Association of Heated Tobacco Product Use With Risk of Type 2 Diabetes
Year: 2026
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: Heated tobacco products (HTPs) are marketed as safer alternatives to conventional cigarettes, but evidence on their metabolic health effects is limited. Cigarette smoking is a known risk factor for type 2 diabetes; understanding the association between use of HTPs and diabetes risk is important for tobacco control policy. METHODS: This cohort study included 29,584 workers (82.5% male; mean age 45.9 [SD=9.9] years) without diabetes at baseline (April 2018-March 2019) from the Japan Epidemiology Collaboration on Occupational Health study. Participants were categorized into the following 5 groups based on their self-reported tobacco use: those who have never smoked, those who formerly smoked, those who smoke cigarettes exclusively, those who use HTPs exclusively, and those who use both cigarettes and HTPs. Incident type 2 diabetes was identified from health checkups conducted from 2019 to 2025. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals. Analyses were conducted in 2025. RESULTS: During 140,797 person-years of follow-up, 2,141 participants developed type 2 diabetes (15.2 per 1,000 person-years). Incidence was higher among those who used tobacco products (18.5-21.7 per 1,000 person-years) than among those who have never smoked (11.3 per 1,000 person-years). Compared with those who have never smoked, those who use HTPs exclusively (hazard ratio [HR]=1.61; 95% CI=1.39, 1.86), those who use both cigarettes and HTPs (HR=1.76; 95% CI=1.48, 2.09), and those who smoke cigarettes exclusively (HR=1.53; 95% CI=1.34, 1.74) had a higher risk of diabetes. Among those who have ever smoked, those who use HTPs exclusively had a comparable risk of diabetes to those who smoke cigarettes exclusively (HR=1.01; 95% CI=0.86, 1.18), suggesting no observable reduction in risk within the follow-up period. Moreover, a dose-response association was observed between daily tobacco product use and the risk of diabetes across all tobacco use groups. CONCLUSIONS: Among those who use HTPs exclusively, most of whom had a prior history of cigarette smoking, HTP use was not associated with a lower risk of type 2 diabetes compared with smoking cigarettes exclusively during the follow-up period. As the findings cannot distinguish whether the elevated risk reflects an independent effect of HTP use or residual effects of prior cigarette exposure, longer follow-up is needed to evaluate whether diabetes risk differs over time between those who use HTPs and those who smoke cigarettes.
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,300
Awards: G1894528168, G1901034624, G2112411051, Development of diabetec risk score and study on the association with blood nutrients among workers, G3009749969, Workplace multicenter study on the use of heated tobacco products and its health effect among employees, G4644069065, The physical and mental effects of heated tobacco products, G834566351, Brain-derived neurotrophic factor as predictor of depression, and dietary and nutritional factors in a Japanese working population, Development of risk scores for cardiovascular events and serious diseases among workers
OpenAlex ID: W7152042472