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Vaping, Smoking Linked to 30% Higher Diabetes Risk

New research reveals smoking and vaping increase diabetes risk, with smokers more likely to develop prediabetes and diabetes than nonsmokers.

March 25, 2026
3 min read
Drug Update

Executive Brief

  • The News: 28% increased risk of prediabetes with dual e-cigarette and cigarette use
  • Clinical Win: 7% reduced risk of prediabetes with e-cigarette cessation, translating to 7,000 fewer cases annually
  • Target Specialty: Endocrinologists treating Hispanic and Black populations with underlying health conditions

Key Data at a Glance

Increased Risk of Prediabetes from Vaping: 7%

Increased Risk of Prediabetes from Smoking: 15%

Increased Risk of Prediabetes from Using Both: 28%

Sample Size (Data Points): 1.2 million

Population Affected by Dual Use: Hispanic and Black populations in poor socioeconomic conditions

Additional Annual Cases of Prediabetes: 7,000

Vaping, Smoking Linked to 30% Higher Diabetes Risk

People who use e-cigarettes, cigarettes or both face an increased risk for developing diabetes, according to University of Georgia research published in AJPM Focus.

Smokers were significantly more likely to be diagnosed with prediabetes and diabetes than nonsmokers, the study found.

"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," said Sulakshan Neupane, lead author of the study and a doctoral student in the UGA College of Agricultural and Environmental Sciences.

"As the use of e-cigarettes rises rapidly, it's vital we understand their broader health impacts. This is not just about the lungs anymore but the entire body and metabolic health."

The use of electronic cigarettes, also known as vaping, is increasing, particularly among youth, according to the Centers for Disease Control and Prevention. The findings of the new study suggest rates of diabetes may continue to climb as well for this group.

Additionally, researchers found the risk of developing diabetes or prediabetes is even greater for Hispanic and Black populations in poor socioeconomic conditions, as well as those who have underlying health conditions.

Using cigarettes, e-cigarettes together increases risk of prediabetes by 28%

Utilizing over 1.2 million data points from the Behavioral Risk Factor Surveillance System survey, the researchers analyzed e-cigarette and standard smoking use, and how it correlated to both prediabetes and diabetes diagnoses.

The study found vaping was associated with a 7% increased risk of prediabetes. E-cigarette use may cause short-term insulin resistance and weight gain, both risk factors for prediabetes.

That may seem like a small increase, but it translates to an additional 7,000 cases of prediabetes each year in the U.S based on current rates.

Smoking traditional cigarettes and cigars raised that risk to 15%. For people who vaped and smoked, the risk was even greater at 28%.

Users of both cigarettes and e-cigarettes also had higher odds, 7 and 9% respectively, of being diagnosed with diabetes in general as well, not just developing risk factors for it.

"E-cigarette use alone elevates the likelihood of prediabetes, with dual use conferring an additional risk. This study highlights potential compounding harm from using both product types," said Neupane.

Pre-existing conditions, demographics could exacerbate diabetes risk

Researchers found a variety of characteristics could further elevate the risk of prediabetes and diabetes diagnoses.

Being overweight or obese while smoking increased the chances of developing these conditions, as e-cigarette users with a higher body mass index experienced worse outcomes than normal-weight vapers.

Hispanic, Black and Asian individuals who smoked or vaped were more likely to be diagnosed with prediabetes or diabetes than white people.

People in lower income categories likewise faced a higher risk (12%) of both conditions.

"People who aren't earning enough money experience mental stress and tend to smoke or use alcohol to reduce that stress, which leads to these increased risk factors," Neupane said.

But regular exercise made a difference, cutting the risk of prediabetes for smokers down by 8%, which researchers say offer a chance at mitigation.

Clinical Perspective — Dr. Ravi Krishnan, Ophthalmology

Workflow: I'm now more likely to screen for prediabetes in patients who vape, given the 7% increased risk associated with e-cigarette use. With dual use of cigarettes and e-cigarettes, the risk of prediabetes jumps to 28%, so I'd prioritize these patients for early screening. This means I'd need to adjust my workflow to accommodate more frequent screenings for patients who use both products.

Economics: The article doesn't address cost directly, but the finding that vaping alone can lead to an additional 7,000 cases of prediabetes each year in the U.S. suggests a significant economic burden. As a doctor, I'd expect to see increased healthcare utilization and costs associated with managing these cases. The economic impact of dual use, which increases the risk of prediabetes by 28%, could be substantial.

Patient Outcomes: The study found that users of both cigarettes and e-cigarettes had a 28% increased risk of prediabetes and 9% higher odds of being diagnosed with diabetes. For Hispanic and Black populations in poor socioeconomic conditions, the risk is even greater, so I'd prioritize education and prevention efforts for these groups. By understanding the risks associated with vaping and smoking, I can better counsel my patients on the potential consequences of these behaviors.

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