Switching to E-Cigarettes After Type 2 Diabetes Diagnosis and Health Outcomes

Use of electronic cigarettes has increased, partly driven by the perception that they may serve as a "harm-reduction" alternative to combustible cigarettes. Evidence cited in prior work includes higher cessation rates versus nicotine replacement therapy in a randomized trial and reductions in biomarkers of potential harm after switching from combustible cigarettes to e-cigarettes; observational data in high-risk PCI populations have also suggested lower MACCE risk after switching. However, constituents such as nicotine and heavy metals may adversely affect diabetes management, and most prior studies have emphasized potential harms of e-cigarette use itself. As a result, whether switching from combustible cigarettes to e-cigarettes confers a harm-reduction benefit in patients with diabetes remains uncertain. In this regards, the current study evaluated clinical outcomes associated with switching from combustible cigarettes to e-cigarettes in patients with diabetes and to assess whether the degree of switching (partial vs full transition) modifies the risk of adverse clinical events.

Inclusion criteria

• Patients diagnosed with diabetes who reported being a "current smoker" at a health examination within the 4 years prior to the diabetes diagnosis.

Exclusion criteria

• age <40 years or ≥75 years
• Pre-existing AMI before diabetes diagnosis
• Pre-existing Revascularization before diabetes diagnosis
• Pre-existing diabetes complications before diabetes diagnosis
• Pre-existing cancer before diabetes diagnosis
• Death within 6 months of the first health examination after diabetes diagnosis
• Cancer within 6 months of the first health examination after diabetes diagnosis