An analysis of data from a large, nationally representative survey of the United States population shows that e-cigarette use is associated with increased odds of prediabetes. The findings were published this month in the American Journal of Preventive Medicine.
The following material was published by the journal’s publisher, Elsevier, on 3 March 2022. According to Elsevier, the findings add important evidence about the health effects of e-cigarettes and can help shape public health best practices.
“Our study demonstrated a clear association of prediabetes risk with the use of e-cigarettes,” explained lead investigator Dr Shyam Biswal of the Department of Environmental Health and Engineering at the Johns Hopkins Bloomberg School of Public Health in the United States.
“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.”
According to the Centers for Disease Control and Prevention (CDC), traditional cigarette smokers are 30% to 40% more likely than non-smokers to develop type 2 diabetes, which increases their risk for cardiovascular diseases such as atherosclerotic disorders, stroke and peripheral vascular diseases.
E-cigarettes are sometimes promoted as a risk reduction product for current traditional cigarette smokers. The use of e-cigarettes is rising among younger population, which remains a public health concern.
To determine the association between e-cigarette use and prediabetes, the investigators analysed 2016 to 2018 data from the Behavioral Risk Factor Surveillance System. It is the largest annual nationally representative health survey of US adults with data on health outcomes, health-related risk behaviours, preventive services and chronic medical conditions.
Among the 600,046 respondents, 9% – more than 66,000 individuals – were current e-cigarette users who self-reported prediabetes diagnoses. The data also showed that e-cigarette users have a higher prevalence of high-risk lifestyle factors and worse self-related mental and physical health status than non-smokers.
Survey respondents were 50.4% female, 67.7% non-Hispanic white, 12.2% non-Hispanic black, 5% Hispanic, and 28.6% were age 35 or older. In this representative sample of US adults, e-cigarette use was associated with greater odds of prediabetes compared to those who did not use e-cigarettes or traditional cigarettes.
The association of e-cigarettes with prediabetes heightens significant concerns for public health officials.
“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,” commented Biswal. “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.”
Prediabetes is reversible with lifestyle management. Based on these findings, the authors make a compelling recommendation for targeting the reduction in e-cigarette use and education of young adults as a therapeutic lifestyle management strategy for the reduction of diabetes risk.
“Our effort for smoking cessation has led to a decrease in smoking traditional cigarettes. With this information, it is time for us to ramp up our public health efforts to promote the cessation of e-cigarettes,” cautioned Biswal.
Prediabetes is defined as the presence of impaired fasting glucose (greater than 100-125 mg/dL), impaired glucose tolerance (greater than 140-199 mg/dL two hours after a 75-g oral intake of glucose), or haemoglobin A1c between 5.7&–6.4%), which indicate an intermediate glycemic state between normal glycemia and diabetes.
The CDC has reported that prediabetes has become increasingly common in the past few decades, and recent estimates indicate that 38% of American adults have this condition. It is also on the rise among an increasingly younger population. Projections estimate that by 2030, more than 470 million people worldwide will be diagnosed with prediabetes.
Study details
The Association Between E-Cigarette Use and Prediabetes: Results From the Behavioral Risk Factor Surveillance System, 2016–2018
Zhenyu Zhang, Zhihua Jiao, Michael J Blaha, Albert Osei, Venkataramana Sidhaye, Jr Murugappan Ramanathan and Shyam Biswal.
Author affiliations: Peking University School of Public Health in China; Johns Hopkins University School of Medicine in the United States; and Bloomberg School of Public Health at Johns Hopkins University.
Published online by the American Journal of Preventive Medicine on 2 March 2022.
Abstract
Both e-cigarette use and the prevalence of prediabetes have risen dramatically in the past decade. It is crucial to understand whether e-cigarette use is associated with the risk of prediabetes.
Methods
Participants who completed the prediabetes and e-cigarette modules of the Behavioral Risk Factor Surveillance System survey (2016–2018) were included in this study.
E-cigarette use information was collected by asking: Have you ever used an e-cigarette or other electronic ‘vaping’ product, even just one time, in your entire life? We defined sole e-cigarette users as current e-cigarette users who are never combustible-cigarette users, and dual users were defined as both current e-cigarette and combustible-cigarette users.
Participants with prediabetes were identified by asking: Ever been told by a doctor or other health professional that you have prediabetes or borderline diabetes? Multivariable logistic regression was used to determine the association between e-cigarette use and prediabetes.
Results
Among the 600,046 respondents, 28.6% of respondents were aged <35 years. The prevalence of prediabetes among current e-cigarette, sole e-cigarette users, and dual users was 9.0% (95% CI=8.6, 9.4), 5.9% (95% CI=5.3, 6.5), and 10.2% (95% CI=9.8, 10.7) respectively.
In the fully adjusted model, the ORs for prediabetes were 1.22 (95% CI=1.10, 1.37) for current e-cigarette users and 1.12 (95% CI=1.05, 1.19) for former e-cigarette users compared with that of never e-cigarette users. The ORs for prediabetes were 1.54 (95% CI=1.17, 2.04) for sole e-cigarette users and 1.14 (95% CI=0.97, 1.34) for dual users.
Conclusions
In this representative sample of US adults, e-cigarette use was associated with greater odds of prediabetes. The results were consistent in sole e-cigarette users.
Evidence links e-cigarette use with increased odds of prediabetes
See also from the MedicalBrief archives
Don’t offer e-cigarettes as an 'official' alternative to smoking, French doctors advised
In world first, NHS may prescribe e-cigarettes for smoking cessation
Draft UK guidelines to tackle the health burden of smoking
E-cigarettes: Misconceptions may prevent people from quitting smoking
Study shows e-cigarettes boost likelihood of stroke and heart attack
To deliver health benefits, vaping must replace smoking – American Heart Association