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Unlike Cigarettes, Use of Swedish "Snus" Smokeless Tobacco Does Not Increase Diabetes Risk

Influence of Smoking and Snus on the Prevalence and Incidence of Type 2 Diabetes Amongst Men: the Northern Sweden MONICA study. Published in the Journal of Internal Medicine, Volume 256, pages 101-110, August 2004. By Mats Eliasson, Kjell Asplund, Salmir Nasic and Brad Rodu. (UAB TRF)

Cigarette smoking has been a known risk factor for adult-onset (Type 2) diabetes in men since the late 1980s. But unanswered was the question, Are users of smokeless tobacco also at increased risk for diabetes? Newly published research, focusing on large numbers of Swedes who use smokeless tobacco in the form of moist snuff, called snus, answers that question with a resounding “No”.

“The risk of diabetes for snus users was not significantly increased,” wrote three Swedish university researchers and their U.S. co-author, Dr. Brad Rodu, Professor of Pathology at the University of Alabama at Birmingham School of Medicine, in the August 2004 issue of the Journal of Internal Medicine. Their article looks at the frequency of adult-onset diabetes among tobacco users.

At the time subjects enrolled in the study, diabetes was diagnosed 1.6 to 1.8 times as often in current or former smokers as in nonusers of tobacco. In contrast, diabetes was diagnosed no more often among current or former snus users than those who never used tobacco in any form.

Over a period of nearly nine years following their enrollment, smokers developed diabetes at 4.6 times the frequency of nonusers of tobacco; ex-smokers developed the disease at 3.1 times nonusers. But in a remarkable contrast, there were no new cases of diabetes among snus users. All results were adjusted for age, weight gain, physical activity and alcohol consumption.

The new research confirms previous observations that smoking is a risk factor for adult-onset diabetes, and it reveals for the first time that snus use is not a risk factor.

Dr. Rodu noted, “This is the first population-based, cross-sectional and longitudinal study of the influence of smokeless tobacco use, in the form of snus, on the occurrence of diabetes. The results add to the scientific evidence that smokeless tobacco is vastly safer than cigarettes with regard to virtually every facet of health, including cancer, heart disease, lung problems and metabolic disorders like diabetes. This research removes the smokescreen that has for decades obscured from consumers the fact that smokeless tobacco is an excellent alternative for inveterate cigarette smokers who are desperate to quit but irreversibly addicted to nicotine.”

The researchers used data from the northern Sweden component of the World Health Organization Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases (MONICA) study. Data was collected from 3,384 men in four surveys from 1986 to 1999. Follow-up information on about 70 percent of participants was collected in 1999.

Dr. Rodu received support from the Tobacco Research Fund (UAB TRF).

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