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Use of Swedish smokeless tobacco (snus) and the risk of Type 2 diabetes and latent autoimmune diabetes of adulthood ( LADA )
Author(s) -
Rasouli B.,
Andersson T.,
Carlsson P.O.,
Grill V.,
Groop L.,
Martinell M.,
Midthjell K.,
Storm P.,
Tuomi T.,
Carlsson S.
Publication year - 2017
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.13179
Subject(s) - medicine , snus , type 2 diabetes , smokeless tobacco , diabetes mellitus , odds ratio , type 1 diabetes , snuff , population , confidence interval , environmental health , endocrinology , tobacco use , pathology
Aims It has been suggested that moist snuff (snus), a smokeless tobacco product that is high in nicotine and widespread in Scandinavia, increases the risk of Type 2 diabetes. Previous studies are however few, contradictory and, with regard to autoimmune diabetes, lacking. Our aim was to study the association between snus use and the risk of Type 2 diabetes and latent autoimmune diabetes of adulthood ( LADA ). Method Analyses were based on incident cases (Type 2 diabetes, n = 724; LADA , n = 200) and population‐based controls ( n = 699) from a Swedish case–control study. Additional analyses were performed on cross‐sectional data from the Norwegian HUNT study ( n = 21 473) with 829 prevalent cases of Type 2 diabetes. Odds ratios ( OR ) were estimated adjusted for age, BMI family history of diabetes and smoking. Only men were included. Results No association between snus use and Type 2 diabetes or LADA was seen in the Swedish data. For Type 2 diabetes, the OR for > 10 box‐years was 1.00 [95% confidence interval ( CI ), 0.47 to 2.11] and for LADA 1.01 (95% CI , 0.45 to 2.29). Similarly, in HUNT , the OR for Type 2 diabetes in ever‐users was estimated at 0.91 (95% CI , 0.75 to 1.10) and in heavy users at 0.92 (95% CI , 0.46 to 1.83). Conclusion 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.