{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T15:58:11Z","timestamp":1790956691851,"version":"4.1.0"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n The risk of diabetic microvascular complications is well established among smokers with type 2 diabetes. However, whether and to what extent this excess risk declines according to smoking cessation duration remains unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To investigate the association between smoking cessation duration and the risk of incident diabetic microvascular complications in patients with diabetes.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This nationwide, population-based cohort study included participants first diagnosed with type 2 diabetes in Korea between 2003 and 2013 and whose smoking status was assessed at least 4 times across repeated health checkups, with a final checkup during 2009 to 2013. Data were analyzed from November 10, 2025, to April 16, 2026.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Smoking status and cessation duration. Quitters were defined as participants who reported current smoking at their initial health checkup and reported smoking cessation at all subsequent checkups without relapse. Continuous smokers were defined as participants who consistently reported current smoking at every health checkup. Among quitters, smoking cessation duration was categorized as less than 2, 2 to 3, 4 to 5, 6 to 7, and 8 or more years.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n Outcomes of interest were incident diabetic microvascular complications, including diabetic nephropathy, retinopathy, and neuropathy, identified using\n International Statistical Classification of Diseases and Related Health Problems, Tenth Revision<\/jats:italic>\n (\n ICD-10<\/jats:italic>\n ) diagnostic codes. Cox proportional hazards models were used to estimate unadjusted and adjusted hazard ratios (aHRs) and 95% CIs.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 209\u202f698 adults (mean [SD] age, 57.2 [10.3] years; 127\u202f823 [61.0%] female) were included in the analyses. Compared with continuous smokers, cessation for 8 or more years was associated with a lower risk of all microvascular complications (aHR, 0.81; 95% CI, 0.70-0.95), diabetic nephropathy (aHR, 0.79; 95% CI, 0.64-0.94), diabetic retinopathy (aHR, 0.59; 95% CI, 0.36-0.97), and diabetic neuropathy (aHR, 0.80; 95% CI, 0.66-0.98). Smoking cessation for 6 to 7 years was associated with lower risk of diabetic neuropathy (aHR, 0.76; 95% CI, 0.64-0.89). In subgroup analyses by sex, these associations were significant only among male participants (eg, all microvascular complications: aHR, 0.82; 95% CI, 0.70-0.95).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this retrospective cohort study of patients with diabetes, smoking cessation for 8 or more years was associated with a lower risk of all diabetic microvascular complications, diabetic nephropathy, retinopathy, and neuropathy compared with continuous smoking. These associations were observed mainly among male participants, underscoring the potential importance of sustained long-term smoking cessation for microvascular risk reduction.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.37278","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T15:30:23Z","timestamp":1790955023000},"page":"e2637278","source":"Crossref","is-referenced-by-count":0,"title":["Smoking Cessation Duration and Diabetic Microvascular Complications"],"prefix":"10.1001","volume":"9","author":[{"given":"Soonsu","family":"Shin","sequence":"first","affiliation":[{"name":"Department of Preventive Medicine, Graduate School, Kyung Hee University, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Ho","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Graduate School, Kyung Hee University, Seoul, Korea"},{"name":"Ewha Medical Data Organization, Ewha Womans University Medical Center, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae-Hong","family":"Ryoo","sequence":"additional","affiliation":[{"name":"Department of Occupational and Environmental Medicine, School of Medicine, Kyung Hee University, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,10,2]]},"reference":[{"issue":"2","key":"zoi261005r2","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1038\/nrendo.2017.151","article-title":"Global aetiology and epidemiology of type 2 diabetes mellitus and its complications.","volume":"14","author":"Zheng","year":"2018","journal-title":"Nat Rev Endocrinol"},{"issue":"2","key":"zoi261005r3","doi-asserted-by":"publisher","first-page":"e144","DOI":"10.1016\/S2214-109X(20)30489-7","article-title":"Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study.","volume":"9","author":"Steinmetz","year":"2021","journal-title":"Lancet Glob Health"},{"issue":"S1","key":"zoi261005r4","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1111\/dom.14007","article-title":"An updated overview of diabetic nephropathy: diagnosis, prognosis, treatment goals and latest guidelines.","volume":"22","author":"Selby","year":"2020","journal-title":"Diabetes Obes Metab"},{"issue":"12","key":"zoi261005r5","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1016\/S2213-8587(19)30081-6","article-title":"Diabetic peripheral neuropathy: advances in diagnosis and strategies for screening and early intervention.","volume":"7","author":"Selvarajah","year":"2019","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"2","key":"zoi261005r6","doi-asserted-by":"publisher","DOI":"10.1002\/edm2.321","article-title":"Impact of micro- and macrovascular complications of type 2 diabetes on quality of life: Insights from the DISCOVER prospective cohort study.","volume":"5","author":"Arnold","year":"2022","journal-title":"Endocrinol Diabetes Metab"},{"issue":"8","key":"zoi261005r7","doi-asserted-by":"publisher","first-page":"1732","DOI":"10.2337\/dc20-0072","article-title":"Health care costs associated with macrovascular, microvascular, and metabolic complications of type 2 diabetes across time: estimates from a population-based cohort of more than 0.8 million individuals with up to 15 years of follow-up.","volume":"43","author":"Chen","year":"2020","journal-title":"Diabetes Care"},{"issue":"1","key":"zoi261005r8","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.52239","article-title":"Adherence to a healthy lifestyle in association with microvascular complications among adults with type 2 diabetes.","volume":"6","author":"Liu","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"4","key":"zoi261005r9","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1177\/1479164117701876","article-title":"The impact of smoking on the development of diabetes and its complications.","volume":"14","author":"Sliwinska-Mosson","year":"2017","journal-title":"Diab Vasc Dis Res"},{"issue":"5","key":"zoi261005r10","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1016\/S0033-0620(03)80004-X","article-title":"Cigarette smoking and diabetes.","volume":"45","author":"Eliasson","year":"2003","journal-title":"Prog Cardiovasc Dis"},{"issue":"8","key":"zoi261005r11","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3697","article-title":"Changes in smoking status, amount of smoking and their relation to the risk of microvascular complications in men with diabetes mellitus.","volume":"39","author":"Park","year":"2023","journal-title":"Diabetes Metab Res Rev"},{"issue":"8","key":"zoi261005r12","doi-asserted-by":"publisher","first-page":"427","DOI":"10.3349\/ymj.2023.0355","article-title":"The association of smoking status with diabetic microvascular complications in Korean patients with type 2 diabetes.","volume":"65","author":"Cho","year":"2024","journal-title":"Yonsei Med J"},{"issue":"11","key":"zoi261005r13","doi-asserted-by":"publisher","first-page":"1471","DOI":"10.1111\/j.1742-1241.2006.01175.x","article-title":"Diabetic microvascular complications: can patients at risk be identified\u2014a review.","volume":"60","author":"Girach","year":"2006","journal-title":"Int J Clin Pract"},{"issue":"6","key":"zoi261005r14","doi-asserted-by":"publisher","first-page":"1555","DOI":"10.2337\/db09-1377","article-title":"Association between CNDP1 genotype and diabetic nephropathy is sex specific.","volume":"59","author":"Mooyaart","year":"2010","journal-title":"Diabetes"},{"key":"zoi261005r15","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2023.110975","article-title":"Association of BMI and waist circumference with diabetic microvascular complications: a prospective cohort study from the UK Biobank and Mendelian randomization analysis.","volume":"205","author":"Huang","year":"2023","journal-title":"Diabetes Res Clin Pract"},{"issue":"15","key":"zoi261005r16","doi-asserted-by":"publisher","first-page":"1565","DOI":"10.1056\/NEJMoa0806359","article-title":"Long-term follow-up after tight control of blood pressure in type 2 diabetes.","volume":"359","author":"Holman","year":"2008","journal-title":"N Engl J Med"},{"issue":"2","key":"zoi261005r17","doi-asserted-by":"publisher","first-page":"111","DOI":"10.4093\/kdj.2010.34.2.111","article-title":"The association between serum GGT concentration and diabetic peripheral polyneuropathy in type 2 diabetic patients.","volume":"34","author":"Cho","year":"2010","journal-title":"Korean Diabetes J"},{"key":"zoi261005r18","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1147458","article-title":"Non-alcoholic fatty liver disease and incidence of microvascular complications of diabetes in patients with type 2 diabetes: a prospective cohort study.","volume":"14","author":"Deravi","year":"2023","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"12","key":"zoi261005r19","doi-asserted-by":"publisher","first-page":"4343","DOI":"10.1210\/jc.2017-01922","article-title":"Diabetic microvascular disease: an Endocrine Society scientific statement.","volume":"102","author":"Barrett","year":"2017","journal-title":"J Clin Endocrinol Metab"},{"issue":"5","key":"zoi261005r20","doi-asserted-by":"publisher","first-page":"1353","DOI":"10.2337\/dc13-2727","article-title":"The relationship between alcohol consumption and vascular complications and mortality in individuals with type 2 diabetes.","volume":"37","author":"Blomster","year":"2014","journal-title":"Diabetes Care"},{"issue":"12","key":"zoi261005r21","doi-asserted-by":"publisher","first-page":"3101","DOI":"10.2337\/dc22-0886","article-title":"Physical activity and risk of major diabetes-related complications in individuals with diabetes: a systematic review and meta-analysis of observational studies.","volume":"45","author":"Rietz","year":"2022","journal-title":"Diabetes Care"},{"issue":"446","key":"zoi261005r22","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1080\/01621459.1999.10474144","article-title":"A proportional hazards model for the subdistribution of a competing risk.","volume":"94","author":"Fine","year":"1999","journal-title":"J Am Stat Assoc"},{"issue":"3","key":"zoi261005r23","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1111\/jdi.14385","article-title":"Smoking and diabetic nephropathy: an updated systematic review and meta-analysis.","volume":"16","author":"Zhu","year":"2025","journal-title":"J Diabetes Investig"},{"issue":"2","key":"zoi261005r24","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1016\/j.jdiacomp.2016.06.020","article-title":"Patients with type 2 diabetes having higher glomerular filtration rate showed rapid renal function decline followed by impaired glomerular filtration rate: Japan Diabetes Complications Study.","volume":"31","author":"Moriya","year":"2017","journal-title":"J Diabetes Complications"},{"issue":"3","key":"zoi261005r25","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1016\/j.diabres.2004.07.021","article-title":"Microalbuminuria and risk factors in type 1 and type 2 diabetic patients.","volume":"67","author":"Cederholm","year":"2005","journal-title":"Diabetes Res Clin Pract"},{"issue":"2","key":"zoi261005r26","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1007\/s12020-018-1697-y","article-title":"The association of smoking and risk of diabetic retinopathy in patients with type 1 and type 2 diabetes: a meta-analysis.","volume":"62","author":"Cai","year":"2018","journal-title":"Endocrine"},{"issue":"5","key":"zoi261005r27","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2024.103044","article-title":"Influence of quitting smoking on diabetes-related complications: a scoping review with a systematic search strategy.","volume":"18","author":"Walicka","year":"2024","journal-title":"Diabetes Metab Syndr"},{"issue":"2","key":"zoi261005r28","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0212574","article-title":"The risk factors for diabetic peripheral neuropathy: a meta-analysis.","volume":"14","author":"Liu","year":"2019","journal-title":"PLoS One"},{"issue":"8","key":"zoi261005r29","doi-asserted-by":"publisher","first-page":"1193","DOI":"10.1007\/s11606-015-3354-y","article-title":"The effect of cigarette smoking on diabetic peripheral neuropathy: a systematic review and meta-analysis.","volume":"30","author":"Clair","year":"2015","journal-title":"J Gen Intern Med"},{"issue":"1","key":"zoi261005r30","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1186\/s13643-025-02995-w","article-title":"The association between smoking and diabetic neuropathy: a systematic review and meta-analysis.","volume":"14","author":"Bader","year":"2025","journal-title":"Syst Rev"},{"key":"zoi261005r31","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1016\/j.diabres.2019.05.035","article-title":"The global prevalence of tobacco use in type 2 diabetes mellitus patients: a systematic review and meta-analysis.","volume":"154","author":"Roderick","year":"2019","journal-title":"Diabetes Res Clin Pract"},{"key":"zoi261005r32","doi-asserted-by":"publisher","first-page":"S77","DOI":"10.2337\/dc24-S005","article-title":"5. Facilitating positive health behaviors and well-being to improve health outcomes: standards of care in diabetes\u20142024.","volume":"47","author":"American Diabetes Association Professional Practice Committee","year":"2024","journal-title":"Diabetes Care"},{"issue":"1","key":"zoi261005r33","doi-asserted-by":"publisher","first-page":"9","DOI":"10.23838\/pfm.2021.00135","article-title":"National general health screening program in Korea: history, current status, and future direction.","volume":"6","author":"Shin","year":"2022","journal-title":"Precis Future Med"},{"key":"zoi261005r1","volume-title":"IDF Diabetes Atlas","author":"International Diabetes Federation","year":"2025","edition":"11th ed"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2854759\/shin_2026_oi_261005_1790346341.28338.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T15:30:24Z","timestamp":1790955024000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2854759"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,2]]},"references-count":33,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.37278","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,2]]}}}