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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. 


  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 

Bryn Evans
Bryn Evans
I graduated with a major in biochemistry, a minor in physics, and a certificate in business from Queen’s University. My long-term goal is to become a family physician (MD) and earn a Master’s in Public Health (MPH). I am passionate about public health, mental health, & wellness. I'm currently completing a Certificate in Effective Writing for Healthcare because I recognize how important it is to communicate effectively with the public!


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