1. Smoking and Type-2 Diabetes Mellitus Toshimi Sairenchi, M.Sc. Ibaraki Health Plaza, Ibaraki Health Service Association, Ibaraki-ken, JAPAN

2. Contents  Epidemiology of type-2 diabetes mellitus in Japan  Smoking and type-2 diabetes mellitus in middle-aged population  Smoking and type-2 diabetes mellitus in elderly population  Possible mechanism  Conclusion

3. Contents  Epidemiology of type-2 diabetes mellitus in Japan  Smoking and type-2 diabetes mellitus in middle-aged population  Smoking and type-2 diabetes mellitus in elderly population  Possible mechanism  Conclusion

4. Prevalence of diabetes among Japanese men (Ministry of Health, Labour and Welfare Japan, 2004) All age20-2930-3940-4950-5960-6970- Age (years) HbA 1c (%)>6.1 or medication 5.6<HbA 1c (%)<6.1 without medication Left bar: in 1997 Right bar : in 2002

5. (Ministry of Health, Labour and Welfare Japan, 2004) Prevalence of diabetes among Japanese women 40-4950-5960-6970- Age (years) HbA 1c (%) > 6.1 or medication 5.6 < HbA 1c (%)<6.1 without medication Left bar: in 1997 Right bar: in 2002

6. Notice  The proportion of diabetes of borderline type increased in the elderly for both sexes. Type-2 diabetes mellitus among elderly is an increasing public health problem.

7. Contents  Epidemiology of type-2 diabetes mellitus in Japan  Smoking and type-2 diabetes mellitus in middle-aged population  Smoking and type-2 diabetes mellitus in elderly population  Possible mechanism  Conclusion

8. Follow-up studies for smoking and type-2 diabetes mellitus among middle-aged persons Author DateNo. of subjects followed Uchimoto S., et al.19996,250 men Manson JE., et al.200021,068 men Will JC., et al.2001709,827 men and women

9. Sex-specific risk ratios for type-2 diabetes mellitus according smoking habits among 275,190 men and 434,637 women (Will JC. et al., 2001)

10. Next Question  Smoking is a risk of diabetes mellitus among middle-aged men and women. Is there a relationship between smoking and risk of diabetes mellitus among elderly?

11. Contents  Epidemiology of type-2 diabetes mellitus in Japan  Smoking and type-2 diabetes mellitus in middle-aged population  Smoking and type-2 diabetes mellitus in elderly population  Possible mechanism  Conclusion

12. Age-specific risk ratios for type-2 diabetes mellitus according to smoking habits among 39,528 men, Japan, 1993-2002 0.00 0.50 1.00 1.50 2.00 40-5960-79 Age (years) Never-smoker Current smoker (Sairenchi T. et al., 2004)

13. Age-specific risk ratios for type-2 diabetes mellitus according to smoking habits among 88,613 women, Japan, 1993-2002 0.00 0.50 1.00 1.50 2.00 40-5960-79 Age (years) Never-smoker Current smoker (Sairenchi T. et al., 2004)

14. Contents  Epidemiology of type-2 diabetes mellitus in Japan  Smoking and type-2 diabetes mellitus in middle-aged population  Smoking and type-2 diabetes mellitus in elderly population  Possible mechanism  Conclusion

15. One of the possible mechanisms Insulin action Smoking Oxdative stress Diabetes mellitus Bridges AB. et al., 1993 Paolisso G, et el., 1993

16. Contents  Epidemiology of type-2 diabetes mellitus in Japan  Smoking and type-2 diabetes mellitus in middle-aged population  Smoking and type-2 diabetes mellitus in elderly population  Possible mechanism  Conclusion

17. Smoking and type-2 diabetes  Smoking is a risk factor of type-2 diabetes mellitus not only among middle-aged but also among elderly men and women.