Influence of smoking and snus on the prevalence and incidence of type 2 diabetes amongst men: the northern Sweden MONICA study
Abstract
Abstract.: Objective. To explore the effect of smoking and smokeless tobacco, ‘snus’, on the risk of type 2 diabetes. Design. Population‐based cross‐sectional and prospective follow‐up study in northern Sweden. Subjects. A total of 3384 men, aged 25–74 years, who participated in the MONICA study in 1986, 1990, 1994 or 1999, 1170 of whom had an oral glucose tolerance test. In 1999, 1757 men from previous cohorts returned for re‐examination. Main outcome measures. We compared the prevalence of type 2 diabetes or pathological glucose tolerance (PGT) amongst tobacco users to that of nonusers at entry into the study and at follow‐up, using odds ratios. Results. Compared with never users, the age‐adjusted risk of prevalent clinically diagnosed diabetes for ever smokers was 1.88 (CI 1.17–3.0) and for smokers 1.74 (0.94–3.2). Corresponding odds ratios for snus users were 1.34 (0.65–2.7) and 1.18 (0.48–2.9). We found no increased risk of prevalent PGT in snus users or smokers. Former smokers and snus users had an insignificantly increased risk for PGT. Compared with nonusers, the age‐adjusted risk of developing clinically diagnosed diabetes during follow‐up was 4.63 (1.37–16) in consistent exclusive smokers, 3.20 (1.16–8.8) in ex‐smokers and no cases in consistent snus users. The risk of PGT during follow‐up was not increased in consistent tobacco users but evident, although not statistically significant, in those who quit snus during the follow‐up period, 1.85 (0.60–5.7). Adjustment for physical activity and alcohol consumption did not change the major findings. Conclusions. The risk of diabetes for snus users was not significantly increased. Smoking was associated with prevalent and incident cases of diabetes. Ex‐tobacco users tended towards more PGT.
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Among ever snus users compared to never-users, there are increased odds of diabetes type 2 (OR = 1.34; 95% CI: 0.65-2.7); among current snus users, OR = 1.18; 95% CI: 0.48-2.9.
“increased odds of diabetes type 2 in ever snus users (OR = 1.34; 95% CI: 0.65-2.7)and in current snus users (OR = 1.18; 95% CI: 0.48-2.9)compared to never-users (Eliasson et al. 2004).”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Eliasson et al. 2004
In ever snus users, the odds of diabetes type 2 were OR = 1.34 (95% CI: 0.65-2.7) compared to never-users.
“diabetes type 2 in ever snus users (OR = 1.34; 95% CI: 0.65-2.7)and in current snus users (OR = 1.18; 95%CI: 0.48-2.9)compared to never-users(Eliasson et al. 2004)”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Eliasson et al. 2004
In current snus users, the odds of diabetes type 2 were OR = 1.18 (95% CI: 0.48-2.9) compared to never-users.
“diabetes type 2 in ever snus users (OR = 1.34; 95% CI: 0.65-2.7)and in current snus users (OR = 1.18; 95%CI: 0.48-2.9)compared to never-users(Eliasson et al. 2004)”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Eliasson et al. 2004
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Cites
Manson, J. E., Ajani, U. A., Liu, S., Nathan, D. M., & Hennekens, C. H. (2000) · The American Journal of Medicine · doi:10.1016/s0002-9343(00)00568-4 · Cited by 245 · see citing works
Long-term use of nicotine gum is associated with hyperinsulinemia and insulin resistance
Eliasson, B., Taskinen, M.-R., & Smith, U. (1996) · Circulation · doi:10.1161/01.cir.94.5.878 · Cited by 141 · see citing works
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Active Smoking and the Risk of Type 2 Diabetes: A Systematic Review and Meta-analysis
Willi, C., Bodenmann, P., Ghali, W. A., Faris, P. D., & Cornuz, J. (2007) · JAMA · doi:10.1001/jama.298.22.2654 · Cited by 1,268 · see citing works
Kopa-Stojak, P. N., & Pawliczak, R. (2026) · Exposure and Health · doi:10.1007/s12403-026-00812-w
- Authors
- Eliasson, M., Asplund, K., Nasic, S., & Rodu, B.
- Venue
- Journal of Internal Medicine
- Publisher
- Wiley
- Published
- 2004-07-15
- Volume
- 256
- Issue
- 2
- Pages
- 101-110
- ISSN
- 0954-6820
- 1365-2796
- Cited by
- 57
- References
- 2
- Language
- en
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