Individuals with T2DM who smoke have higher risks of cardiovascular disease and other complications. Many people consider e-cigarette as a "harm-reduction" alternatives to combustible cigarettes, but it is not clear whether switching to e-cigarettes improves health outcomes in patients with diabetes.
Use of electronic cigarettes has increased, partly driven by the perception that they may serve as a "harm-reduction" alternative to combustible cigarettes. Evidence cited in prior work includes higher cessation rates versus nicotine replacement therapy in a randomized trial and reductions in biomarkers of potential harm after switching from combustible cigarettes to e-cigarettes; observational data in high-risk PCI populations have also suggested lower MACCE risk after switching. However, constituents such as nicotine and heavy metals may adversely affect diabetes management, and most prior studies have emphasized potential harms of e-cigarette use itself. As a result, whether switching from combustible cigarettes to e-cigarettes confers a harm-reduction benefit in patients with diabetes remains uncertain. In this regards, the current study evaluated clinical outcomes associated with switching from combustible cigarettes to e-cigarettes in patients with diabetes and to assess whether the degree of switching (partial vs full transition) modifies the risk of adverse clinical events.
Study Type
OBSERVATIONAL
Enrollment
133,320
Switching to E-cigarette
Samsung Medical Center
Seoul, Gannam-gu, South Korea
Rates of MACE
MACE was defined as the composite of all-cause death, MI, and repeat revascularization. The diagnosis of MI was made if patients were hospitalized with primary diagnostic codes related to MI (ICD-10 I21, I22) during follow-up period. In a previous validation study, the accuracy of diagnosis of MI in NHIS data was 93%.16 Unplanned revascularization was defined as presence of procedure codes for percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) after index date.
Time frame: Up to 5 years
Rates of Diabetic complications
Diabetic complications were defined as presence of diabetic neuropathy (ICD-10: E10.4, E11.4, E12.4, E13.4, E14.4, G59.0, G63.2, and G99.0), diabetic foot without amputation (ICD-10: E10.5, E10.7, E11.5, E11.7, E12.5, E12.7, E13.5, E13.7, E14.5, and E14.7), diabetic foot with amputation (ICD-10: E10.5, E10.7, E11.5, E11.7, E12.5, E12.7, E13.5, E13.7, E14.5, and E14.7; procedure codes: N0572-0575), and diabetic retinopathy, including non-proliferative (ICD-10: H360) and proliferative (ICD-10: H360; procedure codes: S5160 and S516) forms.
Time frame: Up to 5 years
Rates of All-cause death
the individual components of MACE
Time frame: Up to 5 years
Rates of Myocardial infarction
the individual components of MACE. The diagnosis of MI was made if patients were hospitalized with primary diagnostic codes related to MI (ICD-10 I21, I22) during follow-up period.
Time frame: Up to 5 years
Rates of Unplanned Revascularization
Unplanned revascularization was defined as presence of procedure codes for percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) after index date.
Time frame: Up to 5 years
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Rates of Ischemic stroke
Stroke was defined based on ICD codes for ischemic stroke (ICD-10 I63, I64) or intracranial hemorrhage (ICD-10 I60-62), combined with the codes for hospitalization.
Time frame: Up to 5 years
Rates of Hemorrhage stroke
Hemorrhage stroke was defined based on ICD codes for intracranial hemorrhage (ICD-10 I60-62), combined with the codes for hospitalization.
Time frame: Up to 5 years
Rates of Mild pulmonary disease
Mild pulmonary disease were identified using validated ICD-10 codes.
Time frame: Up to 5 years
Rates of Severe exacerbation of Pulmonary disease
Hospitalization for exacerbation in patients with a documented pulmonary disease code.
Time frame: Up to 5 years
Rates of Cancer
Cancer was defined as the presence of cancer-specific insurance claim code (V193 code) with a C code which was an ICD-10 code for cancer.
Time frame: Up to 5 years