New research from the University of Georgia reports that people who use e-cigarettes, traditional cigarettes or both are more likely to develop diabetes. According to the study, smokers showed a notably higher rate of prediabetes and diabetes diagnoses compared with nonsmokers.

“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 Centers for Disease Control and Prevention notes that vaping continues to grow in popularity, especially among younger people. The study’s results indicate that diabetes rates may also rise within these groups as e-cigarette use expands.

Researchers also reported that the likelihood of developing diabetes or prediabetes is even higher for Hispanic and Black individuals living in economically disadvantaged settings, along with people who already have underlying health problems.

Dual Users Face Sharp Increases in Prediabetes

Utilizing more than 1.2 million responses from the Behavioral Risk Factor Surveillance System survey, the research team examined how e-cigarette use and traditional smoking relate to prediabetes and diabetes diagnoses.

The analysis showed that vaping alone was linked to a 7% increase in prediabetes risk. The researchers suggested that e-cigarette use may temporarily impair insulin function and contribute to weight gain, both of which are tied to prediabetes.

While 7% may seem modest, it represents roughly 7,000 additional prediabetes cases each year in the U.S based on current population trends.

The study also found that smoking cigarettes or cigars increased prediabetes risk by 15%. The risk climbed even higher for people who both smoked and vaped, reaching 28%.

Individuals who used both cigarettes and e-cigarettes were also more likely to be diagnosed with diabetes itself, with risks rising by 7 and 9% respectively.

“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.

Weight, Income and Demographics Influence Risk Levels

The researchers observed that certain personal and demographic factors further intensified the likelihood of developing prediabetes or diabetes.

People who were overweight or obese and smoked were especially vulnerable, as e-cigarette users with a higher body mass index had worse outcomes than those at a normal weight. Hispanic, Black and Asian individuals who smoked or vaped were more frequently diagnosed with prediabetes or diabetes compared with white individuals.

Lower income was another major contributor. Those in the lowest income groups had a 12% higher risk 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.

Regular physical activity, however, provided some protection. Exercise reduced prediabetes risk for smokers by 8%, offering a potential way to counter some of the harmful effects.

“These findings have important implications for public health efforts to curb smoking and improve diabetes outcomes,” said Neupane.

The study was published in AJPM Focus. Co-authors included Agricultural and Applied Economics Professor Wojciech J. Florkowski and Chandra Dhakal, a Ph.D. graduate from UGA who now works for the CDC Foundation.