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J Intern Med. 2000 Aug;248(2):103-10.

Cigarette smoking, oral moist snuff use and glucose intolerance.

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  • 1Division of Epidemiology, Karolinska Hospital, Stockholm County Council, Karolinska Institutet, Stockholm, Sweden.



To investigate the association between cigarette smoking and use of oral moist snuff and impaired glucose tolerance and type 2 diabetes.


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.


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).


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.

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