Smoking, vaping, and nicotine pouches linked to higher type 2 diabetes risk
Smoking is now confirmed as a major risk factor for type 2 diabetes, with new research revealing that this risk spans all four known subtypes of the disease. The study, presented at the annual meeting of the European Association for the Study of Diabetes (EASD), also shows that vaping and smokeless tobacco products such as nicotine pouches may raise diabetes risk — challenging the perception that these alternatives are “safer.”
Researchers analyzed data from more than 3,300 people with type 2 diabetes and nearly 3,900 controls from Norway and Sweden, dividing participants into four diabetes subtypes:
- Mild age-related diabetes (MARD)
- Mild obesity-related diabetes (MOD)
- Severe insulin-deficient diabetes (SIDD)
- Severe insulin-resistant diabetes (SIRD)
- Smoking doubles risk for insulin-resistant diabetes
Study results revealed that past and current smokers were significantly more likely to develop type 2 diabetes than non-smokers, with the strongest association seen in those with SIRD — where risk more than doubled. Smoking also increased risk by 20% for SIDD, 27% for MARD, and 29% for MOD.
Related story: The impact of smoking and vaping on oral health: What you need to know
Heavy smokers — those consuming around 20 cigarettes daily for 15 years — faced even greater risk: 2.35 times higher likelihood of developing SIRD, and 45–57% higher risk across other subtypes.
Nicotine may be the driver
The study also found that smokeless tobacco users had a 19% higher chance of developing SIDD and 13% higher risk of SIRD. Lead author Emmy Keysendal, PhD student at Karolinska Institutet, said these findings point to nicotine itself as a potential driver of diabetes risk by worsening insulin resistance — the hallmark of SIRD.
“Our findings suggest that, like smoking, snus raises the risk of type 2 diabetes,” Keysendal explained. “This is important considering the rising popularity of e-cigarettes and nicotine pouches that deliver high doses of nicotine.”
Busting myths about smoking and weight
Experts say these findings dispel the long-held myth that smoking may reduce diabetes risk because of its effect on appetite and weight control. David Cutler, MD, family medicine physician at Providence Saint John’s Health Center, said this research “helps destroy that myth” and underscores that avoiding smoking is critical for diabetes prevention.
Why it matters
Type 2 diabetes affects 90% of people living with diabetes worldwide, with an estimated 11% of the global population impacted. Since smoking and nicotine use are modifiable risk factors, researchers stress that quitting smoking and avoiding nicotine products can significantly reduce diabetes risk and improve overall health outcomes.
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