Those who use both traditional cigarettes and e-cigarettes are at the highest risk
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Using e-cigarettes, cigarettes, or both is associated with higher risk for prediabetes and diabetes, with dual use being the riskiest.
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Risk is especially elevated in people who are overweight or obese, of Black, Hispanic or Asian background, or of lower income.
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Regular exercise seems to help reduce risk, even among smokers.
Youve likely heard that smoking is bad for your lungs. However, new research suggests it might also be quietly upping your chances of developing metabolic issues like prediabetes and diabetes.
As e-cigarette use grows, especially among younger people, scientists wanted to know: is vaping really a safer alternative or is it hiding other long-term risks?
In an era when e-cigarettes are marketed as a safer alternative to smoking, this suggests they may carry a hidden peril and may be quietly contributing to long-term health problems like prediabetes and diabetes, researcher Sulakshan Neupane said in a news release.
As the use of e-cigarettes rises rapidly, its vital we understand their broader health impacts. This is not just about the lungs anymore but the entire body and metabolic health.
The study
The researchers used data from the Behavioral Risk Factor Surveillance System (BRFSS) a large-scale U.S. survey. They analyzed over 1.2 million responses to compare people who smoke traditional cigarettes, those who vape (i.e. use e-cigarettes), people who do both, and those who do neither. Key outcomes they looked for were diagnoses of prediabetes and diabetes.
They also considered demographic and health-related factors: body mass index (BMI), race/ethnicity, income, and whether respondents had existing health conditions. That allowed them to see not just if risk was higher in general, but how it varied depending on other characteristics.
The results
Heres what the study uncovered:
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Prediabetes risk:
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Vaping alone was associated with about a 7% higher risk of prediabetes compared to non-users.
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Smoking traditional cigarettes raised that to about 15%.
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Using both cigarettes and e-cigarettes conferred a 28% higher riskthe largest increase seen.
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Diabetes risk (diagnosed disease, not just risk factors):
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Smokers had higher odds of having diabetes than non-smokers.
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Those who both smoked and vaped similarly showed elevated risk (roughly 7-9% more likely) of being diagnosed with diabetes.
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Other factors that make a difference:
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Overweight or obesity amplified the risk: people with higher BMI who smoked or vaped fared worse.
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Race/ethnicity mattered: Black, Hispanic, and Asian individuals using tobacco or vaping had higher rates of prediabetes or diabetes than white respondents in similar situations.
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Income played a role: lower income categories were tied to greater risk for both conditions.
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On a positive note, regular exercise appeared to reduce risk for smokersshowing that lifestyle can still make a difference.
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These findings have important implications for public health efforts to curb smoking and improve diabetes outcomes, Neupane said in the news release."
Posted: 2025-09-18 18:02:38