Use of Heated Tobacco Products Tied to Increased Risk of Type 2 Diabetes: Study
Japan: Exclusive use of heated tobacco products was associated with an increased risk of developing type 2 diabetes compared with never smoking. Importantly, individuals who used only heated tobacco products—most of whom were former cigarette smokers—did not have a lower risk of type 2 diabetes than those who exclusively smoked conventional cigarettes. These findings suggest that switching from cigarettes to heated tobacco products may not lessen diabetes risk.
Published in the American Journal of Preventive Medicine, the study by Huan Hu and colleagues investigated whether heated tobacco product (HTP) use is associated with the risk of developing type 2 diabetes.
The researchers analyzed data from 29,584 diabetes-free workers enrolled in the Japan Epidemiology Collaboration on Occupational Health study. Participants were classified according to tobacco use status, and incident cases of type 2 diabetes were identified through health checkups conducted between 2019 and 2025.
Over 140,797 person-years of follow-up, 2,141 participants developed type 2 diabetes. The incidence of diabetes was notably higher among users of tobacco products than among individuals who had never smoked. Compared with never smokers, exclusive HTP users had a 61% higher risk of developing type 2 diabetes. Similarly, dual users of cigarettes and HTPs had a 76% higher risk, while exclusive cigarette smokers had a 53% higher risk.
Key findings from the study included:
- Exclusive HTP use was associated with a significantly increased risk of type 2 diabetes compared with never smoking.
- Individuals who used both cigarettes and HTPs had the highest diabetes risk among the tobacco-use groups.
- Exclusive cigarette smoking was also linked to a substantially elevated risk of diabetes.
- Among people with a history of smoking, exclusive HTP users had a diabetes risk comparable to that of exclusive cigarette smokers.
- A dose-response relationship was observed, with greater daily tobacco product use associated with higher diabetes risk across all tobacco-use groups.
The researchers noted that it remains unclear whether the elevated diabetes risk is due to heated tobacco product use itself or the lingering effects of prior cigarette smoking, as most HTP users were former smokers.
The study was limited by self-reported tobacco use, potential residual confounding, and a predominantly male workforce from a single Japanese company, which may affect the broader applicability of the findings.
Overall, exclusive HTP users did not have a lower risk of type 2 diabetes than exclusive cigarette smokers. The authors called for longer-term studies to determine whether diabetes risk changes over time after switching from conventional cigarettes to heated tobacco products.
Reference:
Hu, H., Nakagawa, T., Honda, T., Yamamoto, S., Konishi, M., & Mizoue, T. (2026). Association of Heated Tobacco Product Use With Risk of Type 2 Diabetes. American Journal of Preventive Medicine, 71(3), 108368. https://doi.org/10.1016/j.amepre.2026.108368
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