THE ASSOCIATION BETWEEN CIGARETTE AND WATERPIPE SMOKING WITH GLYCEMIC CONTROL AMONG PATIENTS WITH T2DM ATTENDING AT THE National Center for Diabetes, Endocrinology and Genetics NCDEG

Objective: Smoking is one of the modifiable risk factors for multiple diseases, such as cardiovascular diseases (CVD), cancer, and diabetes. As smoking aggravates the insulin resistance already presented in T2DM, it contributes to increasing glucose in the bloodstream, thus the risk for developing diabetes complications also rises. The association between tobacco smoking and glycemic control may explain the role of smoking in increasing the risk of diabetes and its complications. The aim of this study is to measure the association between cigarette smoking and waterpipe (WP) smoking on Glycemic control. Design and Setting: A descriptive cross-sectional study was conducted in the NCDEG in Amman, Jordan. Methods: This study recruited 879 male participants. The target population consisted of all male patients diagnosed with T2DM, who had two or more regular visits to the Diabetes and Endocrinology Clinic. The sample was collected during the period from 15 November 2015 to 15 March 2016. All patients attending the center during the study period were asked to take part in the study. The study subjects were selected using a systematic random sample selection (every two patients) from the nursing room. Results: In the study sample, 65.1% of male participants did not achieve the target level of HbA1c with a mean 7.6 (SD±1.21); the age of the participants ranged between 30 and 90 years with a mean of 58 years (SD±11); the mean duration of diabetes was 9.9 (±7.2) years. In the present study, 65.1% participants did not achieve the recommended target level for glycemic control (HbA1c <7). About 43% of the participants were smokers. An overall 32.3% were cigarette smokers, 69.6% of whom were of poor glycemic control; 7.3% were water pipe smokers, 71.4% of whom had poor glycemic control, and the remaining 3.7% were dual (cigarettes and WP) smokers of whom 75% were of poor glycemic control. This study reported, on overall smoking, cigarette smoking and dual smoking were significantly associated with poor glycemic control (p-values were 0.017, 0.032) respectively, after adjustment of other confounders including duration of diabetes, age of patients 65 years old and above, drug adherence, dietary adherence and waist circumference. On the other hand, participants on waterpipe alone were less likely to have good glycemic control compared with non-smokers, although it was a positive association but not a significant one. In our study, the number of cigarettes smoked was not significant at using binary logistic regression analysis. However, the chi-square test indicated that glycemic control differed significantly between participants according to the number of cigarettes smoked. Conclusion: Most of diabetic smokers did not achieve the target level of glycemic control. Smoking cigarettes and waterpipe smoking were found to have a significant association with poor glycemic control, after adjustment of other confounders such as duration of DM, age, drug adherence, dietary adherence and waist circumference. Keywords: Glycemic control, Diabetes, Cigarette smoking, Water pipe smoking, T2