Heterogeneous Association Between E-Cigarette Use and Diabetes Prevalence Among U.S. Adults.

Introduction: E-cigarette use has increased among U.S. adults. Although the association between traditional cigarette smoking and the diabetes or prediabetes prevalence is well established, the relationship between e-cigarette use and these conditions remains unclear. This study examines the association between different types of cigarette use (including e-cigarettes alone, combustible cigarettes alone, and dual use) and the prevalence of prediabetes and diabetes among U.S. adults. Methods: This study analyzed 1,285,783 observations from the 2020-2022 Behavioral Risk Factor Surveillance System surveys. Self-reported prediabetes and diabetes diagnoses were outcomes of interest. Propensity score matching with one-to-one nearest-neighbor matching was used to create balanced groups of smokers and nonsmokers. Multivariable logistic regressions examined associations between self-reported smoking status and outcomes. The study also conducted subgroup analyses to assess potential variations in these associations. Analyses were performed in September-December 2023. Results: After propensity score matching and adjusting for covariates, sole e-cigarette users (AOR=1.07; 95% CI=1.03, 1.11) and dual users (AOR=1.28; 95% CI=1.23, 1.33) had higher odds of prediabetes diagnosis than never users. Sole e-cigarette use was not associated with diabetes risk, but dual users showed higher odds for diabetes diagnosis (AOR=1.09; 95% CI=1.06, 1.11) versus never users. E-cigarette use was associated with varying odds of prediabetes and diabetes across different demographic groups. Conclusions: This cross-sectional analysis found that e-cigarette use is associated with higher odds of prediabetes, with dual use potentially linked to increased odds of both prediabetes and diabetes. However, because of study limitations, including the cross-sectional design, self-reported data, and unmeasured confounders, these findings should be interpreted cautiously. Because causal relationships and temporal sequences cannot be established, large prospective studies are needed to explore the metabolic health implications of emerging tobacco product use.