According to a commentary, although observational data to support a link between smoking and increased diabetes risk are plentiful, and this study provides important new information to support this association, the existing evidence base is not definitive. It highlights that although adjustment for potential confounders was carried out, full adjustment for all confounders is not possible, and residual confounding might still be present in these data.
The commentators advise clinicians in the meantime to mention to patients that, as well as being a risk factor for cardiovascular disease and many cancers, smoking should also be regarded as a risk factor for diabetes (albeit with a small effect relative to, for example, lung cancer). They note that smoking status now features as an independent risk factor in the QDiabetes risk calculator, an easily accessible UK-based diabetes risk score, and, as such, the link between smoking and diabetes should be increasingly appreciated in clinical settings. They add that patients who smoke should also be informed that stopping smoking and maintaining long-term abstinence will not only lessen their cardiovascular and cancer risks, but over time, might also lessen their diabetes risk.