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Use of e-cigarettes may be linked to higher odds of prediabetes, according to an analysis of survey data from over 600,000 U.S adults.

Current e-cigarette users had 20% higher odds of having prediabetes compared with those who never used e-cigarettes (OR 1.22, 95% CI 1.10-1.37), reported Shyam Biswal, PhD, of Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues.

In addition, former e-cigarette users had lower but still elevated odds of prediabetes (OR 1.12, 95% CI 1.05-1.19), they noted in the .

"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," Biswal said in a .

, people who smoke traditional cigarettes are 30% to 40% more likely to develop type 2 diabetes. They also have more difficulty managing their diabetes, regardless of the type.

"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," Biswal added.

In this study, current e-cigarette users had higher odds of prediabetes compared with people who never smoked either e-cigarettes or combustible cigarettes (OR 1.54, 95% CI 1.17-2.04), the researchers reported. When comparing former e-cigarette users and dual users (both e-cigarettes and combustible cigarettes) with never smokers, the results did not reach statistical significance (OR 1.13, 95% CI 1.00-1.29 and OR 1.14, 95% CI 0.97-1.34, respectively).

The team also found that current occasional e-cigarette users had 25% higher odds of prediabetes compared with never e-cigarette users (OR 1.25, 95% CI 1.09-1.43), but in current daily e-cigarette users, the results did not reach statistical significance (OR 1.19, 95% CI 1.00-1.44).

Overall, the prevalence of prediabetes among the smoking groups was as follows:

• Never e-cigarette user: 10.9%
• Current e-cigarette user: 9.0%
• Former e-cigarette user: 9.2%
• Sole e-cigarette user (never used combustible cigarette): 5.9%
• Never combustible cigarette user: 9.3%
• Current combustible cigarette user: 13.4%
• Former combustible cigarette user: 10.2%
• Dual smokers 10.2%

"E-cigarettes remain the most controversial smoking-cessation intervention," Biswal and colleagues noted. Health officials worry that the rise in e-cigarette use, especially among non-smokers, may "outstrip the potential utility of e-cigarettes as quit devices among tobacco smokers."

The findings in this study are "critical information because the prevalence of e-cigarette use among young adults and adolescents is rising rapidly," they added.

The study included 600,046 adults interviewed by landlines or cell phones in the 2016-2018 survey. Respondents were excluded if they had a history of diabetes, were pregnant, or had missing data for covariates, such as BMI, physical activity, and medical conditions that may impact their risk of diabetes.

Of the study population, 28.6% were older than age 35, two-thirds were white, 12.2% were Black, and just over half were women. Current e-cigarette users were more likely to be men and have lower education levels.

Biswal and team noted that since the study used self-reported data from a survey, "a causal relationship between e-cigarette use and prediabetes cannot be inferred."

In addition, the study "could not rule out diet-related information, which would reduce the observed association to the null," they wrote.

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