E-cigarette use increases risk of prediabetes, study finds

Substantial evidence on the health effects of e-cigarettes can help shape best public health practices in the United States, the results of a review suggest.

E-cigarette use is associated with an increased likelihood of prediabetes, an analysis of data from a large representative survey of the US population has shown.1

The findings, published in American Journal of Preventive Medicinesuggested important evidence on the health effects of e-cigarettes that can help shape best public health practices, according to the investigators.1

“Our study demonstrated a clear association between prediabetes risk and e-cigarette use,” said Shyam Biswal, PhD, of the Department of Environmental Health and Engineering at the Johns Hopkins Bloomberg School of Public Health, in a communicated. “With the dramatic increase in e-cigarette use and the prevalence of prediabetes over the past decade, our finding that e-cigarettes carry a similar risk to traditional cigarettes with respect to diabetes is important for understanding and treat the vulnerable.”1

To determine the association between e-cigarette use and prediabetes, researchers analyzed data from the Behavioral Risk Facto Surveillance System between 2016 and 2018.1

The survey is the largest representative annual health survey of American adults and provides data on chronic medical conditions, health outcomes, health-related risk behaviors and preventive services.1

Of the 600,046 respondents, approximately 66,000 were current e-cigarette users who reported a diagnosis of prediabetes. The data also showed that these people had a higher prevalence of high-risk lifestyle factors and worse mental and physical health status than non-smokers.1

Survey respondents were approximately 50.4% female, 67.7% non-Hispanic white, 12.2% non-Hispanic black, and 5% Hispanic. In addition, approximately 28.6% were aged 35 and over.1

E-cigarette use was associated with a higher risk of prediabetes compared to those who did not use e-cigarettes or traditional cigarettes.1

“We were surprised by the findings associating prediabetes with e-cigarettes, as they are touted as a safer alternative, which we now know is not the case,” Biswal said. “In the case of smoking, nicotine has a detrimental effect on insulin action, and it appears that e-cigarettes may also have the same effect.”1

Electronic cigarettes are sometimes promoted as a safer alternative or harm reduction product for those who smoke traditional cigarettes. However, the use of electronic cigarettes has increased among young people, which is an ongoing public health problem.1

According to the CDC, people who smoke cigarettes are about 30 to 40 percent more likely to develop type 2 diabetes than people who don’t smoke.2

People with diabetes who smoke are also more likely than those who do not smoke to have problems with insulin dosing and managing their diabetes. This can include other serious health conditions such as heart disease, kidney disease, peripheral neuropathy, low blood sugar in the legs, and retinopathy.2

Prediabetes is a reversible lifestyle that is manageable, according to the statement.1

Investigators recommend that targeting reduction in e-cigarette use and educating young adults could help reduce this risk of diabetes.1


1. Evidence links e-cigarette use to an increased risk of prediabetes. EurekAlert, press release. March 3, 2022. March 4, 2022. https://www.eurekalert.org/news-releases/945011

2. Advice from former smokers: diabetes. CDC. Updated February 8, 2022. Accessed March 4, 2022. https://www.cdc.gov/tobacco/campaign/tips/diseases/diabetes.html#:~:text=In%20fact%2C%20people%20who %20smoke ,people%20who%20do%20not smoke.&text=People%20with%20diabetes%20who%20smoker and%20with%20manage%20their%20condition

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