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 Researchers reviewed medical records for 10,692 adult smokers with
diabetes in the UK and found that smoking cessation led to an uptick
in blood sugar levels that lasted three years and was not caused by
weight gain.
"We know that smoking increases the risk of developing diabetes so
when people stop smoking we would expect things to immediately
improve; however, we found that things get a little worse in terms
of glycemic control before they get better," lead author Dr. Deborah
Lycett, of the faculty of health and life sciences at Coventry
University in the U.K., said by email.
Worldwide, nearly one in 10 adults had diabetes in 2014, and the
disease will be the seventh leading cause of death by 2030,
according to the World Health Organization.
Most of these people have type 2 diabetes, which is associated with
obesity and aging and happens when the body can't properly use or
make enough of the hormone insulin to convert blood sugar into
energy. Left untreated, diabetes can lead to nerve damage,
amputations, blindness, heart disease and strokes.
Lycett and colleagues examined the impact of smoking cessation on
diabetes symptoms by testing hemoglobin A1c, a protein in red blood
cells that gets coated with sugar over time, making it a gauge of
average blood sugar levels for the past two or three months.
Diabetics have A1c levels of at least 6.5 percent.
The study included more men than women, and most participants were
white. At the start of the observation period in 2005, participants
were 62 years old on average and had been living with diabetes for
about six years. Many were taking at least one medication to lower
blood sugar.
The group included 3131 people who quit smoking and remained
abstinent for at least a year. Even after adjusting for factors such
as age, gender and weight, there was a significant 0.21 percent
increase in A1c during the first year of cessation.
In the long term, blood sugar levels gradually decreased. By three
years, the diabetics who quit smoking had blood sugar levels similar
to the people who kept smoking.
While the researchers did account for cessation-related weight gain,
it's still possible that the initial surge in blood sugar levels
might be related to added pounds or dietary changes, the researchers
wrote in the Lancet Diabetes and Endocrinology.
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Establishing that cessation causes a short-term lapse in blood sugar
control is unlikely to change clinical practice or recommendations
to smokers, writes Amy Taylor, a tobacco researcher at the
University of Bristol, in an editorial.
Even if smoking cessation doesn't directly cause blood sugar levels
to increase, taking away cigarettes can lead to food cravings that
influence blood sugar, Patricia Folan, director of the Center for
Tobacco Control at North Shore University Hospital on Long Island,
said by email.
"While smoking, individuals are basically administering an appetite
suppressant (nicotine) every time they smoke," Folan, who wasn't
involved in the study, said by email. "In heavy smokers, this can be
20 to 40 times a day."
To minimize the risk of blood sugar levels rising, smokers with
diabetes should focus on developing healthy diet and exercise habits
before they quit and then consider medications to control nicotine
urges as well as blood sugar once they stop smoking, Folan said.
"The benefits of quitting smoking dramatically outweigh any
potential extra, short term risk of having higher blood sugars," Dr.
James Stein, a cardiovascular researcher at the University of
Wisconsin School of Medicine and Public Health in Madison who wasn't
involved in the study, said by email. "Smokers who quit should be
careful to avoid risk factors for worsening glucose control - weight
gain, diets high in sweets and carbs - and should exercise."
SOURCE: http://bit.ly/1DMDV9s Lancet Diabetes and Endocrinology,
online April 29, 2015.
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