title: Cigarette smoking, oral moist snuff use and glucose intolerance.
abstract: OBJECTIVE
  To investigate the association between cigarette smoking and use of oral moist snuff and impaired glucose tolerance and type 2 diabetes.
  
  
  METHODS
  We performed a population-based cross-sectional study of glucose intolerance and tobacco use in Stockholm during 1992-94. The sample consisted of 3128 men, aged 35-56 years, of whom 52% had a family history of diabetes. In an oral glucose tolerance test, we detected 55 men with type 2 diabetes and 172 with impaired glucose tolerance. Information on cigarette smoking and oral moist snuff use was collected by a questionnaire.
  
  
  RESULTS
  The odds ratio of type 2 diabetes was increased for smokers of 25+ cigarettes day-1 (odds ratio = 2.6, 95% confidence interval = 1.1-5.9) as well as for moist snuff dippers of 3+ boxes week-1 (odds ratio = 2.7, 95% confidence interval = 1.3-5.5). The odds ratio of relatively high (highest tertile) fasting insulin levels in subjects with impaired glucose tolerance associated with cigarette smoking of 25+ cigarettes day-1 was 1.5 (95% confidence interval = 0.7-3.6). The corresponding estimate of a relatively low (lowest tertile) 2 h insulin response was 2.5 (95% confidence interval = 0.9-7.1).
  
  
  CONCLUSIONS
  These results indicate that heavy users of cigarettes or moist snuff have an increased risk of type 2 diabetes. The results could suggest that tobacco use is associated with a low insulin response.
authors.affiliation: Division of Epidemiology, Karolinska Hospital, Stockholm County Council, Karolinska Institutet, Stockholm, Sweden.
authors.forename: P G
authors.initials: PG
authors.lastname: Persson
authors.forename: S
authors.initials: S
authors.lastname: Carlsson
authors.forename: L
authors.initials: L
authors.lastname: Svanström
authors.forename: C G
authors.initials: CG
authors.lastname: Ostenson
authors.forename: S
authors.initials: S
authors.lastname: Efendic
authors.forename: V
authors.initials: V
authors.lastname: Grill
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000503:physiopathology; D018149:Glucose Intolerance / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010947:Plants, Toxic; D012307:Risk Factors; D012907:Smoking / Q000503:physiopathology*; D014030:Tobacco, Smokeless / Q000009:adverse effects*