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Clinical Summary

Type 2 diabetes: smoking and disease duration strongly predict albuminuria

Takeaway

  • Continuing to smoke and longer diabetes duration are strong predictors of albuminuria in smokers with type 2 diabetes mellitus (T2DM).

Why this matters

  • Smoking cessation at an early stage of disease trajectory is likely to be one of the most effective intervention strategies to prevent the development of albuminuria in smokers with T2DM.

Study designs

  • Meta-analysis of 30 studies involving 113,140 patients with T2DM identified after a search across Medline and Embase electronic databases.
  • Funding: East Midlands Collaboration for Leadership in Applied Health Research and Care.

Results

  • Smokers with T2DM were at higher risk of developing albuminuria vs non-smokers (OR, 2.13; 95% CI, 1.32-3.45).
  • Apart from smoking, other cardiometabolic risk factors associated with albuminuria were:
    • Age, 1.24 (aOR, 1.24; P<.001);
    • Male sex, 1.39 (aOR, 1.39; P=.003);
    • Duration of diabetes (aOR, 1.78; P<.001);
    • Haemoglobin A1c (aOR, 0.63; P<.001);
    • Systolic BP (aOR; 6.03; P<.001);
    • Diastolic BP (aOR, 1.85; P<.001);
    • Total cholesterol (aOR, 0.06; P=.31);
    • High-density lipoprotein cholesterol (aOR, − 0.01; P=.47);
    • Triglyceride (aOR, 0.22; P<.001) and
    • Body mass index (aOR, 0.40; P=.05).
  • After adjustment for confounders, duration of diabetes was a statistically significant risk factor for the development of albuminuria (OR, 3.18; P=.001).
  • Meta-regression model also suggested that risk for albuminuria was higher in smokers after a diabetes duration of 9 (aOR, 1.53; 95% CI, 1.10–2.43) and 16 (aOR, 5.94; 95% CI, 2.58-15.05) years.

Limitations

  • Heterogeneity among studies.

References


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