Smoking Habits and the Risk of Type 2 Diabetes - Article Example

SUMMARY OF JOURNAL ARTICLE of Article: Smoking habits and the risk of type 2 diabetes: A case-control study (Radzeviciene and Ostrauskas) A) The goals/purpose of the work that was described Diabetes a major health issue worldwide; it can affect individuals and countries in pandemic proportions. There are two types of diabetes. Type 1 is the condition where the body cannot produce insulin, the pancreas-produced hormone that regulates blood glucose levels. In type 2 diabetes, the body produces insulin, but does not respond to the signaling cues given by insulin. With diabetes, the body cannot utilize blood glucose for energy. Similar to many other countries, cases of Type 2 diabetes in Lithuania have risen with urbanization, ageing, increased obesity, and decreased physical exercise. Another major health concern in Lithuania is the prevalence of smoking, even in patients who have been diagnosed with diabetes. Many studies conducted in other countries have shown that there is a positive association between smoking and increased risk in Type 2 diabetes. Data also show that the prevalence of smoking in diabetics is similar to that of the general population. However, community studies of this kind have not been conducted in Lithuania, where smoking is also prevalent. Therefore, the goal of this study was to assess the association between smoking and type 2 diabetes in Lithuanian patients. The study further aimed to compare the degree of risk for type 2 diabetes between smokers and non-smokers. B) The methodology used Two hundred and thirty-four patients who went to the same clinic were included in a case-control study. The selected patients have just been diagnosed with type 2 diabetes within year 2001. The control group was made up of patients who attended the same clinic but do not have type 2 diabetes. For each case, two controls were provided. A questionnaire was use to collect basic information on the participants’ lifestyle, education, family history of diabetes, family status, health, diet, alcohol intake, and cigarette smoking. Height, weight, hip and waist measurements were taken, and the body mass index (BMI) was calculated. Laboratory tests were performed to determine blood and venous glucose levels, oral glucose tolerance and triglyceride concentrations. In addition, smoking was assessed by the patient’s duration of smoking, number of cigarettes smoked daily, smoking habits, packs smoked, smoking cessation, years as non-smoker. The responses of the diabetes cases and controls were categorized based on the data on BMI, family history of diabetes, education, and marital status were divided into several categories. There were 3 categories for BMI, 2 categories for family history, 3 education categories and 4 groupings of marital status. Statistical analysis of the data was performed using STATA 7 software. The relationship between smoking and type 2 diabetes was determined with linear regression analysis. C) A summary of the results and the authors’ conclusions The results show that diabetic patients were significantly less educated, have higher BMI, and have more relatives that have a history of diabetes in the family. Data for the assessment of smoking was used in a regression analysis; the first was adjusted for BMI and family history. Further adjustment of the data involved the removal the additional confounders, waist circumference, blood triglycerides and education level. There was a dose-response relationship between smoking and increased risk of diabetes; the more cigarettes smoked in more number of years, the higher the chance of getting the disease. There was a two-fold risk for smokers of 20-39 years, and three-fold risk for those who have smoked for more than 40 years. Smoking 10 or more cigarettes a day increased the risk three-fold compared to non-smoking. However, this relationship was rendered insignificant after adjustments for family history of diabetes, BMI, triglyceride levels, waist circumference, and educational attainment. Giving up smoking does not reduce the risk for diabetes; but the risk became insignificant after adjusting the data for confounders. This means that if an individual has no family history of diabetes, is controlling his weight and triglyceride levels, then diabetes can be avoided. Based on their data and the regression analyses, the authors conclude that smoking may be an independent risk factor for type 2 diabetes. D) Concluding paragraphs summarizing your thoughts about the work and the article The likelihood of developing diabetes increases with a positive family history for the illness, but more than this, lifestyle factors contribute significantly. These factors are obesity, excessive alcohol intake, hypertension, physical inactivity, and smoking, which has been associated with increased likelihood of type 2 diabetes as shown in the many studies that were cited in the discussion. For this reason, I think that the research conducted and reported in this article is not original, except that it was the first of its kind conducted on Lithuanian subjects. Most results of the study were very similar to results coming from previous studies, although a few dissimilarities were also observed. Such observations could be attributed to the inherent differences in sample populations. Regarding the presentation of the data, I felt that it was confusing because of all the numbers presented in the tables, and in the text itself, where all the statistical figures were interspersed freely. Since the results were all subjected to linear regression analyses, graphs should have been used to present the results, especially those where a dose-response relationship is present. The significance of the results would have had more impact if it can be shown, for example, that the increase in the number of cigarettes smoked is directly proportional to the increase in the risk of the disease. In articles where relationships are discussed, a graph always gives a better picture of the associations. The conclusion arrived at has also been given in countless of studies, showing that no matter how one looks at the smoking and diabetes connection, one will always come out with the same conclusion: there is a direct relationship between smoking and type 2 diabetes. Again, the dangers of smoking are validated in this experiment. The authors discussed lengthily other reports that verified their results, including a brief review of the proposed mechanisms on the effects of smoking on metabolism and consequently, diabetes. However, they did not examine the relationship to age, which is important. For example, if an individual has been smoking for forty years, this means that he must have been more advanced in age compared to another who has smoked for only ten years. This makes the comparison unfair, because age, which contributes to metabolism, confounds the interpretation of results. Therefore, the cumulative lifestyle effects on the older patient would also contribute significantly towards the development of diabetes. Another claim made in the paper was that when people stop smoking, their risk of developing diabetes drops considerably. This should be interpreted with care since this was only arrived at after the data used in the regression analysis was adjusted for other confounding factors. Certainly, the problem of diabetes should not be viewed from a narrow mindset; being a disease that is brought about by lifestyles, a holistic approach must be recommended for preventing and controlling the disease. Cessation in smoking must therefore be accompanied by other lifestyle changes, like reducing weight, eating a low-fat, healthy diet and exercising more. Article Radzeviciene, L and R. Ostrauskas. "Smoking habits and the risk of type 2 diabetes: A case-control study ." Diabetes and Metabolism 35 (2009): 192-197. Read More