Differential Associations Between Smoking, E-Cigarette Use, and Diabetes Prevalence

Background: Cigarette smoking is a well-established risk factor for diabetes, but the relationship between ecigarette use and diabetes remains uncertain. Evidence to date has been drawn almost entirely from North America and Asia, with little information from European populations. Methods: We conducted a cross-sectional study of 17,854 adults aged 16 years and older from the 2017, 2018, 2019, and 2021 waves of the nationally representative Scottish Health Survey. Diabetes status was based on selfreport of doctor-diagnosed diabetes. Participants were classified into six mutually exclusive categories of smoking and e-cigarette use: never users of either cigarettes or e-cigarettes, ex-smokers (former smokers who never used e-cigarettes), current exclusive cigarette smokers, current exclusive e-cigarette users, current dual users, and former e-cigarette users. Weighted prevalence estimates and survey-weighted binary logistic regression models were used to examine associations, adjusting for