Use of Swedish smokeless tobacco (snus) and the risk of Type 2 diabetes and latent autoimmune diabetes of adulthood (LADA)

Abstract

The risk of Type 2 diabetes and LADA is unrelated to the use of snus, despite its high nicotine content. This opens the possibility of the increased risk of Type 2 diabetes seen in smokers may not be attributed to nicotine, but to other substances in tobacco smoke.

Smokeless tobacco (snus) is associated with an increased risk of type 2 diabetes: results from five pooled cohorts

“…Our results were consistent with the findings of two small previous studies . By contrast, no association was found in two other studies, including a recent study by us . However, lack of power precluded the possibility of drawing any firm conclusions regarding the risk in high consumers in these previous studies.…”

“…Results of studies to date are inconclusive; findings from two small studies based on the Stockholm Diabetes Prevention Programme indicated an increased risk of type 2 diabetes in snus users [16,17]. By contrast, no association was found in the Swedish MONICA study or in a recent analysis based on two Scandinavian studies in which only never smokers were included, thereby minimizing confounding due to smoking [18,19]. Despite the latter being the largest study to date including >700 cases, numbers of high consumers were small and therefore risk estimates unstable.…”

Etiology and Pathogenesis of Latent Autoimmune Diabetes in Adults (LADA) Compared to Type 2 Diabetes

“…This indicates that smoking may confer both positive and negative effects and population characteristics including degree of underlying autoimmunity may determine whether the net effect is beneficial or detrimental. The effects may also cancel out each other which may explain why we did not find an association between use of Swedish oral moist snuff and LADA (Rasouli et al, 2017a). Interaction with genetic factors may account for some of this heterogeneity; notably, strong interaction between smoking and HLA genotypes has been demonstrated in relation to rheumatoid arthritis (Kallberg et al, 2007) but this remains to be explore in relation to LADA.…”

Diabetes and risk

“…By contrast, Rasouli et al . showed that snus (smokeless tobacco or moist snuff) was not a risk factor for Type 2 diabetes or latent autoimmune diabetes of adulthood, suggesting that the reason why smokers are at increased risk of diabetes may not be attributed to nicotine, but to other substances in tobacco smoke. The last of the articles describes how an inexpensive virtual assistance‐based lifestyle intervention can reduce diabetes risk factors .…”