A Study of HbA1c, fasting and 2 hour plasma glucose levels in current smokers presenting at a tertiary care hospital in North India


  • Niket Verma Department of General Medicine, Army College of Medical Sciences, Delhi Cantt., New Delhi, India




Blood glucose, Glycosylated, Haemoglobin A, Smoking


Background: There is a concern that smokers are at increased risk of diabetes and this association has received surprisingly little attention. This study aims to study the relationship of smoking with three glycaemic variables (HbA1c, fasting and 2 hour post prandial plasma glucose levels) in current smokers and describe the potential impact of smoking in the context of screening for diabetes by using one of these glycaemic variables.

Methods: 150 patients attending the OPD of Santosh Medical College were part of this Cross sectional population based study. One hundred were smokers and fifty non-smokers and non-diabetics. All participants were subjected to fasting plasma glucose level, 2 hour plasma glucose level and HbA1c testing.

Results: Mean values of all three variables are substantially higher in smokers as compared to non-smokers. HbA1c levels show an increasing trend with increasing age among both groups. Mean plasma glucose levels show increasing values with increasing age but the trend is not uniform. Among females, only HbA1c levels whereas among males all three variables show a strong correlation with smoking. No correlation was observed between the number of cigarettes smoked daily or smoking index and the glycaemic variables. All variables show an increasing trend as the number of years of smoking increases.

Conclusions: A higher prevalence of diabetes is seen in current smokers when we consider HbA1c levels indicating the beneficial effect of using HbA1c levels for identifying current smokers at risk of diabetes mellitus.



Narayan KM, Boyle JP, Geiss LS, Saddine JB, Thompson TJ. Impact of recent increase in incidence on future diabetes burden: U.S 2005-2050. Diabetes care. 2006;29:2114-6.

Shai I, Liang R, Manson JE. Ethinicity, obesity, and risk of type 2 diabetes in women: a 20-years follow up study. Diabetes Care. 2006;29:1585-90.

Ehasson B. Cigarette smoking and diabetes. Prog Cardiovasc Dis. 2003;45(5):405-13.

Chiolero A, Faeh D, Paccaud F, Cornuz J. Consequences of smoking for body weight, body fat distribution, and insulin resistance. American J Clinic Nutrit. 2008;87(4):801-9.

Haire-Joshu D. Glasgow RE. Tibbs TL. Smoking and diabetes. Diabetes care. 2004;27(suppl. 1):574-5.

Simon D, Senam C, Saint GP, Paul M, Papoz I. Epidemiological features of glycated haemoglobin A1c- distribution in healthy population. The telecom study. Diabetol. 1989;32:864-9.

Modan M, Meytes D, Rozerman P, Significance of high Hb A1c levels in normal glucose tolerance. Diabetes care. 1988;11:422-8.

Nilsson PM, Land L, Pollare T, Berne C, Lithell HO. Increased level of hemoglobin A1c but not impaired insulin sensitivity found in hypertension and normotensive smokers Metabolism. 1995:44:557-61.

WHO Expert Committee on Diabetes Mellitus Technical Report Series 727, World Health Organisation, Geneva; 1985.

Nathan DM, Singer DE, Hurxthal K, Goodson JD. The clinical information value of the glycosylated hemoglobin assay. N Engl J Med. 1984;310:341-6.

Goldstein DE. Is glycosylated hemoglobin clinically useful? N Engl J Med. 1984;310:384-5.

Health and public policy committee, American college of physicians Glycosylated hemoglobin assays in the management and diagnosis of diabetes mellitus. Ann Intern Med. 1984;101:710-3.

Baynes JW, Bunn HF, Goldstein DE, Harris M, Martin DB, Peterson C, et al. National Diabetes Data Group : report of the expert committee on glucosylated hemoglobin. Diabetes Care. 1984;7: 602-6.

Santiago JV, Davis JE, Fisher F. Hemoglobin A1c levels in a diabetes detection program. J Clin Endocrinol Metab. 1978;47:578-80.

Dunn PJ, Cole RA, Soeldner JS, Gleason RE Reproductibility of hemoglobin A1c and sensitivity to various degrees of glucose intolerance. Ann Int Med. 1979;91:390-6.

Kesson CM, Young RE, Talmar D, Whitelaw JW, Robb DA Glycosylated hemoglobin in the diagnosis of non-insulin dependent diabetes mellitus. Diabetes Care. 1982;5:395-8.

Simon D, Coignet MC, Thibult N, Senan C, Eschwege E. Comparison of glycosylated hemoglobin and fasting plasma glucose with two- hour post-load plasna glucose in the detection of diabetes mellitus Am J Epidemiol. 1985;122:589-93.

Little RR, England JD, Wiedmeyer HM, Mc Kenzie EM, Pettitt DJ. Knowler WC, et al. Relationship of glycosylated hemoglobin to oral glucose tolerance. Implications for diabetes screening. Diabetes. 1988;37:60-4.

Bunn F. Evaluation of glycosylated haemoglobin in diabetic patients. Diabetes. 1981;30:613-7.

Goldstein DE, Parker KM, England JD, England Jr JE, Wied-meyer HM, Rawlings SS. Hess R, Little RR, Simonds JF, Breyfogle RP Clinical application of glycosylated hemoglobin measurements. Diabetes. 1982;31(Suppl 3):70-8.

Mortensen HB, Nielsen L, Seogaard U, Svendsen PAA, Nerup J. Comparison of six assays for glycosylated haemoglobin determination. Scand J Clin Lab Invest. 1983;43:357-62.

Prignot J. Quantification and chemical markers of tobacco exposure. Europ J Resp Dis.1987;70:1-7.

Pakhale SS, Jayant K, Sanghvi LD. Chemical constituents of tobacco smoke in relation to habits prevalent in India. Ind J Chest Dis and Alli Sci. (Special No.) 1982:36-43.

Soulimane S. Hb A1c fasting and 2 h plasma glucose in current, ex-and never smokers: a meta -analysis. Diabetol. 2014;57:30-9.

Glumer C, Jogensen T, Borch-Johnson K. Prevalences of diabetes and impared glucose regulation in a Danish population: the inter 99 study. Diabetes care. 2003;26:2335-40.

Simon D, Senan C, Garnier P, Saint-Paul M, Papoz L Epidemiological features of glycated haemoglobin A1c- distribution in a healthy population. The Telecom Study. Diabetol. 1989;32:864-9.

Herman WH, Ali MA, Aubert RE. Diabetes mellitus in Egypt: risk factors and prevalence. Diabet Med. 1995;12:1126-31.

Gimeno SG, Ferreira SR, Franco LJ Hirai AT, Matsumura L, Moises RS. Prevalence and 7 -years incidence of type II diabetes mellitus in a Japanese-Brazilian population: an alarming public health problem Diabetol. 2002;45:1635-8.

Stengard JH, Tuomilehto J, Pekkanen J Diabetes mellitus, impaired glucose tolerance and mortality among elderly men: the Finnish cohorts of the Seven Countries Study. Diabetol. 1992;35:760-5.

Dunstan DW, Zimmet PZ, Welborn TA. The Australian Diabetes, Obesity and Lifestyle Study (AusDiab)-methods and response rates. Diabetes Res Clin Pract. 2002;57:119-29.

Deepa M, Pradeepa R, Rena M. The Chennai Urban Rural Epidemiology Study (CURES)-study design and methodology (urban component) (CURES-1). J Assoc Physicians India. 2003;51:863-70.

Milson AS. The effect of nicotine on blood glucose levels and plasma non-esterified fatty acid levels in the intact and adrenalectomized rat. Br J Fharmacol. 1966;26:256-9.

Sandberg H, Roman L, Zavodnick J, Kupers N. The effect of smoking on serum somatotropin, immuno-reactive insulin and blood glucose levels of young adult males. J Pharmacol Exp Ther. 1973;184(3): 787-91.

Facchini FS, Hollenbeck CB, Jeppesen J, Chen YD, Reaven GM. Insulin resistance and cigarette smoking Lancet. 1992;339:1128-30.

Attvall S, Fowelin J, Lager I. Smoking induces insulin resistance - a potential link with the insulin resistance syndrome. J Inter Med. 1993;233:327-32.

Mokded AH, Ford ES, Bowman BA. The continuing increase of diabetes in the US. Diabetes Care. 2001:24(2):412.

Arnetz BB, Kallner A, Theorell T The influence of aging on hemoglobin A1c (Hb A1c). J Gerontol. 1982;37:648-50.

Spence JC. Some observations on sugar tolerance with a special reference to variations found at different ages. Quart J Med. 1921;4:314-26.

Tuomilehto J, Nnissinen A, Kivela SL. Prevalence of diabetes mellitus in elderly men aged 65 to 84 years in eastern and western Finland. Diabetol. 1986;29:611-5.

Wingard DL, Sinheimer P, Barrett-Connor EL, McPhillips JB. Community based study of prevalence of NIDDM in older adults. Diabetes Care. 1990;(Suppl 2):3-8.






Original Research Articles