Smoking cessation was not linked to higher diabetes risk at 15 years

A target trial emulation using repeated annual cohorts of Japanese employees found a higher relative risk of diabetes among people who quit smoking at three years, but not at 15 years. The analysis included 52,880 unique participants and 331,701 cohort enrollments.

Analysis included 52,880 Japanese employees aged 40 or older.
Three-year diabetes risk was higher among those who quit.
No clear risk difference was seen at 15 years.
Per-protocol analyses showed a similar pattern.

Researchers used annual health-check data from Japanese employees aged 40 years or older between 2008 and 2022 to emulate a target trial of smoking cessation. Participants were current smokers without diabetes at enrollment; inverse probability weighting was used to adjust for baseline confounding. Across 52,880 unique individuals, there were 331,701 sequential-cohort follow-ups, and 25,749 participants developed diabetes.

Compared with persistent smoking, quitting was associated with a higher diabetes risk at three years (risk ratio 1.15; 95% CI, 1.07–1.24). At 15 years, the estimate was 0.95 (95% CI, 0.85–1.06), showing no statistically clear difference. Per-protocol analyses showed a similar pattern. The findings suggest that the excess risk associated with cessation may diminish over time. However, this was an observational emulation using employee health-check data, and residual confounding and limited generalizability remain possible; the results do not establish that quitting causes short-term diabetes risk.

In practice

For adults aged 40 years or older who smoke and are free of diabetes, this analysis found a modestly higher relative diabetes risk among those who quit at three years, but no clear increase at 15 years. The findings may help contextualize concern about diabetes following cessation, but they do not show that quitting causes the short-term increase or establish an individual patient's risk. The study emulated a target trial using observational employee health-check data, so residual confounding and limited generalizability are important caveats; it does not justify changing clinical practice.

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Source

Diabetes, Obesity and Metabolism: Preventive Effect of Smoking Cessation on Diabetes Onset: A Target Trial Emulation Approach ↗

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