title: Smoking as a modifiable risk factor for type 2 diabetes in middle-aged men.
abstract: OBJECTIVE
  To examine the effects of cigarette smoking, giving up smoking, and primary or secondary pipe or cigar smoking on the risk of type 2 diabetes.
  
  
  METHODS
  A prospective study followed 7,735 men aged 40-59 years from general practices in 24 British towns for an average of 16.8 years. Incident cases of physician-diagnosed diabetes were ascertained by repeated postal questionnaires and systematic reviews of primary care records.
  
  
  RESULTS
  A total of 290 incident cases of diabetes were found in 7,124 men with no history of diabetes, coronary heart disease, or stroke. Cigarette smoking was associated with a significant increase in risk of diabetes, even after adjustment for age, BMI, and other potential confounders. The benefit of giving up smoking was only apparent after 5 years of smoking cessation, and risk reverted to that of never-smokers only after 20 years. The risk of diabetes in those who switched from smoking cigarettes to pipe or cigars remained equal to the risk in continuing cigarette smokers. Men who gave up smoking during the first 5 years of follow-up showed significant weight gain and subsequently higher risk of diabetes than continuing smokers.
  
  
  CONCLUSIONS
  Cigarette smoking is an independent and modifiable risk factor for type 2 diabetes. Smoking cessation is associated with weight gain and a subsequent increase in risk of diabetes, but in the long term, the benefits of giving up smoking outweigh the adverse effects of early weight gain.
authors.affiliation: Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London NW3 2PF, U.K. goya@pcps.ucl.ac.uk
authors.forename: S G
authors.initials: SG
authors.lastname: Wannamethee
authors.forename: A G
authors.initials: AG
authors.lastname: Shaper
authors.forename: I J
authors.initials: IJ
authors.lastname: Perry
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003327:Coronary Disease / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D015444:Exercise; D005194:Family Practice; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009017:Morbidity; D018579:Patient Selection; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation; D020521:Stroke / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D015430:Weight Gain
chemical_list: D001786:Blood Glucose