Stress and working environments are risk factors for diabetes mellitus. A new occupational health policy called the Stress Check Program was started in Japan in 2015. Therefore, we clarified whether the presence or absence of high job stress (HJS) as determined using the Brief Job Stress Questionnaire (BJSQ) is related to the comorbidity of diabetes.

The results of a single year's BJSQ and medical examinations were investigated for 30,694 Japanese active office workers who were 30 to 59 years old. Presence or absence of HJS was assessed using the BJSQ and investigated using a personal computer in a medical interview. Furthermore, the relationships between HJS and diabetes comorbidity were analyzed.

The mean age of the subjects was 43.8 ± 10.5 years old, and the proportion of subjects with HJS was 10%. After adjustment for age and sex, HJS was associated with a risk of diabetes comorbidity (odds ratio, 1.30; 95% confidence interval 1.13-1.49). HJS was not a significant diabetic comorbidity factor when adjusted for lifestyle habits in addition to age and sex.

HJS measured using the BJSQ and unhealthy lifestyles synergistically contributed to diabetes comorbidity.

Previous studies suggest that smoking and higher alcohol consumption are associated with greater type 2 diabetes (T2D) risk. However, studies examining whether this reflects causal relationships are limited and often do not consider continuous glycaemic traits. We conducted both two-sample and one-sample Mendelian randomisation (MR), using publicly available GWAS data and UK Biobank data, respectively, to examine the potential causal effects of lifetime smoking index (LSI) and alcoholic drinks per week (DPW) on T2D and continuous traits (fasting glucose, fasting insulin and glycated haemoglobin, HbA1c). Two-sample MR results suggested possible causal effects of higher LSI on T2D risk (OR per 1SD higher LSI: 1.42, 95% CI 1.22 to 1.64); however, sensitivity analyses did not consistently support this finding. There was no robust evidence that higher DPW influenced T2D risk (OR per 1 SD higher log-transformed DPW: 1.04, 95% CI 0.40 to 2.65). There was evidence of a potential causal effect on higher fasting glucose (difference in mean fasting glucose in mmol/l per 1SD higher log-transformed DPW: 0.34, 95% CI 0.09 to 0.59), though, this was attenuated when accounting for body mass index (BMI), suggesting BMI confounding might explain the potential effect. One-sample MR results suggested a possible causal effect of higher DPW on T2D risk (OR per 1 SD higher log-transformed DPW: 1.71, 95% CI 1.24 to 2.36), but lower HbA1c levels (difference in mean SD of log transformed HbA1c (mmol/mol) per 1 SD higher log-transformed DPW: -0.07, 95% CI -0.11 to -0.02). Our results suggest effective public health interventions to prevent and/or reduce smoking and alcohol consumption are unlikely to reduce T2D prevalence.

This study aimed to investigate the association and population-attributable fraction (PAF) of maternal smoking and secondhand smoke (SHS) exposure during pregnancy with placental abruption.

Prospective cohort study.

15 regional centres in Japan.

Pregnant women registered between January 2011 and March 2014 from the Japan Environment and Children's Study.

Data were transcribed from medical records and two self-administered questionnaires. The outcome measure was the incidence of placental abruption. Maternal smoking exposure during pregnancy was categorised based on the number of cigarettes smoked (≤10 or ≥11 cigarettes per day). SHS exposure during pregnancy was evaluated by frequency and duration (almost never or never, 1-3 days/week and/or <1 hour/day and 4-7 days/week and ≥1 hour/day). A modified Poisson regression model, adjusted for known placental abruption risk factors, calculated the risk ratio (RR) and PAF for placental abruption with a 95% Cl.

Of the 81 974 eligible pregnant women, pregnant women smoking ≥11 cigarettes/day during pregnancy had a significantly higher risk of placental abruption. The adjusted RR (aRR) was 2.21 (95% CI 1.21 to 4.06), and the adjusted PAF (aPAF) was 1.90% (95% CI 0.09 to 3.71%). Pregnant women among never-smokers with SHS exposure of 4-7 days/week and ≥1 hour/day had a significantly higher risk (aRR: 2.34, 95% CI 1.29 to 4.28), and the aPAF was 1.89% (95% CI -0.05 to 3.83). Additionally, pregnant women among those who smoked during pregnancy with similar SHS exposure had a significantly higher risk (aRR: 2.21, 95% CI 1.30 to 3.76), with the aPAF of 2.29% (95% CI 0.11 to 4.48).

Maternal smoking and SHS exposure during pregnancy significantly contribute to the risk of placental abruption in Japan. Therefore, preventive interventions and measures to reduce exposure are required to prevent placental abruption.

Lifestyle-related factors have been studied as a fundamental aspect in the onset and progression of type 2 diabetes mellitus. However, behavioral factors are easily overlooked in clinical practice. This study investigated whether lifestyle changes were associated with diabetes remission in newly diagnosed type 2 diabetes patients.

We enrolled patients with new-onset type 2 diabetes from 2009 to 2012 using a health examination cohort from the Korean National Health Insurance Service (KNHIS). Remission was defined as a fasting glucose level less than 126 mg/dL at least once during a health examination after stopping medication. A self-administered questionnaire was used to investigate patients' lifestyles. We investigated smoking, alcohol consumption, and regular exercise before and after starting diabetes medication and the odds ratios (ORs) of logistic regression on remission to evaluate the associations.

A total of 138,211 patients diagnosed with type 2 diabetes from 2009 to 2012 were analyzed, and 8,192 (6.3%) reported remission during the follow-up period to 2017. Baseline fasting blood glucose level measured before starting diabetes medication was significantly higher in the non-remission group (180 mg/dL vs. 159 mg/dL, P < 0.001). In addition, the use rate of combined oral hypoglycemic agent treatment was higher in the non-remission group (15% vs. 8%, P < 0.001). Consistent smoking and drinking showed negative associations with remission (OR, 0.72; 95% confidence interval [CI], 0.67-0.77 and OR, 0.90; 95% CI, 0.84-0.95, respectively), and initiation of regular exercise presented a positive association with remission (OR, 1.54; 95% CI, 0.46-1.63). Abstinence from alcohol increased the likelihood of remission in the male population (OR, 1.20; 95% CI, 1.10-1.32). The association with smoking history or smoking cessation was not clear, but new smoking behavior interfered with remission in women (OR, 0.48; 95% CI, 0.28-0.81).

We confirmed associations between a healthy lifestyle and diabetic remission in new-onset type 2 diabetes patients. The results of this study suggest that improving lifestyle after diabetes diagnosis may contribute to disease remission.

The risk factors for type 2 diabetes mellitus (T2DM) have been increasingly researched, but the lack of systematic identification and categorization makes it difficult for clinicians to quickly and accurately access and understand all the risk factors, which are categorized in this paper into five categories: Social determinants, lifestyle, checkable/testable risk factors, history of illness and medication, and other factors, which are discussed in a narrative review. Meanwhile, this paper points out the problems of the current research, helps to improve the systematic categorisation and practicality of T2DM risk factors, and provides a professional research basis for clinical practice and industry decision-making.

Diabetic foot ulcers have caused significant medical, economic and social consequences for patients, families and society. With appropriate treatment, many diabetic foot ulcers can heal, temporarily avoiding possible amputation. Unfortunately, even if foot ulcers subside, recurrence is still common. The recurrence of ulcer has brought another physical and psychological trauma to diabetic foot patients who yearn for a better life. Therefore, it may be more useful to evaluate the factors associated with ulcer recurrence in diabetic foot ulcer patients.

The PubMed, Web of Science, Embase and China National Knowledge Infrastructure databases were comprehensively searched for prospective or retrospective studies published up to February 1, 2024. All English or Chinese language studies on diabetic foot ulcer patients who experience recurrence were included, and RevMan 5.3 software was used to analyze the data.

A total of 22 studies meeting the eligibility criteria were ultimately included in this meta-analysis. 1861 of 5252 diabetic foot ulcer patients experienced recurrence during follow-up. The following variables were associated with an increased risk of ulcer recurrence: male (OR = 1.26, 95% CI = 1.10 ~ 1.44, P = 0.0009), smoking history (OR = 1.18, 95% CI = 1.04 ~ 1.35, P = 0.01), living alone (OR = 1.86, 95% CI = 1.21 ~ 2.86, P = 0.004), plantar ulcers (OR = 2.44, 95% CI = 1.41 ~ 4.23, P = 0.001), diabetic retinopathy (OR = 1.59, 95% CI = 1.35 ~ 1.88, P < 0.00001), diabetic nephropathy (OR = 1.37, 95% CI = 1.12 ~ 1.68, P = 0.002), diabetic peripheral neuropathy (OR = 1.78, 95% CI = 1.45 ~ 2.19, P < 0.00001), foot deformity (OR = 2.51, 95% CI = 1.85 ~ 3.40 P < 0.00001) and peripheral arterial disease (OR = 3.10, 95% CI = 2.43 ~ 3.95 P < 0.00001). However, hypertension (OR = 1.16, 95% CI = 0.96 ~ 1.40, P = 0.13) and body mass index (MD = 0.20, 95% CI = -0.12 ~ 0.53, P = 0.22) were not associated with diabetic foot ulcer recurrence.

Our meta-analysis identified the following important risk factors for diabetic foot ulcer recurrence: male sex, smoking history, living alone, plantar ulcer, diabetic retinopathy, diabetic nephropathy, diabetic peripheral neuropathy, foot deformity, and peripheral arterial disease. Understanding these factors and their impact on ulcer recurrence is crucial for multidisciplinary teams to develop management and treatment plans for diabetic foot ulcer patients.

Emerging evidence has demonstrated the unfavourable cardiovascular risk of individuals with lean type 2 diabetes mellitus (T2DM). Our study aims to investigate the prognostic value of lean T2DM in patients with acute myocardial infarction (AMI), stratified by sex.

The study cohort examines the clinical characteristics and long-term outcomes of individuals with AMI, stratified by four phenotypes based on T2DM and lean body category-lean T2DM, non-lean T2DM, lean non-T2DM and non-lean non-T2DM. The primary outcome was long-term all-cause mortality. Cox regression model was constructed to investigate the associations of lean and non-lean T2DM phenotypes with mortality, adjusted for age, ethnicity, previous AMI, AMI type, chronic kidney disease, angiotensin converting enzyme inhibitor or angiotensin receptor blockers, beta-blockers, and smoking status.

A cohort of 9545 AMI patients was examined, with a mean follow-up duration of 3.4 ± 2.4 years. Majority had the non-lean T2DM phenotype (40.4%), followed by non-lean non-T2DM (29.8%), lean non-T2DM (15.9%), and lean T2DM (13.9%). In the T2DM group, one-quarter was lean (N = 1324), while the vast majority (74.5%) was non-lean. Individuals with lean T2DM tended to be female and older. Patients with lean T2DM had the highest rates of heart failure (23.3%, p < 0.001), cardiogenic shock (9.1%, p = 0.036), and long-term all-cause mortality (32.6%, p < 0.001). Cox regression demonstrated that lean T2DM was an independent predictor of mortality (adjusted hazard ratio [aHR] 1.171, 95% CI 1.040-1.319, p = 0.009) after adjustment. The presence of higher mortality risk following AMI was present in males (aHR 1.201, 95% CI 1.037-1.391, p = 0.015), but not in females (aHR 1.066, 95% CI 0.869-1.308, p = 0.538).

The lean T2DM phenotype was present in one-quarter of the AMI cohort with T2DM. The lean T2DM phenotype was an independent predictor of long-term mortality following AMI, although this association was stronger in males than in females.

Background: Obesity is a risk factor for leading causes of death. Aim: This study investigated the associations of obesity with demographic and lifestyle factors among adults aged 18-64 in Hong Kong. Methods: The study uses data (n = 24,855) from the government online database. It uses T-tests to compare mean values for body mass index (BMI), waist circumference, and weight-to-height ratio obese; analysis of variance for not-obese, BMI-obese-only, central-obese, and BMI + central-obese; Pearson chi-square tests for categorical variables; and multinomial logistic regression to obtain the odd ratios. It uses IBM SPSS version 26 to conduct all analyses, and at a 95% confidence level. Results: The analyses show that the risks of central-obese, and BMI + central-obese increase by 4%, and 4%/year of age, respectively. Females have 60%, 38%, and 60% lower risks of BMI-obese-only, central-obese, and BMI + central-obese, respectively, and people with tertiary education have 28%, 20%, and 20% lower risks, respectively. Employed people have a 40% higher risk of BMI-obese-only when compared with the unemployed; students have a 46% lower risk of BMI + central-obese and home-makers have a 38% higher risk. The risk of central-obese decreases by 14%/10 min/day of moderate physical activity, but could be different among females, and vigorous physical activity yielded mixed results. The risk of BMI + central-obese decreases by 9%/day/week of vegetable intake. Conclusions: Obesity is associated with multiple demographic and lifestyle factors. Keep doing vigorous and moderate physical activity but state alert to obesity risk factors, and frequent vegetable intake are recommended. Lifelong learning and continuing education could be an effective strategy to combat obesity.

Cigarette smoking and diabetes mellitus (DM) increase risks of cardiovascular diseases and all-cause mortality in cancer survivors. An increased risk of DM incidence in cancer survivors has been observed and smoking is an important modifiable risk factor for DM development in the general population. Thus, we investigated the association between smoking behavior change after cancer diagnosis and DM incidence in cancer survivors.

This retrospective cohort study using the Korean National Health Insurance System database included patients with newly diagnosed cancers between 2010 and 2016. Smoking behavior changes after cancer diagnosis were categorized as never smoker, ex-smoker, quitter, smoking starter, and persistent smoker. The associations between smoking behavior changes and DM incidence in overall and specific cancers were investigated using Cox regression analyses.

Of the 263,940 cancer survivors, 67.6 % were never smokers, 16.0 % were ex-smokers, 9.3 % were quitters, 1.0 % were smoking starters, and 6.2 % were persistent smokers. During a mean follow-up of 4.0 years, 12,175 patients were diagnosed with DM after cancer development. Compared to the never smokers, the adjusted hazard ratios (95 % confidential interval) of DM incidence were 1.06 (1.00-1.13) for ex-smokers, 1.45 (1.35-1.54) for quitters, 1.46 (1.25-1.71) for starters, and 1.57 (1.45-1.69) for persistent smokers.

Compared with never smokers, cancer survivors who engaged smoking at any point before or after cancer diagnosis showed an increased risk of DM incidence after cancer diagnosis. Cancer survivors should be advised to quit smoking promptly and to maintain abstinence throughout cancer survivorship.

As patients with diabetes are at a significantly higher risk of cardiovascular diseases than those without diabetes, it is important to gain a clinical understanding of the differential effects of smoking cessation on several risk factors between patients with and without diabetes.

Patients who participated in a smoking cessation program received an assessment of the outcomes of interest. The outcomes were changes in metabolic parameters and renal function from baseline to 6-month follow-up after the smoking cessation program.

A total of 1954 patients joined the smoking cessation program, and 1381 patients were in the smoking cessation failure (SCF) group and 573 were in the smoking cessation success (SCS) group. The decrease in HbA1c after smoking cessation was only observed in patients with diabetes. Smoking cessation was also associated with a significant decrease in LDL cholesterol in patients with diabetes. In terms of renal function, smoking cessation was associated with an improvement in eGFR, and the trend was similar in patients with and without diabetes.

Successful smoking cessation was associated with improvement in renal function. Moreover, it was associated with improvements in HbA1c and LDL cholesterol in patients with diabetes, despite significant weight gain.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Systemic inflammation plays a pivotal role in the development of type 2 diabetes (T2D).

We hypothesized that circulating levels of calprotectin, a myeloid cell-derived biomarker of inflammation, is associated with the development of new-onset T2D in the general population.

A total of 4815 initially nondiabetic participants of the Prevention of Renal and Vascular End-stage Disease (PREVEND), a prospective population-based cohort study, were assessed for plasma levels of calprotectin at baseline. Circulating levels of calprotectin were investigated for potential associations with the risk of new-onset T2D, defined as a fasting plasma glucose level of 7.0 mmol/L or greater, a random plasma glucose level of 11.1 mmol/L or greater, a self-reported physician-based diagnosis of T2D, the use of glucose-lowering drugs, or any combinations thereof.

Median plasma calprotectin levels were 0.49 (0.35-0.69) mg/L. Plasma calprotectin levels were significantly associated with the risk of new-onset T2D (hazard ratio [HR] per doubling 1.42 [95% CI, 1.22-1.66]; P < .001). The association remained independent of adjustment for age and sex (HR 1.34 [95% CI, 1.14-1.57]; P < .001), but not after further adjustment for potentially confounding factors (HR 1.11 [95% CI, 0.90-1.37]; P = .326), with adjustment for hyperlipidemia and high-sensitivity C-reactive protein explaining the loss of significance. Stratified analyses showed significant effect modification by hypertension, history of cardiovascular disease (CVD), the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) (Pinteraction ≤ .001 for each), and the use of lipid-lowering drugs (Pinteraction ≤ .05), with higher HRs in individuals without hypertension, without history of CVD, with below-median HOMA-IR, and in those not using lipid-lowering drugs.

Elevated plasma levels of calprotectin are associated with a higher risk of developing T2D in the general population and may represent a moveable inflammatory biomarker. This association, however, does not represent a direct effect, and seems dependent on hyperlipidemia and systemic inflammation.

Disease burden associated with cardiovascular diseases (CVDs) in low- and middle-income countries has been on an increasing trend in the past decades. Despite the worldwide genetic, cultural, and environmental variations in determinants of CVDs, few studies have attempted the identification of risk factors of CVDs in low- and middle-income countries. This article aims to introduce the Khánh Hòa Cardiovascular Study, a prospective cohort study among middle-aged community dwellers in rural Khánh Hòa, Vietnam. A total of 3000 individuals, aged 40-60 years at baseline, participated in the baseline survey conducted from June 2019 to June 2020 and will be followed up for the subsequent 10 years. The baseline survey collected information on sociodemographic variables, disease history, lifestyle, social environment, and mental health via questionnaires, physical examinations, and biochemical measurements. Information on the incidence of severe health outcomes (i.e., mortality, CVDs, and cancer) has been and will be collected using a study-specific disease registry. Results showed that the prevalences of excess body weight (body mass index ≥25 kg/m2), hypertension, diabetes mellitus, and dyslipidemia were 25.9%, 39.6%, 10.2%, and 45.1%, respectively. Furthermore, by March 2023, 21 participants had died, including 5 CVD deaths and 12 cancer deaths. Moreover, we recorded 22 and 31 cases of nonfatal CVDs and cancer, respectively. These results suggest that many rural residents in Vietnam have high cardiometabolic risk, and underscore the importance of advancing research to identify risk factors and prevent the onset of serious health events.

To determine the impact of PM2.5 exposure in old age and its interactive effect with smoking on incident diabetes.

A total of 2766 participants aged ≥60 years in China were interviewed at baseline for disease risk factors in 2001-03 and were then followed up for 10 years to document incident diabetes. They were assessed for daily PM2.5 exposure in 2005. Multivariate Cox regression models were used to examine the association of PM2.5 exposure with incident diabetes and interactive effect between PM2.5 and smoking on incident diabetes.

During the cohort follow-up, 176 participants developed diabetes. The incidence of diabetes increased with PM2.5 exposure; the multiple-adjusted hazard ratio (HR) of diabetes was 2.27 (95 % CI 1.36-3.77) in participants with PM2.5 at ≥62.0 μg/m3 compared to those at <62.0 μg/m3. There was a significant interaction effect of PM2.5 with smoking on increased risk of diabetes. The adjusted HR for participants exposed to PM2.5 levels ≥62.0 μg/m3 who smoked was 4.39 (95 % CI 1.72-11.21), while for non-smokers it was 1.65 (95 % CI 0.88-3.09), compared to those at <62.0 μg/m3.

Exposure to PM2.5 in old age was associated with an increased incidence of diabetes and smoking enhanced the impact of PM2.5 on diabetic risk. These findings underscore the urgent need for air quality improvement measures and smoking cessation programs to mitigate the risk of diabetes in aging populations.

Smoking increases insulin resistance via multiple mechanisms but is a poorly understood risk factor for onset of type-2 diabetes. It is also associated with impaired beta-cell function in humans, but again the mechanisms are poorly understood. Mechanistic studies of the impact of smoking on carbohydrate metabolism mainly evaluated nicotine as the causal agent, and more rarely other tobacco constituents, making it impossible to conclude that the risk of diabetes is linked to the effects of nicotine alone. Active smoking also has negative impact on glycemic control in both type-1 and type-2 diabetic patients. It increases the risk of all-cause mortality and worsens the chronic complications of diabetes. Impact on microangiopathic complications in type-2 diabetic patients, however, is more controversial. Data on pharmacological and behavioral strategies for smoking cessation used in the general population are more sparse in diabetic patients, despite opportunities with recent therapeutic trials involving varenicline and GLP-1 analogues. It is essential for diabetic patients to stop smoking, and diabetologists must get involved in smoking cessation as they have done for many years in therapeutic education, which can easily include measures to help patients stop smoking.

Leptin (LEP) is an anti-obesity hormone that regulates food intake, energy expenditure, and glucose metabolism. The genetic variants in LEP and the LEP receptor (LEPR) gene may play an important role in the pathogenesis of type 2 diabetes mellitus (T2DM) and obesity. The current study aimed to investigate the association of serum LEP levels, and LEP polymorphisms in LEP (rs7799039, 2548 G/A) with T2DM in Egyptian patients.

A total of 205 subjects were included in the present case-control study, consisting of 100 T2DM patients and 105 healthy controls. The anthropometric, psychometric, and biochemical measurements were taken from all the subjects. The genotyping of LEP gene variants was carried out by polymerase chain reaction TaqMan technology. Serum LEP levels were measured by the ELISA technique.

T2DM patients had significantly elevated levels of glycated haemoglobin (HbA1c), fasting blood sugar (FBS), postprandial blood sugar (PPBS), international normalisation ratio (INR), creatinine, urea, cholesterol, triglyceride (TG), and low-density lipoproteins (LDL) and significantly decreased high-density lipoprotein (HDL) compared to healthy subjects. serum LEP levels were significantly decreased p (<0.001) as compared to the control group. LEP gene SNP rs7799039 was associated with an increased diabetic risk with A allele being more frequent in T2DM patients than control subjects. The distribution of the AA genotype and GA genotype of LEP SNP rs7799039 was higher in the diabetic group than control one. In addition, AA + GA genotype carriers had significantly elevated HbA1c, FBS, PPBS, TG, and LDL levels and on the contrary, decreased serum LEP levels compared to GG homozygotes.

The genetic polymorphism rs7799039 showed a highly significant correlation with blood LEP. The co-dominant and dominant models of the LEP genetic polymorphism (rs7799039, 2548 G/A) were shown to have a significant correlation with complicated and uncomplicated diabetes individuals, but we have found that serum LEP levels were inversely related with control and diabetes patients. A positive significant association was found between LEP genetic polymorphism (rs7799039, 2548 G/A) and serum LEP in patients and controls. LEP levels and its rs7799039 genetic variant may play a vital role in increasing T2DM susceptibility.

Smoking and nicotine impose detrimental health effects including adipose tissue dysfunction. Despite extensive physiological evidence, the cellular mechanisms remain poorly understood, with few studies examining the effects of cigarette smoke extract (CSE) or nicotine on adipocyte differentiation.

Primary human bone marrow-derived mesenchymal stromal cells (MSCs) were exposed to CSE or nicotine (50-500 ng/ml) during adipogenic differentiation. Cell viability and metabolic activity were assessed via MTT assay. Lipid droplet accumulation was evaluated using Sudan III staining and quantitative image analysis. Adiponectin, IL6, and IL8 concentrations were measured after 35 days using ELISA.

At these doses, CSE and nicotine do not immediately affect cell viability but inhibit undifferentiated cell proliferation. Notably, both agents at 50 ng/ml significantly increased lipid accumulation during adipogenesis, while higher CSE doses nearly completely inhibited this process. Additionally, CSE dose-dependently decreased adiponectin secretion and increased IL6 and IL8, indicating a shift towards an inflammatory state. Nicotine alone primarily increased IL6 secretion with less pronounced effects.

The study highlights the complex impact of CSE and nicotine on adipocyte function during early differentiation from MSCs. Dose-dependent changes in lipid accumulation, cytokine, and adiponectin secretion induced by CSE and nicotine can partly explain smoking-related adipose tissue dysfunction.

The association between secondhand smoking (SHS) and the risk of Type 1 diabetes mellitus (DM) has garnered increasing interest. The aim of this study is to examine whether exposure to SHS is associated with an increased likelihood of Type 1 DM.

This study was designed as a case-control study. Children aged 4-14 years diagnosed with Type 1 DM who were followed in the Endocrine and Metabolic Diseases Outpatient Clinic were included as cases, and healthy children (without any chronic disease) in the same age range were included as the controls. A total of 248 children were included in the study, with two research arms. The structured questionnaire was applied face-to-face. Adjusted odds ratios (AOR) and 95% confidence intervals (CIs) of other risk factors were evaluated by multivariable regression analysis.

No difference was found in the number of cigarettes mothers smoked daily and the duration of the smoking period during pregnancy and lactation, between the two groups. Among the cases, the daily number of cigarettes smoked by parents at home was 3.28 ± 4.90, higher than in the controls (p=0.039). Comparing the controls, children with Type 1 DM were more likely to be exposed to SHS at home by 1.08 (95% CI: 1.004-1.15, p=0.039) times in cases.

Children with Type 1 DM had higher odds of being exposed to SHS at home. These results suggest substantial health gains could be made by extending effective public health interventions to reduce exposure to SHS and prevent Type 1 DM in children.

Smoking is a significant risk factor for numerous diseases, including coronary artery disease (CAD). Chronic inflammation from smoking affects endothelial function and may alter adipokine secretion, particularly resistin, in perivascular adipose tissue (PVAT). This study investigated the association between resistin concentrations in PVAT and smoking status in CAD patients undergoing coronary artery bypass grafting (CABG).

The study included 110 patients with advanced CAD scheduled for CABG. Patients were categorized into never-smokers and ever-smokers, with the latter further divided into current and past smokers. Resistin concentrations in PVAT and plasma, along with plasma interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) concentrations, were measured using ELISA.

Significant differences in PVAT resistin concentrations were observed between never-smokers and ever-smokers (p < 0.0001), as well as between never-smokers and both current (p < 0.0001) and past smokers (p < 0.0001). PVAT resistin concentrations correlated positively with the number of pack-years (p < 0.0001) and plasma resistin (p < 0.0001) and IL-6 concentrations (p < 0.0001). Plasma resistin, IL-6, and hs-CRP concentrations were higher in ever-smokers compared with never-smokers. Multiple regression analysis indicated that smoking is significantly correlated with higher PVAT resistin concentrations, with increased pack-years (p = 0.0002), higher plasma resistin concentrations (p < 0.0001), and IL-6 concentrations (p < 0.0001), all contributing to elevated PVAT resistin.

Smoking status in advanced CAD patients requiring CABG is positively associated with PVAT resistin concentrations, with a clear demonstration of dose-dependency.

Orlistat is recommended as an adjunct to diet and exercise for weight loss in the treatment of type 2 diabetes mellitus (T2DM).

To explore associations between patient characteristics and orlistat prescribing, and to determine associations of orlistat with weight loss in T2DM and prediabetes.

Cohort study using anonymised health records from a UK database of general practice.

The UK Clinical Practice Research Datalink (CPRD) Aurum database was searched to compile a cohort of patients aged ≥18 years, first diagnosed with T2DM or prediabetes in 2016 or 2017. Once the data had been collated, multivariable logistic regression models were used to determine associations with starting orlistat and stopping it early (<12 weeks of prescriptions) and orlistat's associations with weight loss in those who had not been prescribed second-line antidiabetic medications.

Out of 100 552 patients with incident T2DM or prediabetes, 655 (0.8%) patients with T2DM and 128 (0.7%) patients with prediabetes were prescribed orlistat. Younger people, females, those in areas of deprivation, current smokers, those coprescribed metformin, and those recorded as having hypertension were statistically significantly more likely to be prescribed orlistat; higher baseline glycated haemoglobin levels were associated with early stopping. In comparison with patients not on orlistat, those who continued using it for ≥12 weeks were more likely to lose ≥5% weight (adjusted odds ratio [AOR] 1.69, 95% confidence interval [CI] = 1.07 to 2.67) but those who stopped orlistat early were less likely to lose ≥5% weight (AOR 0.56, 95% CI = 0.29 to 1.09).

Orlistat was significantly associated with weight loss in patients with T2DM and prediabetes when taken for at least 12 weeks; however, it was infrequently prescribed and often taken for <12 weeks. Orlistat may be a useful adjunct to lifestyle modifications for patients with T2DM and prediabetes, but barriers to continued use means it may not be effective for everyone in managing weight loss.

Cardiovascular diseases (CVDs) and chronic kidney disease (CKD) are common causes of morbidity and mortality. However, the impact of changes in lifestyle and rehabilitation programs on the progression of cardiovascular, renal, and metabolic (CRM) conditions, remains unclear.

In a retrospective manner, we analyzed charts of 200 patients admitted for cardiorespiratory rehabilitation at our facility in 2023. A 6 min walk test, echocardiographic features, and laboratory values were investigated to evaluate the impact of cardiorespiratory rehabilitation in patients post cardiac surgery. This study examined the impact of combined lifestyle and exercise scores (diet, alcohol consumption, smoking, aerobic physical activity, sedentary behavior, sleep duration, and social connection) on cardio-renal-metabolic profiles and on a quality-of-life score measured by the Borg Scale.

During the rehabilitation program, left ventricular ejection fraction (LVEF) significantly increased (51.2 vs. 54.3%, SEM 0.51 p = 0.001). The six-minute walk test (6 MWT) significantly improved in terms of meters (133 vs. 373 m, SEM 6.41, p < 0.001) and Borg scale (6.6 vs. 2.5, SEM 0.06, p < 0.001). Glycemia levels reduced significantly (114.5± vs. 107.4± mg/dL, SEM 2.45, p = 0.001). While total cholesterol levels (119.4 vs. 129.6 mg/dL, SEM 2.4, p < 0.001) as well as HDL levels (29.9 vs. 40 mg/dL, SEM 0.62, p < 0.001) significantly increased, triglyceride levels significantly decreased (128.5 vs. 122.1 mg/dL, SEM 3.8, p = 0.048). There was no change in LDL levels. Creatinine levels remained stable throughout the period of rehabilitation.

Cardiorespiratory rehabilitation has a significant impact on myocardial function, quality of life in terms of exercise capacity and symptoms (6 MWT) as well as laboratory levels relevant for cardiovascular prevention such as glycemia and lipid profile.

Active smokers are known to be at an increased risk of both gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD), however the role of passive smoking remains unclear. In this study, we aimed to examine whether secondhand smoke (SHS) is associated with PUD and GERD.

In this population-based study, we conducted a large-scale analysis with 88,297 never-smokers (male: 18,595; female: 69,702; mean age 50.1 ± 11.0 years) from the Taiwan Biobank. The exposure group was comprised of those who had been exposed to SHS, and the no exposure group as those without SHS exposure. According to the frequency of exposure, we further divided the participants into "no exposure," "<1 h per week," and "≥1 h per week" groups. A cutoff point of 1 h per week was chosen according to the median exposure time in our participants. Associations between SHS and SHS frequency with PUD and GERD were assessed.

Of the 88,297 enrolled participants, 11,909 (13.5%) had PUD and 76,388 (86.5%) did not. In addition, 11,758 (13.3%) had GERD and 76,539 (86.7%) did not. Multivariable analysis showed a significant association between SHS with PUD (odds ratio [OR] = 1.166; 95% confidence interval [CI] = 1.084-1.254; p < 0.001), and GERD (OR = 1.131; 95% CI = 1.053-1.216; p = 0.001). Furthermore, those exposed to SHS ≥ 1 h per week (vs. no exposure) were associated with higher risks of PUD (OR = 1.232; 95% CI = 1.121-1.355; p < 0.001) and GERD (OR = 1.200; 95% CI = 1.093-1.319; p < 0.001).

SHS was significantly associated with PUD and GERD. Furthermore, exposure to SHS ≥ 1 h per week (vs. no exposure) was associated with a 1.23-fold higher risk of PUD and 1.20-fold higher risk of GERD. This study represents the largest population-based investigation to explore the association between SHS with PUD and GERD in Taiwanese never-smokers.

Tobacco use represents a significant public health burden, being especially harmful for smokers with Type 2 Diabetes Mellitus (T2DM). Effective smoking cessation interventions are required for this vulnerable population. The goal is to describe a study protocol of a randomized controlled trial (RCT) aimed at analyzing the effectiveness and efficiency of a multicomponent smoking cessation intervention for T2DM smokers, including a training protocol on healthy lifestyle habits and self-management of T2DM (DiMe-SALUD2 project).

This RCT will assign participants to: (1) Control Group (n = 30), including a brief psychoeducation advice about smoking cessation; (2) Cognitive-behavioral treatment (CBT) for smoking cessation (n = 30), based on a multicomponent program implemented in group-based sessions over an eight-week period; and (3) CBT plus DiMeSALUD2 protocol (n = 30), which will develop an additional psychoeducational protocol specifically designed to improve healthy lifestyle habits. Participants will be assessed at baseline, post-treatment and several follow-ups (1-, 6- and 12-months). Primary outcomes will include smoking abstinence (24-h point prevalence abstinence at post-treatment and 7-day point prevalence at follow-ups) and smoking continuous abstinence. Secondary outcomes will include treatment retention, changes in smoking patterns and nicotine dependence, as well as the impact on T2DM clinical variables, mental health, and quality of life.

The DiMeSALUD2 program could assist T2DM smokers in quitting tobacco use and improving their overall quality of life. This project will help incorporating improvements in routine clinical practice with T2DM patients, offering a smoking cessation program adapted to their specific needs.

ClinicalTrials.gov. Identifier: NCT05885659. Date of registration: June 2nd, 2023.

Diabetes mellitus (DM) is a prevalent metabolic illness that arises as a result of a complex interplay between genetic predisposition, environmental influences, and lifestyle choices. The precise mechanisms elucidating the association between smoking and the onset of DM remain incompletely understood, despite the proposal of several ideas. The objective of this study ‎was to conduct a comparative analysis of blood glucose levels, hemoglobin A1c (HbA1c) levels, insulin hormone levels, and homeostasis model assessment of insulin resistance (HOMA-IR) ‎levels in diabetic patients who smoked and those who did not.

The study included a total of 320 volunteers divided into four groups, with each group consisting of 80 volunteers. The first group served as the control group and consisted of ‎healthy individuals. The remaining three groups consisted of type 2 diabetes mellitus (T2DM) patients, categorized based on their smoking habits. The second ‎group comprised T2DM patients who did not smoke, the third group consisted of T2‎DM patients who smoked cigarettes, and the fourth group included T2DM patients ‎who smoked e-cigarettes.‎ At recruitment, data on age, fat %, waist circumference (cm), and body mass index (kg/m2) was collected. Biochemical markers measured were fasting blood glucose (FBG), HbA1c, insulin, and HOMA-IR‎ levels.

The findings demonstrated a statistically significant increase (P<0.001) in the levels of each parameter, particularly among patients with T2DM who engaged in e-cigarette smoking, compared to the control group.‎ It was found that engaging in dual smoking, which involves the use of both traditional cigarettes and e-cigarettes, was associated with a higher likelihood of elevated HbA1c levels and other negative health effects.

When it comes to the management of diabetic patients, abstaining from smoking and participating in smoking cessation programs, for patients who smoke, should be the essential approaches. It was found that dual smoking led to a higher likelihood of elevated HbA1c levels and this association was most pronounced among male individuals, those who were physically inactive, and those classified as obese. Further studies should be conducted on the detrimental health consequences associated with e-cigarettes, with a particular focus on enhancing the awareness of healthcare professionals and their patients of the potential risks. This is particularly significant due to the prevailing perception that e-cigarettes are inherently "safe".

This study aimed to analyze patterns and predictors of secondhand smoke (SHS) exposure among adolescents (12-16 years old) in Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Nationally representative data from the most recent Global Youth Tobacco Survey in each country were analyzed (N = 17,220). SHS exposure at home, in public places, and at school was assessed. Descriptive statistics summarized exposure prevalence overall and by sex. Multivariable logistic regression examined factors associated with each SHS exposure's outcome. The results showed that SHS exposure was high overall, with exposure at home and school ranging from 12.7 to 20.7%, respectively, in Oman to 39.4% and 36.7%, respectively, in Kuwait. Almost half of the adolescents reported exposure to SHS in public places, with a prevalence of 40.8% in Saudi Arabia to 65.9% in Kuwait. The prevalence of exposure varied between countries, with the highest rates occurring in Kuwait. Girls had higher exposure at home, while boys had higher exposure in public and at school. Factors associated with higher exposure included parental smoking, friend smoking, and tobacco advertising. The belief that SHS is harmful was associated with lower home exposure. In conclusion, adolescents in the Gulf Cooperation Council countries are exposed to concerning levels of SHS, especially in public places. These findings underscore the urgent need for stronger tobacco control policies, including comprehensive smoke-free laws covering all public venues, to protect youth from SHS exposure. Additionally, the results support the development of targeted interventions promoting smoke-free homes and social norms against smoking.

We evaluated the association between smoking and diabetes, as well as the effects of gender differences and hidden smoking among females on this association using nationally representative data. Analyzing data from 44,049 individuals aged 19 and older, we utilized multivariable logistic regression to investigate associations, controlling for sociodemographic factors. Subgroup analysis based on smoking status determined factors associated with diabetes. To better our understanding of the smoking-diabetes relationship, we introduced a new variable, survey-cotinine verified smoking status (SCS). This study provides valuable insight by exploring the correlation between smoking and diabetes using different definitions of smoking status. Both male and female smokers showed correlations with diabetes according to cotinine-verified smoking status (OR: 1.22 and 1.48, respectively). According to smoking amount, cotinine-verified heavy smokers correlated with diabetes in males (OR: 1.37), while light smokers exhibited a negative correlation with diabetes in females for both cotinine-verified smoking status (OR: 0.60) and survey-cotinine verified status (OR: 0.58) Smoking was associated with diabetes in the overall population, with gender differences observed. When evaluating this association, we should consider variables of smoking amount, passive and intermittent smoking, and specifically, account for the influence of hidden smoking among females, particularly when utilizing self-reported questionnaires in Korea.

Nonalcoholic fatty liver disease (NAFLD) is a prevalent metabolic disorder strongly linked to type 2 diabetes mellitus (T2DM). Understanding the predictive value of lipid parameters in identifying abnormal glucose metabolism in NAFLD patients is crucial for early intervention.

This study analyzed data from the National Health and Nutrition Examination Survey(NHANES) database (2017-2020) involving 1066 NAFLD patients. Participants were categorized into three groups: T2DM (n=414), prediabetes mellitus (pre-DM) (n=507), and normoglycemia (NG) (n=145). Traditional lipid parameters [triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C)] and nontraditional lipid parameters [atherogenic index of plasma (AIP), residual cholesterol (RC), and non-high-density lipoprotein cholesterol (non-HDL-C)] were evaluated for their association with T2DM and pre-DM.

Elevated TG levels were significantly associated with an increased risk of T2DM and pre-DM, whereas high HDL-C demonstrated a protective effect. Among nontraditional lipid parameters, increased AIP and RC were most strongly associated with T2DM risk, while high non-HDL-C was best associated with the development of pre-DM. Stratified analyses revealed that these associations were stronger in younger, non-obese, smoking, and female NAFLD patients.

Nontraditional lipid parameters, particularly AIP and RC, show superior predictive value over traditional lipid parameters in identifying abnormal glucose metabolism in NAFLD patients. Incorporating these novel biomarkers into clinical practice could enhance early detection and prevention strategies for T2DM and pre-DM in this high-risk population.

The social environment (SE), that is, the social relationships and social context in which groups of people live and interact, is an understudied element of the broader living environment which impacts health. We aim to summarise the available evidence on the associations between SE and cardiometabolic disease (CMD) outcomes.

Systematic review and meta-analysis.

PubMed, Scopus and Web of Science Core Collection were searched from inception to 28 February 2024.

We included studies for which determinants were SE factors such as area-level deprivation and social network characteristics and outcomes were type 2 diabetes mellitus and cardiovascular diseases incidence and prevalence.

Titles and abstracts and full text were screened in duplicate. Data appraisal and extraction were based on the study protocol published in PROSPERO. Methodological quality was assessed with the Newcastle-Ottawa Scale. We synthesised the data through vote counting and meta-analyses.

From 10 143 records screened, 281 studies reporting 1108 relevant associations are included in this review. Of the 384 associations included in vote counting, 271 (71%) suggested that a worse SE is associated with a higher risk of CMD. 14 meta-analyses based on 180 associations indicated that worse SE was associated with increased odds of CMD outcomes, with 4 of them being statistically significant. For example, more economic and social disadvantage was associated with higher heart failure risk (OR 1.58, 95% CI 1.08 to 1.61; n=18; I2=95%). With the exception of two meta-analyses for men, meta-analysed sex-specific associations consistently showed results in the same direction as the overall meta-analyses.

Worse SE seems to be associated with increased odds of CMD outcomes, although certain SE dimensions are underexplored in relation to CMD.

CRD42021223035.

To estimate the impact of reducing obesity, smoking, and physical inactivity (PIA) prevalence, and of introducing physical activity (PA) as an explicit intervention, on the prevalence, incidence, and mortality of type 2 diabetes mellitus (T2DM) in Oman.

A deterministic population-level mathematical model was employed to investigate the impact of different scenarios for reducing T2DM risk factors on T2DM epidemiology. The model was stratified by sex, age group, risk factor status, T2DM status, and intervention status and parameterized with nationally representative data. Intervention scenarios were calculated and compared with a baseline (no-intervention) scenario for changes in T2DM prevalence, incidence, and mortality among adult Omanis between 2020 and 2050.

In the no-intervention scenario, T2DM prevalence increased from 15.2% in 2020 to 23.8% in 2050. Achieving the goals of halting the rise of obesity, reducing smoking by 30%, and reducing PIA by 10% as outlined in the WHO's Global Action Plan for Non-communicable Diseases (implemented between 2020 and 2030 and then maintained between 2031 and 2050) would reduce T2DM prevalence by 32.2%, cumulative incidence by 31.3%, and related deaths by 19.3% by 2050. Halting the rise of or reducing obesity prevalence by 10%-50% would reduce T2DM prevalence by 33.0%-51.3%, cumulative incidence by 31.9%-53.0%, and related deaths by 19.5%-35.6%. Reducing smoking or PIA prevalence by 10%-50% would lead to smaller reductions of less than 5% in T2DM prevalence, cumulative incidence, and related deaths. Introducing PA with varying intensities at a 25% coverage would reduce T2DM prevalence by 4.9%-14.1%, cumulative incidence by 4.8%-13.8%, and related deaths by 3.4%-9.6% by 2050.

Intervention-for-prevention efforts targeting obesity reduction and introducing PA could result in major reductions in the T2DM burden. Prioritizing such interventions could alleviate the burden of T2DM in Oman and other countries with similarly high T2DM and obesity burdens.

Gestational diabetes mellitus (GDM) is a common prenatal condition. Many risk factors have been linked to its occurrence. This study aimed to assess the risk factors of GDM among pregnant women attending antenatal care (ANC) in King Saud Medical City (KSMC), Riyadh, Saudi Arabia, and explore the relationship between risk factors and different socio-demographic factors.

This cross-sectional observational study was conducted on a total of 184 participants using a self-administered questionnaire distributed among pregnant women attending ANC. The collected data included sociodemographic information, medical history, obstetric history, and family history of GDM and its associated risk factors. Qualitative data was expressed in the form of numbers and percentages (N and %). The chi-square (χ2) test was used to examine qualitative data between two groups. The associations of GDM with these risk factors and other comorbidities were assessed, with a p-value of less than 0.05 considered significant.

The prevalence of GDM was 23.9%. There was a significant association between GDM and family history of diabetes (n=39, p-value=0.0218), above normal glucose tolerance test (n=19, p-value≤0.001), and the last trimester of pregnancy (n=24, p-value=0.0139). There were no significant associations between GDM and smoking, hypertension, and adherence to health advice (p-value>0.05).

GDM exhibited a high prevalence among pregnant women in KSMC, Riyadh, Saudi Arabia. It showed significant associations with family history of diabetes, abnormal glucose tolerance test results, and the last trimester of pregnancy.

Smoking is a major risk factor for type 2 diabetes (T2D), but the evidence has mostly relied on self-reports. We aimed to compare the associations of smoking exposure as assessed by self-reports and urine cotinine with T2D.

Using the PREVEND prospective study, smoking status was assessed at baseline by self-reports and urine cotinine in 4708 participants (mean age, 53 years) without a history of diabetes. Participants were classified as never, former, light current and heavy current smokers according to self-reports and analogous cut-offs for urine cotinine. Hazard ratios (HRs) with 95% CIs were estimated for T2D.

During a median follow-up of 7.3 years, 259 participants developed T2D. Compared with self-reported never smokers, the multivariable adjusted HRs (95% CI) of T2D for former, light current, and heavy current smokers were 1.02 (0.75-1.4), 1.41 (0.89-2.22), and 1.30 (0.88-1.93), respectively. The corresponding adjusted HRs (95% CI) were 0.84 (0.43-1.67), 1.61 (1.12-2.31), and 1.58 (1.08-2.32), respectively, as assessed by urine cotinine. Urine cotinine-assessed but not self-reported smoking status improved T2D risk prediction beyond established risk factors.

Urine cotinine assessed smoking status may be a stronger risk indicator and predictor of T2D compared to self-reported smoking status.

The role of lifestyle factors and their relative contributions to the development and mortality of cardio-renal-metabolic multimorbidity (CRMM) remains unclear.

A study was conducted with 357,554 UK Biobank participants. CRMM was defined as the coexistence of two or three cardio-renal-metabolic diseases (CRMDs), including cardiovascular disease (CVD), type 2 diabetes (T2D) and chronic kidney disease (CKD). The prospective study examined the associations of individual and combined lifestyle scores (diet, alcohol consumption, smoking, physical activity, sedentary behavior, sleep duration and social connection) with longitudinal progression from healthy to first cardio-renal-metabolic disease (FCRMD), then to CRMM, and ultimately to death, using a multistate model. Subsequently, quantile G-computation was employed to assess the relative contribution of each lifestyle factor.

During a median follow-up of 13.62 years, lifestyle played crucial role in all transitions from healthy to FCRMD, then to CRMM, and ultimately to death. The hazard ratios (95% CIs) per score increase were 0.91 (0.90, 0.91) and 0.90 (0.89, 0.91) for healthy to FCRMD, and for FCRMD to CRMM, and 0.84 (0.83, 0.86), 0.87 (0.86, 0.89), and 0.90 (0.88, 0.93) for mortality risk from healthy, FCRMD, and CRMM, respectively. Among the seven factors, smoking status contributed to high proportions for the whole disease progression, accounting for 19.88-38.10%. High-risk diet contributed the largest proportion to the risk of transition from FCRMD to CRMM, with 22.53%. Less-frequent social connection contributed the largest proportion to the risk of transition from FCRMD to death, with 28.81%. When we further consider the disease-specific transitions, we find that lifestyle scores had slightly stronger associations with development to T2D than to CVD or CKD.

Our study indicates that a healthy lifestyle may have a protective effect throughout the longitudinal progression of CRMM, informing more effective management and treatment. Smoking status, diet, and social connection played pivotal roles in specific disease transitions.

To investigate the association between cigarette smoking, smoking cessation and the trajectory of cardiometabolic multimorbidity (CMM), and further to examine the association of age at smoking initiation and smoking cessation with CMM.

This study included 298,984 UK Biobank participants without cardiometabolic diseases (CMDs) (including type 2 diabetes, coronary heart diseases, stroke, and hypertension) at baseline. Smoking status was categorized into former, current, and never smokers, with age at smoking initiation and smoking cessation as a proxy for current and former smokers. The multi-state model was performed to evaluate the association between cigarette smoking, smoking cessation and CMM.

During a median follow-up of 13.2 years, 59,193 participants developed first cardiometabolic disease (FCMD), 14,090 further developed CMM, and 16,487 died. Compared to former smokers, current smokers had higher risk at all transitions, with hazard ratio (95% confidence interval) = 1.59 (1.55 ∼ 1.63) vs. 1.18 (1.16 ∼ 1.21) (P = 1.48 × 10- 118) from health to FCMD, 1.40 (1.33 ∼ 1.47) vs. 1.09 (1.05 ∼ 1.14) (P = 1.50 × 10- 18) from FCMD to CMM, and 2.87 (2.72 ∼ 3.03) vs. 1.38 (1.32 ∼ 1.45) (P < 0.001) from health, 2.16 (1.98 ∼ 2.35) vs. 1.25 (1.16 ∼ 1.34) (P = 1.18 × 10- 46) from FCMD, 2.02 (1.79 ∼ 2.28) vs. 1.22 (1.09 ∼ 1.35) (P = 3.93 × 10- 17) from CMM to death; whereas quitting smoking reduced the risk attributed to cigarette smoking by approximately 76.5% across all transitions. Reduced risks of smoking cessation were also identified when age at quitting smoking was used as a proxy for former smokers.

Cigarette smoking was associated with a higher risk of CMM across all transitions; however, smoking cessation, especially before the age of 35, was associated with a significant decrease in CMM risk attributed to cigarette smoking.

Smokers are at increased risk of type 2 diabetes (T2D), but the underlying mechanisms are unclear. We investigated if the smoking-T2D association is mediated by alterations in the metabolome and assessed potential interaction with genetic susceptibility to diabetes or insulin resistance.

In UK Biobank (n = 93,722), cross-sectional analyses identified 208 metabolites associated with smoking, of which 131 were confirmed in Mendelian Randomization analyses, including glycoprotein acetyls, fatty acids, and lipids. Elastic net regression was applied to create a smoking-related metabolic signature. We estimated hazard ratios (HR) of incident T2D in relation to baseline smoking/metabolic signature and calculated the proportion of the smoking-T2D association mediated by the signature. Additive interaction between the signature and genetic risk scores for T2D (GRS-T2D) and insulin resistance (GRS-IR) on incidence of T2D was assessed as relative excess risk due to interaction (RERI).

The HR of T2D was 1·73 (95% confidence interval (CI) 1·54 - 1·94) for current versus never smoking, and 38·3% of the excess risk was mediated by the metabolic signature. The metabolic signature and its mediation role were replicated in TwinGene. The metabolic signature was associated with T2D (HR: 1·61, CI 1·46 - 1·77 for values above vs. below median), with evidence of interaction with GRS-T2D (RERI: 0·81, CI: 0·23 - 1·38) and GRS-IR (RERI 0·47, CI: 0·02 - 0·92).

The increased risk of T2D in smokers may be mediated through effects on the metabolome, and the influence of such metabolic alterations on diabetes risk may be amplified in individuals with genetic susceptibility to T2D or insulin resistance.

Bayesian network (BN) models were developed to explore the specific relationships between influencing factors and type 2 diabetes mellitus (T2DM), coronary heart disease (CAD), and their comorbidities. The aim was to predict disease occurrence and diagnose etiology using these models, thereby informing the development of effective prevention and control strategies for T2DM, CAD, and their comorbidities.

Employing a case-control design, the study compared individuals with T2DM, CAD, and their comorbidities (case group) with healthy counterparts (control group). Univariate and multivariate Logistic regression analyses were conducted to identify disease-influencing factors. The BN structure was learned using the Tabu search algorithm, with parameter estimation achieved through maximum likelihood estimation. The predictive performance of the BN model was assessed using the confusion matrix, and Netica software was utilized for visual prediction and diagnosis.

The study involved 3,824 participants, including 1,175 controls, 1,163 T2DM cases, 982 CAD cases, and 504 comorbidity cases. The BN model unveiled factors directly and indirectly impacting T2DM, such as age, region, education level, and family history (FH). Variables like exercise, LDL-C, TC, fruit, and sweet food intake exhibited direct effects, while smoking, alcohol consumption, occupation, heart rate, HDL-C, meat, and staple food intake had indirect effects. Similarly, for CAD, factors with direct and indirect effects included age, smoking, SBP, exercise, meat, and fruit intake, while sleeping time and heart rate showed direct effects. Regarding T2DM and CAD comorbidities, age, FBG, SBP, fruit, and sweet intake demonstrated both direct and indirect effects, whereas exercise and HDL-C exhibited direct effects, and region, education level, DBP, and TC showed indirect effects.

The BN model constructed using the Tabu search algorithm showcased robust predictive performance, reliability, and applicability in forecasting disease probabilities for T2DM, CAD, and their comorbidities. These findings offer valuable insights for enhancing prevention and control strategies and exploring the application of BN in predicting and diagnosing chronic diseases.