5 Minutes
A large U.S. study suggests that e-cigarette use is associated with a higher likelihood of prediabetes, and that people who both vape and smoke combustible cigarettes face the greatest risk. Researchers analyzed more than 1.2 million data points from a CDC phone survey to explore links between nicotine product use and raised blood-sugar status, a precursor to type 2 diabetes.
Study design and scientific context
Prediabetes describes blood-glucose levels that are higher than normal but not yet high enough for a type 2 diabetes diagnosis. Though often reversible, prediabetes is clinically important because it signals elevated risk for cardiovascular, kidney, and nerve damage.
Health economist Sulakshan Neupane and colleagues at the University of Georgia examined data collected by the U.S. Centers for Disease Control and Prevention (CDC). The dataset included more than 1.2 million survey responses gathered by telephone, allowing investigators to estimate associations between self-reported use of e-cigarettes, combustible tobacco, or both (dual use) and the prevalence of prediabetes or diabetes. The study was published in AJPM Focus in 2025.
Key findings and numerical results
After adjusting for available covariates, the team reported that exclusive e-cigarette users had a 7% higher likelihood of prediabetes compared with nonsmokers. The authors translated that relative increase into an absolute figure: roughly 7,000 additional cases of prediabetes per 1 million U.S. e-cigarette users.
For exclusive combustible-tobacco users (for example, cigarettes or cigars) the relative prediabetes risk was larger, about 15% above nonsmokers. Dual users—people who both vape and smoke—faced the highest relative prediabetes risk of 28% compared with nonsmokers.
When the team examined diagnosed diabetes, dual users again showed elevated risk: about 9% higher than nonsmokers. By contrast, people who only smoked combustible products had a roughly 7% increased diabetes risk relative to nonsmokers.
Subgroup analyses revealed additional patterns: e-cigarette users who were overweight or obese had higher prediabetes risk than users with lower body mass index. The study also identified racial and ethnic disparities: Hispanic, Black, and Asian respondents experienced greater excess risk associated with vaping than White respondents in the same dataset.
Limitations and interpretation
The authors stress caution in causal interpretation. This is an observational analysis of self-reported survey data collected over a relatively short timeframe, so it cannot establish that vaping causes prediabetes. Reverse causation or confounding factors—such as socioeconomic stressors, heavy alcohol use, or other behaviors tied to both nicotine use and metabolic risk—could contribute to the observed associations.
Neupane notes: "E-cigarette use alone elevates the likelihood of prediabetes, with dual use conferring an additional risk. This study highlights potential compounding harm from using both product types." He also cautioned that social and economic factors may influence both nicotine use and metabolic health.
Another limitation is reliance on self-reported diagnoses and behaviors, which can introduce measurement error. Still, the study’s large sample size strengthens statistical power and helps identify patterns worth further investigation.
Implications for public health and future research
These results add to an expanding body of literature linking vaping to systemic health effects beyond the lungs. Although e-cigarettes are often marketed as a "safer" smoking alternative, this analysis suggests potential metabolic harms that may contribute to long-term disease burden.
Key next steps include longitudinal cohort studies with biochemical measures (for example, HbA1c, fasting glucose, and biomarkers of nicotine exposure) to clarify causality and dose–response relationships. Controlled animal or mechanistic studies could also probe how aerosol constituents influence insulin sensitivity, inflammation, or pancreatic function.
Expert Insight
Dr. Laura Mendes, a public-health epidemiologist (fictional for commentary), says: "This large-scale survey study raises important red flags. Even if vaping carries lower respiratory risk for some users, we must evaluate whole-body impacts. Clinicians should ask patients about all nicotine products when assessing metabolic risk, and policymakers should consider these findings when shaping harm-reduction messaging."
Conclusion
This analysis of CDC survey data indicates that e-cigarette use is associated with a modestly higher likelihood of prediabetes, while combined vaping and smoking is linked to substantially greater risk. Given the observational design and self-reported measures, the findings do not prove causation, but they underscore the need for more rigorous longitudinal and mechanistic studies. Public-health messaging and clinical practice should account for potential metabolic consequences of vaping, especially among people who use multiple nicotine products or who are already overweight.
Source: sciencealert
Leave a Comment