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The Effect of Cigarette Smoking on Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis

Clair, Carole ; Cohen, Marya ; Eichler, Florian ; Selby, Kevin ; Rigotti, Nancy

In: Journal of General Internal Medicine, 2015, vol. 30, no. 8, p. 1193-1203

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    Titre
    • The Effect of Cigarette Smoking on Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis
    Auteur
    • Clair, Carole. Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Lausanne, Switzerland
    • Cohen, Marya. Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
    • Eichler, Florian. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
    • Selby, Kevin. Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Lausanne, Switzerland
    • Rigotti, Nancy. Massachusetts General Hospital, Tobacco Research and Treatment Center, Division of General Internal Medicine, Harvard Medical School, Boston, MA, USA
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • Journal of General Internal Medicine, 2015, vol. 30, no. 8, p. 1193-1203. Springer US; http://www.springer-ny.com
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:332524
    Summary
    Objective: Studies suggest that smoking may be a risk factor for the development of microvascular complications such as diabetic peripheral neuropathy (DPN). The objective of this study was to assess the relationship between smoking and DPN in persons with type 1 or type 2 diabetes. Research Design and Methods: A systematic review of the PubMed, Embase, and Cochrane clinical trials databases was conducted for the period fromJanuary 1966 to November 2014 for cohort, cross-sectional and case-control studies that assessed the relationship between smoking and DPN. Separate meta-analyses for prospective cohort studies and case-control or cross-sectional studies were performed using random effects models. Results: Thirty-eight studies (10 prospective cohort and 28 cross-sectional) were included. The prospective cohort studies included 5558 participants without DPN at baseline. During follow-up ranging from 2 to 10years, 1550 cases of DPN occurred. The pooled unadjusted odds ratio (OR) of developing DPN associated with smoking was 1.26 (95% CI 0.86-1.85; I 2  = 74%; evidence grade: low strength). Stratified analyses of the prospective studies revealed that studies of higher quality and with better levels of adjustment and longer follow-up showed a significant positive association between smoking and DPN, with less heterogeneity. The cross-sectional studies included 27,594 participants. The pooled OR of DPN associated with smoking was 1.42 (95% CI 1.21-1.65; I 2  = 65%; evidence grade: low strength). There was no evidence of publication bias. Conclusions: Smoking may be associated with an increased risk of DPN in persons with diabetes. Further studies are needed to test whether this association is causal and whether smoking cessation reduces the risk of DPN in adults with diabetes.