama; 2Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California; 3Scott and White Clinic, Texas A&M Health Sciences Center, Temple, Texas.

OBJECTIVE To compare A1C and fasting glucose for the diagnosis of diabetes among U.S. adults.

RESEARCH DESIGN AND METHODS This study included 6,890 adults ( ≧ 20 years of age) from the 1999–2006 National Health and Nutrition Examination Survey without a self-reported history of diabetes who had fasted ≧ 9 h. A1C ≧ 6.5% and fasting glucose ≧ 126 mg/dl were used, separately, to define diabetes.

The results of the current study indicate the new recommendation by the International Expert Committee to use A1C to diagnose diabetes would result in the same classification as fasting glucose for 97.7% of U.S. adults.

RESULTS Overall, 1.8% of U.S. adults had A1C ≧ 6.5% and fasting glucose ≧ 126 mg/dl, 0.5% had A1C ≧ 6.5% and fasting glucose ＜ 126 mg/dl, and 1.8% had A1C ＜ 6.5% and fasting glucose ≧ 126 mg/dl. Compared with individuals with A1C ＜ 6.5% and fasting glucose ≧ 126 mg/dl, individuals with A1C ≧ 6.5% and fasting glucose ＜ 126 mg/dl were younger, more likely to be non-Hispanic black, had lower Hb levels, and had higher C- reactive protein.

CONCLUSIONS A1C ≧ 6.5% demonstrates reasonable agreement with fasting glucose for diagnosing diabetes among U.S. adults.

Message 今年 １ A1C という 表記で（米国や欧州 で用いる）世界標準の HbA1C を表示する。 HbA1C の 6.1% は A1C の 6.5% になりま す。 ２ A1C の 6.5% 以上で 「糖尿病型」と する。（これは HbA1C では 6.1% です） 血糖基準も維持する。