A new University of Georgia study reveals that e-cigarette use, traditional smoking, or both significantly raise the risk of prediabetes and diabetes. The research, based on over 1.2 million survey responses, shows heightened dangers for certain demographic groups. Vaping alone increases prediabetes risk by 7%, while dual use elevates it to 28%.
Researchers at the University of Georgia analyzed data from more than 1.2 million responses in the Behavioral Risk Factor Surveillance System survey to examine the links between e-cigarette use, traditional smoking, and metabolic diseases. The study, published in AJPM Focus in 2025, found that smokers have notably higher rates of prediabetes and diabetes diagnoses compared to nonsmokers.
Vaping alone was associated with a 7% increase in prediabetes risk, potentially due to temporary impairment of insulin function and weight gain. Smoking cigarettes or cigars raised this risk by 15%, and dual users—those who both smoke and vape—faced a 28% higher risk for prediabetes. For diabetes itself, dual users saw risks increase 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 Sulakshan Neupane, lead author and a doctoral student in the UGA College of Agricultural and Environmental Sciences.
The findings underscore disparities: Hispanic, Black, and Asian individuals who smoke or vape were more frequently diagnosed with prediabetes or diabetes than white individuals. Those in the lowest income groups faced a 12% higher risk for both conditions. Overweight or obese users showed worse outcomes, while regular physical activity reduced prediabetes risk for smokers by 8%. "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 explained.
As e-cigarette use rises, especially among younger people according to the Centers for Disease Control and Prevention, the study warns of broader health impacts beyond the lungs. "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," Neupane noted. Co-authors include Wojciech J. Florkowski and Chandra Dhakal.