Is it true that smoking electronic cigarettes and vapes with sweet flavors leads to diabetes?

There is widespread concern that nicotine-containing liquids with sweet flavors can trigger diabetes in smokers. We decided to check whether this point of view is supported by scientific data.

They write about the connection between smoking e-cigarettes and the development of diabetes with links to scientists Lenta.ru, "Moskovsky Komsomolets", "News» and other media. Particularly dangerous as reported, liquids with a sweet taste: “When the aerosol enters the body, it causes resistance (immunity) to insulin, which causes a jump in blood sugar levels.” Indicated Also, sweet flavors make e-cigarettes attractive to teenagers. People with diabetes on forums note, that “sweet fruity” liquids affect sugar levels, and on some vaping sites, on the contrary, emphasizedthat compared to regular cigarettes, vaping is much safer for diabetics and even “reduces risk of developing prediabetes." 

To understand whether there is a connection between sweet refills for electronic cigarettes and diabetes, you first need to define what is meant by electronic cigarettes in principle. There are many ways to consume nicotine: chewing tobacco, using nicotine buccally (that is, by placing it between the mucous membrane of the inner surface of the cheek and gums with teeth - for example, using snus), smoking regular cigarettes, using tobacco heating systems (for example, IQOS or Glo), as well as inhaling heated steam, containing or not containing nicotine. Electronic cigarettes come in disposable form and with replaceable cartridges, and based on the amount of vapor they are usually divided into electronic cigarettes and vapes. At the same time, the liquids that are used to refill electronic disposable cigarettes and those produced for home refilling of cartridges and vapes are similar in composition. After studying samples of 54 such liquids, including those manufactured or sold in other countries, German scientists determined the main substances contained in them, in addition to nicotine: glycerin, propylene glycol and ethylene glycol. Also found in some liquids were butanediol, propanediol, diethylene glycol, menthol, ethylvanillin, coumarin, camphor, safrole and thujone.

By information WHO, more than 422 million people in the world suffer from diabetes and about 1.5 million die every year directly due to this disease. According to data According to the Federal Register of Diabetes Mellitus of the Russian Federation at the beginning of 2023, almost 5 million people in Russia had diabetes (more than 3% of the population). 

Diabetes mellitus is not a separate disease, but a common one Name for a group of disorders in the endocrine system that are associated with failures in the processing of glucose. These disorders occur due to a lack of insulin and lead to a constant increase in blood sugar levels - hyperglycemia. The two most common types of diabetes are: first type, the body is not able to produce enough insulin, and with second - cannot use it effectively due to insulin resistance. There are other varieties - for example, LADA (latent autoimmune diabetes of adults) or gestational (diabetes in pregnant women). In diagnostic criteria The American Diabetes Association lists more than ten forms of diabetes, as well as related disorders and medications that can trigger the development of the disease.

Type 1 diabetes is caused by the destruction of beta cells in the pancreas, which are normally responsible for producing insulin. This can be caused by various factors, but key Heredity plays a role. For example, if both parents have diabetes, there is a 25% chance that their child will also have the disease. Revealed more than ten genes and their combinations that predispose to it. There are hypotheses that some viruses (in particular, cytomegalovirus, virus mumps, rotavirus And coxsackievirus) can initiate type 1 diabetes. Research also showthat the risk of its development depends on the place of residence (the further a person lives from the equator, the higher it is) and age (children aged 4 to 7 years and from 10 to 14 years are more susceptible to diabetes). In addition, it has been proven that certain chemicals can damage the beta cells of the pancreas, which contributes to the development of the disease. Among such connections are pyrinuron, previously used as a rodent control agent, antitumor drug streptozocin, alloxan, previously approved in the cosmetics industry, chemical reagents dithizone And dialuric acid. In the modern world they are not used in food, nicotine or cosmetic products. Substances commonly found in e-liquids also do not by themselves destroy beta cells in the pancreas, which produce insulin, meaning there is no link between vaping and type 1 diabetes.

Type 2 diabetes is usually manifests itself in adulthood, but recently it has also been diagnosed in children. Major risk factors include excess weight and obesity, lack of exercise activity, age over 45 years, arterial hypertension, nonequilibrium level cholesterol (low levels of good cholesterol and high levels of bad), as well as the presence of diabetes in parents. There is also evidence that depression or syndrome PCOS may also increase the risk of developing this form of diabetes.

Gestational diabetes, in turn, occurs in pregnant women due to an increase in the production of sex hormones and the hormone cortisol, which can reduce the effectiveness of insulin. LADA-diabetes is an autoimmune disease in which the immune system attacks the beta cells of the pancreas, which are responsible for producing insulin. MODY-diabetes manifests itself due to a genetic mutation, as a result of which pancreatic cells do not produce enough insulin.

None of the types of diabetes are associated with the consumption of sweets as such, but excess calories from such foods (as well as calories from any other) can lead to excess weight and, as a result, the development of type 2 diabetes. When smoking electronic cigarettes, no calories enter the body, so the sweet taste of the liquid for such nicotine consumption systems cannot in itself become a predisposing factor. In this context, there is no difference between a raspberry cheesecake-flavored liquid and a celery-flavored liquid. In principle, calories cannot enter the body by inhaling anything. 

Although there is no relationship with the taste of the liquid, this does not mean that smoking e-cigarettes has nothing to do with diabetes. In 2022, a team of scientists from the Institute of Global Health and Development (China), together with colleagues from the American Johns Hopkins University found outthat the risk of prediabetes (a condition where blood sugar levels are persistently elevated but not yet high enough to warrant a diagnosis of diabetes) is associated with smoking. For those who smoke only e-cigarettes, it is 54% higher, while for those who smoke both e-cigarettes and regular cigarettes, it is only 14%. Earlier, in 2020, a group of Polish researchers came concluded that smoking e-cigarettes does not affect the development of insulin resistance, but may increase glucose levels, promote the development of abdominal obesity and increase blood pressure - all of which, in turn, increase the risk of developing type 2 diabetes. Experiments on rats showthat e-liquid aerosol (both with and without nicotine) causes greater disturbances in glucose metabolism than pure nicotine (administered by intraperitoneal injection to rats). By observations According to Romanian experts, the level of low-density lipoproteins (bad cholesterol) in e-cigarette smokers is higher compared to non-smokers than in the same comparison between “traditional” smokers and non-smokers. In turn, American scientists, having studied a sample from the National Health and Nutrition Research Program, identified relationship between smoking e-cigarettes and the risk of developing insulin resistance, noting that there is insufficient data to draw a connection between smoking-induced tolerance to this hormone and the further development of diabetes. However, in all studies, the authors note that it has not yet been possible to establish the mechanism by which e-liquids affect the above parameters. It is also not yet possible to indicate which substance or combination of substances in such mixtures triggers these reactions. 

Thus, although being overweight and consuming excess calories, including from sweets, significantly increases the risk of type 2 diabetes, the sweet taste of e-liquid itself has no effect on the likelihood of developing the disease. In terms of calorie content, both the raspberry cheesecake flavored liquid and the celery flavored liquid are the same - they have no energy value at all. However, studies and population observations show that consumption of e-cigarettes of any flavor can increase glucose and bad cholesterol levels, the risk of arterial hypertension and abdominal obesity. In turn, they all affect the risk of developing diabetes. While scientists have yet to find out why exactly this is happening, it is already clear that in this sense, electronic cigarettes can hardly be considered a safe replacement for traditional ones.

Cover image: Image by haiberliu from Pixabay

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