Study Links Vaping and Prediabetes

A Johns Hopkins study found an association between use of e-cigarettes and prediabetes. More research is needed to tease out the possible causal elements of the association. Meanwhile, a federal government survey found that 1.72 million high school students and 320,000 middle schoolers are current users of e-cigarettes.

A new study led by a researcher at the Johns Hopkins Bloomberg School of Public Health in Baltimore suggests that people who vape may be increasing their risk of developing prediabetes, even if they don’t smoke conventional cigarettes.

The data on 600,000 U.S. adults showed that those who inhaled the chemicals in e-cigarettes were more likely to have prediabetes than those who hadn’t engaged in vaping or smoking behaviors.

With e-cigarette use on the rise among youth and young adults, health experts are sounding alarm bells about the potential dangers.

“There is a perception among the younger population that e-cigarettes are a safer alternative,” says Shyam Biswal, Ph.D., a professor of environmental health sciences at Johns Hopkins and co-author of the study published in the American Journal of Preventive Medicine. “More data is piling up that e-cigarettes are not harmless as they were originally perceived by the users. They do contain many chemicals which have toxic effects.”

Results of the federal government’s 2021 National Youth Tobacco Survey showed that 13.4% (2.06 million ) of high school students and 4% (470,000) of middle schools were current users of a tobacco product and that that e-cigarettes were the most commonly used products. The survey results, published earlier this month in the Morbidity and Mortality Weekly Report, indicate that 1.72 million high school students use e-cigarettes and 320,000 middle schoolers.

In addition to an elevated risk of prediabetes, lung and heart diseases are major concerns that stem from vaping and smoking, says Biswal, adding that research has linked vaping to erectile dysfunction.

“This study is a good first look at the impacts of vaping and chronic disease development,” says Farah Naz Khan, M.D., a clinical assistant professor in the division of metabolism, endocrinology and nutrition at the University of Washington School of Medicine in Seattle. “More research will be needed to better understand correlation versus causation.” But it is plausible that vaping can affect the development of prediabetes, particularly if a person has other risk factors such as family history, obesity and insulin resistance, Khan says.

Previously, the Surgeon General concluded that cigarette smoking can contribute to the onset of Type 2 diabetes, says Brenna VanFrank, M.D., MSPH, senior medical officer at the CDC’s Office on Smoking and Health.

“Evidence is well established regarding the link between cigarette smoking and inflammation,” VanFrank says. “Cigarette smoke-induced inflammation is a contributing mechanism to a variety of diseases caused by smoking, including cancer, lung disease and cardiovascular disease.”

Cigarette smoking can create low-grade inflammation throughout the body by attacking white blood cells, which protect against invaders and respond to injury. It damages them by activating the release of chemical substances that circulate and localize in tissues, says David C. Christiani, M.D., M.P.H., M.S., a professor at the Harvard T.H. Chan School of Public Health and Harvard Medical School in Boston.

“Animal data and some preliminary human data indicate that vaping can activate some of the same pathways as combustibles, says Christiani, who is also a pulmonologist at Massachusetts General Hospital.

It is still unknown whether prediabetes will develop into full-blown diabetes if a person continues to vape. “This study cannot answer that definitively,” he says.

“However, prediabetes as a condition is linked with adverse health outcomes such as those seen with full-blown diabetes: heart disease, stroke, peripheral vascular disease. So, persistent use will lead to persistent prediabetes, and an elevated risk of these conditions.”

The good news is that quitting smoking decreases markers of inflammation, according to the 2020 Surgeon General’s Report on Smoking Cessation. Yet VanFrank notes that “airway inflammation may persist for months to years after quitting.”

Khan adds that “the best way to try to prevent further inflammation is to stop the offending factor, whether that is smoking or vaping. This can prevent further inflammation from developing, but it is unlikely to reverse any damage that has already occurred.”

Still, Biswal says prediabetes is reversible with lifestyle management. He recommends “doubling down on public health measures to prevent the initiation and use of e-cigarettes, at least among youth.”