The association between e-cigarette use or dual use of e-cigarette and combustible cigarette and prediabetes, diabetes, or insulin resistance: Findings from the National Health and Nutrition Examination Survey (NHANES).

Abstract

Studies have established associations between combustible cigarette use and diabetes. However, there is limited evidence on the association between e-cigarette use or dual use of e-cigarettes and combustible cigarettes and diabetes. With cross-sectional data of 5101 U.S. adults from the National Health and Nutrition Examination Survey, this study examined how e-cigarette use or dual use was related to diabetes, prediabetes, or insulin resistance. The presence of diabetes or prediabetes was determined by fasting glucose level, hemoglobin A1C (HbA1c), or the use of prescribed medications. Insulin resistance was assessed by the homeostatic model (HOMA-IR). The independent association between e-cigarette use or dual use and outcomes was examined using weighted multivariable logistic regression models controlling for potential confounders. Of all participants, 6.3% were current e-cigarette users and 17.1% were former e-cigarette users. In the fully adjusted model, e-cigarette use was not associated with prediabetes or diabetes (P>0.05). However, former e-cigarette users were 22% (95% CI: 1.00, 1.84) more likely to report higher HOMA-IR (Q₃ vs Q₁) than never e-cigarette users. Among ever combustible cigarette users, current e-cigarette users and former e-cigarette users were 63% (95% CI: 1.00, 2.91) and 64% (95% CI: 1.04, 2.59) more likely to report higher HOMA-IR than never e-cigarette users, respectively. There was no significant association between dual use and diabetes, prediabetes, or insulin resistance (P>0.05). E-cigarette use may be associated with insulin resistance. Our findings may inform future tobacco control policies and longitudinal studies assessing insulin resistance associated with e-cigarette use.