Self-reported smoking, urine cotinine, and risk of type 2 diabetes: Findings from the PREVEND prospective cohort study

Setor K Kunutsor; John Tetteh; Richard S Dey; Daan J Touw; Robin P F Dullaart; Stephan J L Bakker

doi:10.1016/j.pcd.2024.04.004

Self-reported smoking, urine cotinine, and risk of type 2 diabetes: Findings from the PREVEND prospective cohort study

Prim Care Diabetes. 2024 May 11:S1751-9918(24)00076-7. doi: 10.1016/j.pcd.2024.04.004. Online ahead of print.

Authors

Setor K Kunutsor¹, John Tetteh², Richard S Dey³, Daan J Touw⁴, Robin P F Dullaart⁵, Stephan J L Bakker⁶

Affiliations

¹ Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK. Electronic address: skk31@cantab.net.
² Department of Population Health Sciences, University of Leicester, Leicester, UK; Department of Community Health, University of Ghana Medical School, Accra, Ghana.
³ Department of Medicine, University of Ghana Hospital, Legon, Ghana.
⁴ Department of Pharmacy and Clinical Pharmacology, University of Groningen and University Medical Center Groningen, the Netherlands.
⁵ Department of Internal Medicine, Division of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
⁶ Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

PMID: 38734534
DOI: 10.1016/j.pcd.2024.04.004

Abstract

Background: 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.

Methods: 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.

Results: 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.

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

Keywords: Cohort study; Cotinine; Risk factor; Smoking; Type 2 diabetes.