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Adults who were exposed to tobacco at an early age may have an increased risk for type 2 diabetes. Jeffrey Glas/Getty Images
  • A study has found a link between tobacco exposure early in life and increased type 2 diabetes risk.
  • Having a high genetic risk for type 2 diabetes made the risk even greater.
  • Experts say it could be that tobacco somehow alters cellular insulin response.
  • Nicotine replacement therapy and medications can make it easier to quit smoking.
  • Other resources include counseling, support groups, apps, and online programs.

According to preliminary research to be presented at the American Heart Association’s Epidemiology and Prevention│Lifestyle and Cardiometabolic Health Scientific Sessions 2024, March 18- 21, in Chicago, being exposed to tobacco while still in the mother’s womb was associated with the later development of type 2 diabetes as an adult.

Being exposed to tobacco during childhood or adolescence was also linked to greater risk.

Those people with a high genetic risk for type 2 diabetes were especially prone to developing the condition.

Smoking as an adult is a known risk factor for type 2 diabetes, according to the U.S. Centers for Disease Control and Prevention. In fact, people who smoke are 30% to 40% more likely to develop this condition than non-smokers.

However, senior study author Victor Wenze Zhong, PhD, stated in a press release that it is not known whether tobacco exposure prior to adulthood can impact whether a person goes on to develop type 2 diabetes.

It is also unclear how having a genetic predisposition to type 2 diabetes might interact with smoking.

Their goal was to help answer these questions.

To perform the study, Zhong and his team of researchers examined data from almost 476,000 adults from the UK Biobank.

The UK Biobank is a large database of medical data for around 500,000 adults living in the United Kingdom who have accessed health care via the National Health Service (NHS).

The collected data was used to estimate the association between prenatal tobacco exposure and beginning smoking during childhood (ages 5–14 years) or adolescence (ages 15–17 years) with subsequent development of type 2 diabetes as an adult.

Polygenic risk scores were used to determine any potential interactions between the study participants’ early tobacco exposure and their genetic vulnerability to develop type 2 diabetes.

The scientists also looked into whether the individuals engaged in healthy behaviors — such as eating well, exercising, getting enough sleep, and abstaining from smoking — that may have influenced the development of type 2 diabetes among those at high risk.

They found that people who were exposed to tobacco before birth had a 22% greater risk for type 2 diabetes when compared to those who had never smoked.

Additionally, those who started smoking as children had twice the risk, while those who started during adolescence had a 57% higher risk.

Also, those who didn’t start smoking until adulthood had a 33% greater risk.

In comparison to those with low genetic risk and no early exposure to tobacco, those individuals who had a high genetic risk score had a 330% higher risk of developing diabetes if they were exposed to tobacco prior to birth, a 639% higher risk if they started smoking in childhood, and a 427% higher risk if they started smoking during adolescence.

However, in those with early tobacco exposure and high genetic risk, following a healthy lifestyle as an adult appeared to mitigate the risk, reducing it by 67% to 81%.

Nicole Renee Sparks, PhD, who is an environmental toxicology researcher and an assistant professor at the UC Irvine Program in Public Health in the Department of Environmental and Occupational Health, explained that the underlying mechanisms between cigarette smoking and diabetes are “complex and not well understood.”

“Some studies suggest that nicotine and other major components of tobacco play a strong role in changing cellular response to insulin, causing an insulin deficiency,” she said.

“Without insulin, the body cannot keep blood sugar levels down in a normal range, thus speeding up the process of developing diabetes.”

Sparks further noted that the prenatal period and early childhood are crucial times during organ and cognitive development.

“Prenatal toxicant exposure, like cigarette smoke, can show adverse health problems throughout life,” she stated. “It is plausible that the cells that produce insulin, pancreatic beta (β) cells, could undergo changes due to exposure, such as cell death or epigenetic changes that lead to inhibited insulin secretion.”

Sparks concluded by saying that obesity is often linked with type 2 diabetes, and it has been shown that children of mothers who smoke have increased fat cells.

John Lowe, MD, an obesity medicine specialist with Restore Care Wellness Clinic, said, “Quitting smoking is challenging, but it’s crucial for improving overall health and reducing the risk of chronic diseases like type 2 diabetes.”

Fortunately, there are several different resources available to support you, he added, including:

  • Nicotine replacement therapy (NRT). This includes such options as patches, gum, and lozenges. They can help manage withdrawal symptoms by providing you with small amounts of nicotine without many of the harmful effects of smoking.
  • Prescription medications. Drugs like bupropion and varenicline can help reduce cravings as well as withdrawal symptoms.
  • Behavioral counseling and support groups. These resources can provide you with guidance and encouragement from trained professionals and your peers.
  • Mobile apps and online programs. Apps and online programs can give you personalized quit plans, tracking tools, and motivational support.

Lowe concluded by saying, “It’s essential for individuals to find a quitting method that works best for them and to seek support from healthcare providers, counselors, or quitlines.

“Remember, quitting smoking is a journey, and every step towards a smoke-free life is a significant achievement,” he advised.

New preliminary research has found that prenatal, childhood, and adolescent tobacco exposure is associated with a greater risk for the development of type 2 diabetes in adulthood.

Also, having a high genetic predisposition for type 2 diabetes is linked with even greater risk.

It is not clear why smoking might increase risk. However, it could be that exposure to tobacco somehow alters how cells respond to insulin.

Nicotine-replacement therapy and medications like bupropion and varenicline can make it easier to quit smoking and reduce your risk for diabetes.

Behavioral counseling, support groups, mobile apps, and online programs are helpful resources as well.