Cigarette smoking, oral moist snuff use and glucose intolerance

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Abstract
Persson P‐G, Carlsson S, Svanström L, Östenson C‐G, Efendic S, Grill V (Karolinska Hospital and Karolinska Institutet, Stockholm, Sweden). Cigarette smoking, oral moist snuff use and glucose intolerance. J Intern Med 2000; 248: 103–110.Objective. To investigate the association between cigarette smoking and use of oral moist snuff and impaired glucose tolerance and type 2 diabetes.Design. We performed a population‐based cross‐sectional study of glucose intolerance and tobacco use in Stockholm during 1992–94. The sample consisted of 3128 men, aged 35–56 years, of whom 52% had a family history of diabetes. In an oral glucose tolerance test, we detected 55 men with type 2 diabetes and 172 with impaired glucose tolerance. Information on cigarette smoking and oral moist snuff use was collected by a questionnaire.Results. The odds ratio of type 2 diabetes was increased for smokers of 25+ cigarettes day–1 (odds ratio = 2.6, 95% confidence interval = 1.1–5.9) as well as for moist snuff dippers of 3+ boxes week–1 (odds ratio = 2.7, 95% confidence interval = 1.3–5.5). The odds ratio of relatively high (highest tertile) fasting insulin levels in subjects with impaired glucose tolerance associated with cigarette smoking of 25+ cigarettes day–1 was 1.5 (95% confidence interval = 0.7–3.6). The corresponding estimate of a relatively low (lowest tertile) 2 h insulin response was 2.5 (95% confidence interval = 0.9–7.1).Conclusions. These results indicate that heavy users of cigarettes or moist snuff have an increased risk of type 2 diabetes. The results could suggest that tobacco use is associated with a low insulin response.