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Relationship of cardiometabolic parameters in non-smokers, current smokers, and quitters in diabetes: a systematic review and meta-analysis

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ABSTRACT

Background: Smoking is associated with increased macrovascular and microvascular complications in people with diabetes. In addition to other concomitant vascular perturbations, it also seems to influence the cardiometabolic parameters, which may partly explain the accelerated rate of vascular complications in smokers with diabetes. While smoking cessation is advocated as a universal component of the management of diabetes, there is some anecdotal evidence that HbA1c could increase following smoking cessation. The aim of this review is to explore the relationship between smoking and its cessation on cardiometabolic parameters in diabetes.

Methods: Searches were conducted on Medline, EMBASE and CINAHL up to March 2016. After screening 6866 studies (Additional file 1), 14 observational studies with a total of 98,978 participants’ with either type 1 or type 2 diabetes were selected for review. Narrative synthesis and meta-analyses were carried out to explore the relationship between smoking and its cessation.

Results: Meta-analysis showed that the pooled mean difference of HbA1c between non-smokers and smokers was −0.61% (95% CI −0.88 to −0.33, p < 0.0001). The difference in LDL cholesterol between non-smokers and smokers was −0.11 mmol/l (95% CI −0.21 to −0.01, p = 0.04). The difference in HDL cholesterol between non-smokers and smokers was 0.12 mmol/l (95% CI 0.08–0.15, p < 0.001). However, there was no statistically significant difference in blood pressure between the two groups. The difference in HbA1c between quitters and continued smokers was not statistically significant −0.10% (95% CI −0.42 to 0.21, p = 0.53). However, a narrative synthesis revealed that over a period of 10 years, the HbA1c was comparable between non-smokers and quitters.

Conclusion: Non-smokers have a statistically significant lower HbA1c and more favourable lipid profile compared to smokers. Smoking cessation does not lead to an increase in HbA1c in long-term and may reduce vascular complications in diabetes by its favourable impact on lipid profile.

Electronic supplementary material: The online version of this article (doi:10.1186/s12933-016-0475-5) contains supplementary material, which is available to authorized users.

No MeSH data available.


Forest plots. Diastolic blood pressure (smokers vs. non-smokers)
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Fig6: Forest plots. Diastolic blood pressure (smokers vs. non-smokers)

Mentions: All the included studies demonstrated a close relationship between smoking, HbA1c, and lipid profiles in people with T1DM and T2DM (Figs. 2, 3, 4). However, there was no consistent relationship identified between blood pressure and smoking status (Figs. 5, 6) In addition, smokers with T2DM were likely to be older, had longer duration of smoking history and poorer glycaemic control compared to non-smokers. Smokers have consistently shown lower HDL cholesterol and higher LDL cholesterol compared to non-smokers. Some studies suggested that smokers lose the natural nocturnal dip in blood pressure while some other studies found no diurnal variation in blood pressure between smokers and non-smokers. Further study is needed to understand the exact relationship between smoking and blood pressure in people with diabetes.Fig. 2


Relationship of cardiometabolic parameters in non-smokers, current smokers, and quitters in diabetes: a systematic review and meta-analysis
Forest plots. Diastolic blood pressure (smokers vs. non-smokers)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5121966&req=5

Fig6: Forest plots. Diastolic blood pressure (smokers vs. non-smokers)
Mentions: All the included studies demonstrated a close relationship between smoking, HbA1c, and lipid profiles in people with T1DM and T2DM (Figs. 2, 3, 4). However, there was no consistent relationship identified between blood pressure and smoking status (Figs. 5, 6) In addition, smokers with T2DM were likely to be older, had longer duration of smoking history and poorer glycaemic control compared to non-smokers. Smokers have consistently shown lower HDL cholesterol and higher LDL cholesterol compared to non-smokers. Some studies suggested that smokers lose the natural nocturnal dip in blood pressure while some other studies found no diurnal variation in blood pressure between smokers and non-smokers. Further study is needed to understand the exact relationship between smoking and blood pressure in people with diabetes.Fig. 2

View Article: PubMed Central - PubMed

ABSTRACT

Background: Smoking is associated with increased macrovascular and microvascular complications in people with diabetes. In addition to other concomitant vascular perturbations, it also seems to influence the cardiometabolic parameters, which may partly explain the accelerated rate of vascular complications in smokers with diabetes. While smoking cessation is advocated as a universal component of the management of diabetes, there is some anecdotal evidence that HbA1c could increase following smoking cessation. The aim of this review is to explore the relationship between smoking and its cessation on cardiometabolic parameters in diabetes.

Methods: Searches were conducted on Medline, EMBASE and CINAHL up to March 2016. After screening 6866 studies (Additional file 1), 14 observational studies with a total of 98,978 participants’ with either type 1 or type 2 diabetes were selected for review. Narrative synthesis and meta-analyses were carried out to explore the relationship between smoking and its cessation.

Results: Meta-analysis showed that the pooled mean difference of HbA1c between non-smokers and smokers was −0.61% (95% CI −0.88 to −0.33, p < 0.0001). The difference in LDL cholesterol between non-smokers and smokers was −0.11 mmol/l (95% CI −0.21 to −0.01, p = 0.04). The difference in HDL cholesterol between non-smokers and smokers was 0.12 mmol/l (95% CI 0.08–0.15, p < 0.001). However, there was no statistically significant difference in blood pressure between the two groups. The difference in HbA1c between quitters and continued smokers was not statistically significant −0.10% (95% CI −0.42 to 0.21, p = 0.53). However, a narrative synthesis revealed that over a period of 10 years, the HbA1c was comparable between non-smokers and quitters.

Conclusion: Non-smokers have a statistically significant lower HbA1c and more favourable lipid profile compared to smokers. Smoking cessation does not lead to an increase in HbA1c in long-term and may reduce vascular complications in diabetes by its favourable impact on lipid profile.

Electronic supplementary material: The online version of this article (doi:10.1186/s12933-016-0475-5) contains supplementary material, which is available to authorized users.

No MeSH data available.