E-cigarette use increases risk of prediabetes, study suggests

E-cigarettes are a relatively new product some have claimed to be “healthier” than conventional cigarettes. However, the use of e-cigarettes may also pose health risks. 

According to a newly published study, e-cigarette use was associated with a higher risk of developing prediabetes.¹ 

Dr. Shyam Biswal, co-author of the study, emphasized the importance of these findings; “With both e-cigarette use and prevalence of prediabetes dramatically on the rise in the past decade, our discovery that e-cigarettes carry a similar risk to traditional cigarettes with respect to diabetes is important for understanding and treating vulnerable individuals.”²

What is prediabetes?

Prediabetes is a condition that usually precedes diabetes. Compared to diabetes, it is the slight impairment in glucose regulation, defined as either a Hemoglobin A1c between 5.7 to 6.4%, fasting blood glucose of 100-125mg/dL, or glucose level of 140-199mg/dL two hours post-75g glucose consumption.^3,4 

The prevalence of prediabetes has increased recently; of the U.S. adult population aged 65 or older, 34.5% and 46.6% had prediabetes in 2013 and 2016, respectively.⁵ Of the U.S. population aged 19-34, the prevalence of prediabetes was 24.0% between 2005-2016.⁶ 

Prediabetes can be reversed by making healthier choices regrading diet and lifestyle.  

E-cigarettes have gained popularity

E-cigarette use has increased exponentially in recent years; of the 10.8 million adult U.S. population, 4.5% were e-cigarette users in 2016.⁷ 

A previous study outlined that cigarette smoke may increase insulin resistance⁸, which can lead to diabetes. Another survey suggested that e-cigarette use may also be associated with prediabetes, however this survey had an unreliable sample size.⁹ 

The study, published in the American Journal of Preventive Medicine, set out to analyze the association between e-cigarette use and prediabetes using a more reliable sample size. They conducted a survey of current, past, and non-smokers.¹ Two groups of particular interest include those considered “sole” e-cigarette users (they have only ever used e-cigarettes and smoke currently) as well as “dual” e-cigarette users (they use both conventional cigarettes and e-cigarettes currently). 

600,046 adults aged 18+ responded to the survey between 2016 to 2018. Participants were asked about the nature of their e-cigarette use (sole, dual, or non-user) and whether they had ever been told by their healthcare professional that they have prediabetes or borderline diabetes. 

The prevalence of prediabetes was higher in e-cigarette users

Of the dual users, the prevalence of prediabetes was 10.2%.¹ Those who currently smoked conventional cigarettes showed a prediabetes prevalence of 13.4%, while 5.9% of sole e-cigarette smokers had self-reported prediabetes.

Former and current e-cigarette users were 12% and 22% more likely to have prediabetes than people who never used e-cigarettes, respectively.

Dual users were 14% more likely to have prediabetes than people who never smoked either cigarettes or e-cigarettes. Those who were former e-cigarette users or current sole e-cigarette users were 13% and 54% more likely to have prediabetes compared to people who never smoked, respectively.

According to Dr. Biswal, “We were surprised by the findings associating prediabetes with e-cigarettes because they are touted as a safer alternative, which we now know is not the case. In the case of cigarette smoking, nicotine has a detrimental effect on insulin action, and it appears that e-cigarettes may also have the same effect.”²

Researchers hope their findings will encourage e-cigarette cessation and treatment programs to help prevent the rise in prediabetes. 

References

1. Zhang, Z. et al. (2022). The Association Between E-Cigarette Use and Prediabetes: Results From the Behavioural Risk Factor Surveillance System, 2016-2018. American Journal of Preventative Medicine. Doi: 10.1016/j.amepre.2021.12.009
2. Leahy, Eileen and Jillian B. Morgan. (2022). Evidence links e-cigarette use with increased odds of prediabetes. EurekAlert! Accessed Mar. 8 2022. Retrieved from https://www.eurekalert.org/news-releases/945011. 
3. American Diabetes Association. (2018). 5. Prevention or delay of type 2 diabetes: standards of Medical Care in Diabetes-2018. Diabetes Care; 41: S51-S54. Doi: 10.2337/dc18-S005.
4. Bansal, N. (2015). Prediabetes diagnosis and treatment: a review. World Journal of Diabetes; 6: 296-303. Doi: 10.4239/wjd.v6.i2.296.
5. Menke, A. et al. (2015). Prevalence of and trends in diabetes among adults in the United States, 1988-2012. JAMA; 314: 1021-1029. Doi: 10.1001/jama.2015.10029.
6. Andes, L.J. et al. (2020). Prevalence of prediabetes among adolescents and young adults in the United States, 2005-2016. JAMA Pediatrics; 174: e194498. Doi: 10.1001/jamapediatrics.2019.4498.
7. Mirbolouk, M. et al. (2018). Prevelence and distribution of e-cigarette use among U.S. adults: Behavourla Risk Fcator Surveillance System, 2016. Annals of Internal Medicine; 169: 429-438. Doi: 10.7326/M17-3440
8. Willi, C. et al. (2007). Active smoking and the risk of type 2 diabetes: a systemic review and meta-analysis. JAMA; 298: 2654-2664. Doi: 10.1001/jama.298.22.2654.
9. Atuegwu. N.C. et al. (2019). E-cigarette use is associated with a self-reported diagnosis of prediabetes in never cigarette smokers: results from the Behavioural Risk Factor Surveillance System survey. Drug Alcohol Dependence; 205: 107692. Doi: 10.1016/j.drugalcdep.2019.107692.

Image by Lindsay Fox from Pixabay