title: Relationship of cardiometabolic parameters in non-smokers, current smokers, and quitters in diabetes: a systematic review and meta-analysis.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK. d.kar@nhs.net.|Derbyshire Community Health Services NHS Foundation Trust, Castle Street Medical Centre, Castle Street, Bolsover, Chesterfield, Derbyshire, UK. d.kar@nhs.net.
authors.forename: Debasish
authors.identifier: 0000-0002-1524-1312
authors.initials: D
authors.lastname: Kar
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Gillies
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK.
authors.forename: Francesco
authors.initials: F
authors.lastname: Zaccardi
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK.
authors.forename: David
authors.initials: D
authors.lastname: Webb
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK.
authors.forename: Samuel
authors.initials: S
authors.lastname: Seidu
authors.affiliation: Academic Unit of Diabetes and Endocrinology, University of Sheffield, Sheffield, UK.
authors.forename: Solomon
authors.initials: S
authors.lastname: Tesfaye
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK.
authors.forename: Melanie
authors.initials: M
authors.lastname: Davies
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK.
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Khunti
mesh_terms: D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D016009:Chi-Square Distribution; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D011379:Prognosis; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000009:adverse effects* / Q000097:blood; D016540:Smoking Cessation; D000074606:Smoking Prevention; D013997:Time Factors
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Diabetes; Glycosylated haemoglobin (HbA1c); Low density lipoprotein (LDL) and high density lipoprotein (HDL) cholesterol: blood pressure (systolic and diastolic—SBP and DBP); Smoking; Smoking cessation