HEALTH RISKS OF CIGAR SMOKING

In the United States, sales of cigars have increased by 50% during the past 5 years. A study in the June 10^th New England Journal of Medicine, from northern California’s Kaiser Permanente health plan, looked at the health risks associated with cigar smoking among nearly 18,000 men who didn’t smoke cigarettes or a pipe; the men had initial health checkups between 1964 and 1973 and were followed for a median of 18 years.

Nine percent of the cohort smoked cigars at baseline. Compared with nonsmokers, cigar smokers had significantly higher risks for coronary events, chronic obstructive pulmonary disease, and cancers of the upper aerodigestive tract, lung, and oropharynx. Adjustments were made for potentially confounding variables. Risks for all of these outcomes were consistently higher among the men who smoked five or more cigars per day than among those who smoked fewer. There was no significant association between cigar smoking and stroke.

This analysis has some limitations, including the eventual disenrollment from the health plan by some members of the cohort and possible changes in cigar-smoking habits over time. Even so, the results corroborate past research findings and should be cited by clinicians that encounter cigar smokers in their practices.

N Eng J Med 1999 Jun 10; 340:1773-80

MULTIPLE INTERVENTIONS TO CONTROL GLUCOSE IN TYPE 2 DIABETES

What does it take to achieve good control of type 2 diabetes? The latest results from the United Kingdom Prospective Diabetes Study suggest that monotherapy often becomes inadequate as time passes. Details appear in the June 2^nd JAMA.

About 4,100 patients with newly diagnosed type 2 diabetes were treated for 3 months with a low-fat, high-carbohydrate, high-fiber diet and then randomized therapy with diet alone, insulin, sulfonylurea, or metformin. Target glycemic levels were defined as a hemoglobin A1c level below 7% or a fasting plasma glucose level of less than 140 mg/dL.

After 3 years, about half of the patients assigned to any of the drug therapies had target hemoglobin A1c levels – below 7% - but the percentage of patients maintaining that target declined in later years. After 9 years of monotherapy, about a quarter of the patients assigned to insulin had hemoglobin A1c levels below 7%, and the other strategies had even lower success rates. Higher baseline levels of hemoglobin A1c or fasting glucose predicted a higher risk for needing multiple therapies.

These findings show disappointingly low rates of good glucose control over a 9-year period in-patients with type 2 diabetes. Clinicians should have a low threshold for adding other therapies to achieve better control.

JAMA 1999 Jun 2; 281-2005-12