title: Association of smoking and nicotine dependence with pre-diabetes in young and healthy adults.
abstract: BACKGROUND
  Several studies have shown an increased risk of type 2 diabetes among smokers. Therefore, the aim of this analysis was to assess the relationship between smoking, cumulative smoking exposure and nicotine dependence with pre-diabetes.
  
  
  METHODS
  We performed a cross-sectional analysis of healthy adults aged 25-41 in the Principality of Liechtenstein. Individuals with known diabetes, Body Mass Index (BMI) >35 kg/m² and prevalent cardiovascular disease were excluded. Smoking behaviour was assessed by self-report. Pre-diabetes was defined as glycosylated haemoglobin between 5.7% and 6.4%. Multivariable logistic regression models were done.
  
  
  RESULTS
  Of the 2142 participants (median age 37 years), 499 (23.3%) had pre-diabetes. There were 1,168 (55%) never smokers, 503 (23%) past smokers and 471 (22%) current smokers, with a prevalence of pre-diabetes of 21.2%, 20.9% and 31.2%, respectively (p <0.0001). In multivariable regression models, current smokers had an odds ratio (OR) of pre-diabetes of 1.82 (95% confidential interval (CI) 1.39; 2.38, p <0.0001). Individuals with a smoking exposure of <5, 5-10 and >10 pack-years had an OR (95% CI) for pre-diabetes of 1.34 (0.90; 2.00), 1.80 (1.07; 3.01) and 2.51 (1.80; 3.59) (p linear trend <0.0001) compared with never smokers. A Fagerström score of 2, 3-5 and >5 among current smokers was associated with an OR (95% CI) for pre-diabetes of 1.27 (0.89; 1.82), 2.15 (1.48; 3.13) and 3.35 (1.73; 6.48) (p linear trend <0.0001).
  
  
  CONCLUSIONS
  Smoking is strongly associated with pre-diabetes in young adults with a low burden of smoking exposure. Nicotine dependence could be a potential mechanism of this relationship.
authors.affiliation: Department of Medicine, University Hospital, Basel, Switzerland, and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Aeschbacher
authors.affiliation: Department of Medicine, University Hospital, Basel, Switzerland, and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Schoen
authors.affiliation: Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland.
authors.forename: Carole
authors.initials: C
authors.lastname: Clair
authors.affiliation: Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
authors.forename: Paula
authors.initials: P
authors.lastname: Schillinger
authors.affiliation: Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
authors.forename: Selina
authors.initials: S
authors.lastname: Schönenberger
authors.affiliation: Labormedizinisches Zentrum Dr Risch, Schaan, Liechtenstein, and Division of Laboratory Medicine, Kantonsspital Graubünden, Chur, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Risch
authors.affiliation: Labormedizinisches Zentrum Dr Risch, Schaan, Liechtenstein; Division of Clinical Biochemistry, Medical University, Innsbruck, Austria; Private University, Triesen, Liechtenstein.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Risch
authors.affiliation: Department of Medicine, University Hospital, Basel, Switzerland, and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Conen
mesh_terms: D000328:Adult; D001794:Blood Pressure; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005260:Female; D006442:Glycated Hemoglobin; D015438:Health Behavior; D006801:Humans; D008015:Liechtenstein / Q000453:epidemiology; D008055:Lipids / Q000097:blood; D008297:Male; D011236:Prediabetic State / Q000453:epidemiology*; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D012959:Socioeconomic Factors; D014029:Tobacco Use Disorder / Q000453:epidemiology*
chemical_list: D006442:Glycated Hemoglobin; D008055:Lipids