Smoking predicts albuminuria in prediabetes and diabetes

the study covered in this summary was published on SSRN’s Preprints With The Lancet as a preprint and has not yet been peer-reviewed.

Key points to remember

  • People who smoked and had prediabetes or diabetes had a higher incidence of albuminuria than non-smokers with prediabetes or diabetes.

  • Smokers with prediabetes are at a significantly higher risk of albuminuria than both smokers and diabetics.

  • People younger than 50 with prediabetes or diabetes had a higher risk of albuminuria than those 50 or older with prediabetes or diabetes.

  • The risk of albuminuria was elevated in people with prediabetes or diabetes despite their use of antihypertensive and lipid-lowering drugs.

  • Former smokers with either disease state did not have a lower risk of albuminuria.

why it matters

  • Albuminuria is an independent predictor of microvascular and macrovascular complications. Therefore, screening for albuminuria in people with prediabetes can help identify those most at risk and prioritize them for preventive interventions.

  • Keeping A1c levels below the diabetes range in people who smoke and have prediabetes may not prevent an increase in vascular complications in people with prediabetes. Current management of cardiorenal risk factors in people with prediabetes may be inadequate. Interventions focused on maintaining A1c in the prediabetes range may not reduce the risk of albuminuria and other vascular complications and may result in late presentation with established microvascular and macrovascular complications that can no longer be reversed.

  • Diabetes management may need to focus more on additional ways to prevent vascular damage beyond cholesterol and blood pressure management, in addition to blood sugar control.

  • Smokers with prediabetes and diabetes should be encouraged/supported not only to quit, but also to stay abstinent. Smokers may need to stay abstinent for an extended period to reduce their vascular risk to levels of non-smokers. In the short term, quitting smoking may not reduce the risk of albuminuria.

study design

  • This cross-sectional study involved 502,490 participants from the UK Biobank with data collected from 2006 to 2010. They completed a lifestyle questionnaire which asked about their socio-demographics and whether they had been diagnosed with diabetes or were taking any insulin or medicines for blood pressure or high cholesterol. The researchers analyzed blood and urine samples from these participants.

  • The primary endpoint of the study was urinary albumin concentration.

  • The researchers used logistic regression analysis of the dataset and performed subgroup analyzes to investigate the effects of age, smoking status, and antihypertensive and lipid-lowering medications on levels of albuminuria in people with prediabetes, diabetes or normal glycemic control.

Principle results

  • The study participants were on average 57 years old. Their prevalence of prediabetes was 4.3% and their prevalence of diabetes was 3.9%. The prevalence of albuminuria in people with prediabetes was 32% and 45% in people with diabetes. The prevalence of smoking was 15% among people with prediabetes and 12% among those with diabetes.

  • In people with prediabetes, the adjusted odds ratio for albuminuria was significantly higher by 21% in current smokers compared to those who had never smoked, after adjusting for cardiorenal risk factors such as age, sex, hypertension, A1c, cholesterol, ischemic heart disease, stroke, deprivation and body mass index.

  • Among people with diabetes, the adjusted odds ratio for albuminuria was significantly higher by 26% in current smokers compared to those who had never smoked.

  • Younger age increased the risk of albuminuria associated with smoking. Among people younger than 50 with prediabetes, the odds ratio for albuminuria in smokers was significantly 43% higher than in nonsmokers. People with diabetes in the same age group who smoked had a significantly higher albuminuria rate of 29% compared to those who did not smoke.

Limits

  • Using data from the UK Biobank, the study took into account the inherent limitations of this database. This included the Biobank’s exclusive enrollment of people aged 40-69 and several aspects that make it unrepresentative of the general UK adult population: its disproportionately high enrollment of white, elderly and female individuals; its disproportionately low enrollment of socioeconomically disadvantaged people; a relatively low prevalence of smoking and obesity; relatively low alcohol consumption; and a relatively low level of self-reported physical or mental health problems.

  • The cross-sectional design of the study identifies associations but cannot determine causal relationships.

Study Disclosures

  • The study received no commercial funding.

  • Several co-authors have served as consultants or advisors or have received research funding from numerous pharmaceutical companies. Several other co-authors had no disclosures.

This is a summary of a pre-publication research study , “Predictors and Determinants of Albuminuria in People with Prediabetes and Diabetes Based on Smoking Status: A Cross-Sectional Study Using the UK Biobank Data”, written by authors from various centers mainly in the UK on SSRN’s Preprints With The Lancet, supplied to you by Medscape. This study has not yet been peer reviewed. The full text of the study is available at papers.SSRN.com.

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