{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T10:52:16Z","timestamp":1788000736199,"version":"build-2784847793"},"reference-count":50,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T00:00:00Z","timestamp":1781308800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T00:00:00Z","timestamp":1781308800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100020307","name":"Azienda Ospedaliero-Universitaria Citt\u00e0 della Salute e della Scienza di Torino","doi-asserted-by":"publisher","award":["Ministero dell\u2019Universita\u0300 e della Ricerca (MUR) Bando PNRR 341\/2022 (Heal Italy-CUP E63C22002080006)."],"award-info":[{"award-number":["Ministero dell\u2019Universita\u0300 e della Ricerca (MUR) Bando PNRR 341\/2022 (Heal Italy-CUP E63C22002080006)."]}],"id":[{"id":"10.13039\/501100020307","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Intern Emerg Med"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Electronic cigarette (e-cigarette) use has grown rapidly worldwide, yet metabolic health consequences, particularly glycaemic outcomes, remain poorly understood. This systematic review and meta-analysis synthesises the available epidemiological evidence on the association between e-cigarette use and diabetes mellitus, prediabetes, and insulin resistance. We conducted a systematic search of PubMed, Scopus and Embase from inception through December 2025, following PRISMA 2020 guidelines. Studies reporting effect estimates for the association between e-cigarette use and diabetes, prediabetes, or insulin resistance in adult populations were eligible. Random-effects meta-analyses were performed, stratified by outcome and exposure category (current exclusive e-cigarette users, dual users, and former e-cigarette users versus never users). Heterogeneity was assessed using I\n                    <jats:sup>2<\/jats:sup>\n                    statistics and Cochran\u2019s Q test. Ten studies (9 cross-sectional, 1 prospective cohort; combined participants exceeding 2.8 million) met inclusion criteria; 8 cross-sectional studies contributed to quantitative pooling, while one cross-sectional study and the prospective cohort were narratively synthesised. For prediabetes, pooled ORs versus never users were 1.34 (95% CI 1.01\u20131.77;\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200974.2%) for current exclusive users, 1.26 (1.06\u20131.49;\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200975.4%) for dual users, and 1.13 (1.06\u20131.20;\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090%) for former users. For diabetes, only dual users showed a significant elevation (OR 1.23; 1.01\u20131.49;\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200977.4%); current exclusive (OR 1.04; 0.93\u20131.16;\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200945.1%) and former users (OR 1.11; 0.80\u20131.54;\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200931.6%) did not differ from never users. For insulin resistance, current exclusive e-cigarette users versus never users had an OR of 1.37 (95% CI 1.06\u20131.77;\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090%). The sole prospective cohort study found no significant association between exclusive e-cigarette use and incident type 2 diabetes (HR 0.88; 95% CI 0.66\u20131.16). Neither cross-sectional nor prospective evidence linked exclusive e-cigarette use to diabetes; significant associations were confined to dual users. Elevated odds of prediabetes and insulin resistance among exclusive users were observed cross-sectionally but cannot support causal claims. Large prospective studies with longer follow-up, objective verification of product exposure status (for example, biomarkers distinguishing exclusive vaping from combustible tobacco use), and standardised laboratory-based glycaemic endpoints are needed.\n                  <\/jats:p>","DOI":"10.1007\/s11739-026-04430-x","type":"journal-article","created":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T05:34:21Z","timestamp":1781328861000},"page":"1879-1893","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Association between electronic cigarette use and prediabetes, diabetes, and insulin resistance: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2381-0984","authenticated-orcid":false,"given":"Yusuff Adebayo","family":"Adebisi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Campagna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Ceriello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anas Ali","family":"Alhur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najim Z.","family":"Alshahrani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anoop","family":"Misra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul","family":"Basit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Russo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadej","family":"Battelino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noel","family":"Somasundaram","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Yazid","family":"Jalaludin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshifumi","family":"Saisho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Walicka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venera","family":"Tomaselli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dianna J.","family":"Magliano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Othmar","family":"Moser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Mitri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Polosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,13]]},"reference":[{"key":"4430_CR1","doi-asserted-by":"publisher","first-page":"100257","DOI":"10.1016\/j.gloepi.2026.100257","volume":"11","author":"T Jerzy\u0144ski","year":"2025","unstructured":"Jerzy\u0144ski T, Mzhavanadze G, Stimson GV (2025) Estimation of the global number of nicotine vapers in 2025. Glob Epidemiol 11:100257. https:\/\/doi.org\/10.1016\/j.gloepi.2026.100257","journal-title":"Glob Epidemiol"},{"key":"4430_CR2","doi-asserted-by":"publisher","first-page":"134567","DOI":"10.1016\/j.scitotenv.2019.134567","volume":"703","author":"YJ Lee","year":"2020","unstructured":"Lee YJ, Na CJ, Botao L, Kim KH, Son YS (2020) Quantitative insights into major constituents contained in or released by electronic cigarettes: Propylene glycol, vegetable glycerin, and nicotine. Sci Total Environ 703:134567. https:\/\/doi.org\/10.1016\/j.scitotenv.2019.134567","journal-title":"Sci Total Environ"},{"issue":"7","key":"4430_CR3","doi-asserted-by":"publisher","first-page":"2017","DOI":"10.1007\/s11739-025-04014-1","volume":"20","author":"YA Adebisi","year":"2025","unstructured":"Adebisi YA, Jimoh ND, Ngoma C (2025) \u2018E-cigarette smoking\u2019 is a misleading term: a critical review of its use in academic literature. Intern Emerg Med 20(7):2017\u20132027. https:\/\/doi.org\/10.1007\/s11739-025-04014-1","journal-title":"Intern Emerg Med"},{"issue":"1","key":"4430_CR4","doi-asserted-by":"publisher","first-page":"24182","DOI":"10.1038\/s41598-021-03310-y","volume":"11","author":"M Caruso","year":"2021","unstructured":"Caruso M, Emma R, Distefano A, Rust S, Poulas K, Zadjali F, Giordano A, Volarevic V, Mesiakaris K, Al Tobi M, Boffo S, Arsenijevic A, Zuccarello P, Giallongo C, Ferrante M, Polosa R, Li Volti G, Replica Project Group (2021) Electronic nicotine delivery systems exhibit reduced bronchial epithelial cells toxicity compared to cigarette: the Replica Project. Sci Rep 11(1):24182. https:\/\/doi.org\/10.1038\/s41598-021-03310-y","journal-title":"Sci Rep"},{"issue":"1","key":"4430_CR5","doi-asserted-by":"publisher","first-page":"17859","DOI":"10.1038\/s41598-023-44626-1","volume":"13","author":"R Emma","year":"2023","unstructured":"Emma R, Fuochi V, Distefano A, Partsinevelos K, Rust S, Zadjali F, Al Tobi M, Zadjali R, Alharthi Z, Pulvirenti R, Furneri PM, Polosa R, Sun A, Caruso M, Li Volti G, Replica Project Group (2023) Cytotoxicity, mutagenicity and genotoxicity of electronic cigarettes emission aerosols compared to cigarette smoke: the REPLICA project. Sci Rep 13(1):17859. https:\/\/doi.org\/10.1038\/s41598-023-44626-1","journal-title":"Sci Rep"},{"key":"4430_CR6","doi-asserted-by":"publisher","first-page":"1433626","DOI":"10.3389\/fchem.2024.1433626.Izquierdo","volume":"12","author":"RA Sussman","year":"2024","unstructured":"Sussman RA, Sipala FM, Ronsisvalle S, Soulet S (2024) Analytical methods and experimental quality in studies targeting carbonyls in electronic cigarette aerosols. Front Chem 12:1433626. https:\/\/doi.org\/10.3389\/fchem.2024.1433626.Izquierdo","journal-title":"Front Chem"},{"issue":"6","key":"4430_CR7","doi-asserted-by":"publisher","first-page":"1671","DOI":"10.1007\/s11739-025-04057-4","volume":"20","author":"R Polosa","year":"2025","unstructured":"Polosa R, Rodu B, Farsalinos K (2025) Health effects of e-cigarettes, heated tobacco, and oral nicotine products. Intern Emerg Med 20(6):1671\u20131673. https:\/\/doi.org\/10.1007\/s11739-025-04057-4","journal-title":"Intern Emerg Med"},{"issue":"6","key":"4430_CR8","doi-asserted-by":"publisher","DOI":"10.3390\/toxics13060470","volume":"13","author":"F Petrella","year":"2025","unstructured":"Petrella F, Faverio P, Cara A, Cassina EM, Libretti L, Torto SL, Pirondini E, Raveglia F, Spinelli F, Tuoro A, Perger E, Luppi F (2025) Clinical Impact of Vaping. Toxics 13(6):470. https:\/\/doi.org\/10.3390\/toxics13060470","journal-title":"Toxics"},{"key":"4430_CR9","unstructured":"Magliano DJ, Boyko EJ; IDF Diabetes Atlas 10th edition scientific committee . IDF DIABETES ATLAS [Internet]. 10th edition. Brussels: International Diabetes Federation; 2021. Chapter 3, Global picture. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK581940\/"},{"issue":"6","key":"4430_CR10","doi-asserted-by":"publisher","first-page":"869","DOI":"10.2174\/1871530320666200217123901","volume":"20","author":"S Mukharjee","year":"2020","unstructured":"Mukharjee S, Bank S, Maiti S (2020) Chronic Tobacco Exposure by Smoking Develops Insulin Resistance. Endocrine, Metabolic & Immune Disorders 20(6):869\u2013877. https:\/\/doi.org\/10.2174\/1871530320666200217123901","journal-title":"Endocrine, Metabolic & Immune Disorders"},{"issue":"6","key":"4430_CR11","doi-asserted-by":"publisher","first-page":"422","DOI":"10.4239\/wjd.v13.i6.422","volume":"13","author":"M Walicka","year":"2022","unstructured":"Walicka M, Russo C, Baxter M, John I, Caci G, Polosa R (2022) Impact of stopping smoking on metabolic parameters in diabetes mellitus: A scoping review. World J Diabetes 13(6):422\u2013433. https:\/\/doi.org\/10.4239\/wjd.v13.i6.422","journal-title":"World J Diabetes"},{"key":"4430_CR12","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1186\/s13098-019-0482-2","volume":"11","author":"D Campagna","year":"2019","unstructured":"Campagna D, Alamo A, Di Pino A et al (2019) Smoking and diabetes: dangerous liaisons and confusing relationships. Diabetol Metab Syndr 11:85. https:\/\/doi.org\/10.1186\/s13098-019-0482-2","journal-title":"Diabetol Metab Syndr"},{"issue":"4","key":"4430_CR13","doi-asserted-by":"publisher","DOI":"10.1111\/1753-0407.70215","volume":"18","author":"YA Adebisi","year":"2026","unstructured":"Adebisi YA, Misra A, Polosa R (2026) Smoking Cessation Inertia in Diabetes Care. J Diabetes 18(4):e70215. https:\/\/doi.org\/10.1111\/1753-0407.70215","journal-title":"J Diabetes"},{"issue":"12","key":"4430_CR14","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(15)00316-2","volume":"3","author":"A Pan","year":"2015","unstructured":"Pan A, Wang Y, Talaei M, Hu FB, & Wu T (2015) Relation of active, passive, and quitting smoking with incident type 2 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 3(12):958\u2013967. https:\/\/doi.org\/10.1016\/S2213-8587(15)00316-2","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"7","key":"4430_CR15","first-page":"2164","volume":"10","author":"C Chen","year":"2018","unstructured":"Chen C, Tu YQ, Yang P, Yu QL, Zhang S, Xiong F, Wang CY (2018) Assessing the impact of cigarette smoking on \u03b2-cell function and risk for type 2 diabetes in a non-diabetic Chinese cohort. Am J Transl Res 10(7):2164\u20132174","journal-title":"Am J Transl Res"},{"key":"4430_CR16","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.trsl.2017.02.004","volume":"184","author":"J Maddatu","year":"2017","unstructured":"Maddatu J, Anderson-Baucum E, Evans-Molina C (2017) Smoking and the risk of type 2 diabetes. Transl Res 184:101\u2013107. https:\/\/doi.org\/10.1016\/j.trsl.2017.02.004","journal-title":"Transl Res"},{"issue":"7","key":"4430_CR17","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1016\/j.tem.2012.03.006","volume":"23","author":"JO Tweed","year":"2012","unstructured":"Tweed JO, Hsia SH, Lutfy K, Friedman TC (2012) The endocrine effects of nicotine and cigarette smoke. Trends Endocrinol Metab 23(7):334\u2013342. https:\/\/doi.org\/10.1016\/j.tem.2012.03.006","journal-title":"Trends Endocrinol Metab"},{"key":"4430_CR18","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71","author":"MJ Page","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM et al (2021) The prisma statement an updated guideline for reporting systematic reviews. BMJ. https:\/\/doi.org\/10.1136\/bmj.n71","journal-title":"BMJ"},{"key":"4430_CR19","doi-asserted-by":"publisher","first-page":"107692","DOI":"10.1016\/j.drugalcdep.2019.107692","volume":"205","author":"NC Atuegwu","year":"2019","unstructured":"Atuegwu NC, Perez MF, Oncken C, Mead EL, Maheshwari N, Mortensen EM (2019) E-cigarette use is associated with a self-reported diagnosis of prediabetes in never cigarette smokers: Results from the behavioral risk factor surveillance system survey. Drug Alcohol Depend 205:107692\u2013107692. https:\/\/doi.org\/10.1016\/j.drugalcdep.2019.107692","journal-title":"Drug Alcohol Depend"},{"issue":"6","key":"4430_CR20","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1016\/j.amepre.2021.12.009","volume":"62","author":"Z Zhang","year":"2016","unstructured":"Zhang Z, Jiao Z, Blaha MJ et al (2016) The Association Between E-Cigarette Use and Prediabetes: Results From the Behavioral Risk Factor Surveillance System, 2016\u20132018. Am J Prev Med 62(6):872\u2013877. https:\/\/doi.org\/10.1016\/j.amepre.2021.12.009","journal-title":"Am J Prev Med"},{"key":"4430_CR21","doi-asserted-by":"publisher","first-page":"110948","DOI":"10.1016\/j.drugalcdep.2023.110948","volume":"251","author":"J Cai","year":"2023","unstructured":"Cai J, Bidulescu A (2023) The association between e-cigarette use or dual use of e-cigarette and combustible cigarette and prediabetes, diabetes, or insulin resistance: Findings from the National Health and Nutrition Examination Survey (NHANES). Drug Alcohol Depend 251:110948\u2013110948. https:\/\/doi.org\/10.1016\/j.drugalcdep.2023.110948","journal-title":"Drug Alcohol Depend"},{"key":"4430_CR22","doi-asserted-by":"publisher","first-page":"e2024029","DOI":"10.4178\/epih.e2024029","volume":"46","author":"W Jeong","year":"2024","unstructured":"Jeong W, Kim S (2024) Impact of electronic cigarette use on the increased risk of diabetes: the Korean Community Health Survey. Epidemiol Health 46:e2024029. https:\/\/doi.org\/10.4178\/epih.e2024029","journal-title":"Epidemiol Health"},{"issue":"3","key":"4430_CR23","doi-asserted-by":"publisher","first-page":"100281","DOI":"10.1016\/j.focus.2024.100281","volume":"4","author":"S Neupane","year":"2025","unstructured":"Neupane S, Florkowski WJ, Dhakal C (2025) Heterogeneous association between e cigarette Use and diabetes prevalence among US adults. J AJPM Focus. 4(3):100281. https:\/\/doi.org\/10.1016\/j.focus.2024.100281","journal-title":"J AJPM Focus."},{"issue":"5","key":"4430_CR24","doi-asserted-by":"publisher","first-page":"327","DOI":"10.4082\/kjfm.23.0141","volume":"46","author":"D Lim","year":"2025","unstructured":"Lim D, Choi JI, Kwon RJ et al (2025) Association between e-cigarette smoking and insulin resistance using the triglyceride-glucose index in Korean adults: Korea National Health and Nutrition Examination Survey. Korean J Fam Med 46(5):327\u2013332. https:\/\/doi.org\/10.4082\/kjfm.23.0141","journal-title":"Korean J Fam Med"},{"issue":"12","key":"4430_CR25","doi-asserted-by":"publisher","first-page":"e0226744","DOI":"10.1371\/journal.pone.0226744","volume":"14","author":"OA Orimoloye","year":"2019","unstructured":"Orimoloye OA, Uddin SMI, Chen LC et al (2019) Electronic cigarettes and insulin resistance in animals and humans: Results of a controlled animal study and the national health and nutrition examination survey (NHANES 2013\u20132016). PLoS ONE 14(12):e0226744. https:\/\/doi.org\/10.1371\/journal.pone.0226744","journal-title":"PLoS ONE"},{"issue":"10","key":"4430_CR26","doi-asserted-by":"publisher","first-page":"103331","DOI":"10.1016\/j.dsx.2025.103331","volume":"19","author":"YA Adebisi","year":"2025","unstructured":"Adebisi YA, Ngoma C, Campagna D et al (2025) Differential associations between smoking, e-cigarette use, and diabetes prevalence. Diabetes Metab Syndr Clin Res Rev 19(10):103331\u2013103331. https:\/\/doi.org\/10.1016\/j.dsx.2025.103331","journal-title":"Diabetes Metab Syndr Clin Res Rev"},{"issue":"1","key":"4430_CR27","doi-asserted-by":"publisher","first-page":"e44","DOI":"10.1210\/clinem\/dgab558","volume":"107","author":"SH Kim","year":"2022","unstructured":"Kim SH, Park M, Kim GR, Joo HJ, Jang SI (2022) Association of Mixed Use of Electronic and Conventional Cigarettes and Exposure to Secondhand Smoke With Prediabetes. J Clin Endocrinol Metab 107(1):e44\u2013e56. https:\/\/doi.org\/10.1210\/clinem\/dgab558","journal-title":"J Clin Endocrinol Metab"},{"issue":"9","key":"4430_CR28","doi-asserted-by":"publisher","first-page":"1651","DOI":"10.1093\/ntr\/ntaf067","volume":"27","author":"J Erhabor","year":"2025","unstructured":"Erhabor J, Yao Z, Tasdighi E, Benjamin EJ, Bhatnagar A, Blaha MJE (2025) E-cigarette Use and Incident Cardiometabolic Conditions in the All of Us Research Program. Nicotine Tob Res 27(9):1651\u20131656. https:\/\/doi.org\/10.1093\/ntr\/ntaf067","journal-title":"Nicotine Tob Res"},{"issue":"4","key":"4430_CR29","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1016\/j.diabet.2010.02.004","volume":"36","author":"E Cosson","year":"2010","unstructured":"Cosson E, Hamo-Tchatchouang E, Banu I et al (2010) A large proportion of prediabetes and diabetes goes undiagnosed when only fasting plasma glucose and\/or HbA1c are measured in overweight or obese patients. Diabetes Metab 36(4):312\u2013318. https:\/\/doi.org\/10.1016\/j.diabet.2010.02.004","journal-title":"Diabetes Metab"},{"issue":"6","key":"4430_CR30","doi-asserted-by":"publisher","first-page":"499","DOI":"10.2217\/dmt.15.43","volume":"5","author":"KK Hood","year":"2015","unstructured":"Hood KK, Hilliard M, Piatt G, Ievers-Landis CE (2015) Effective strategies for encouraging behavior change in people with diabetes. Diabetes Manag (Lond) 5(6):499\u2013510","journal-title":"Diabetes Manag (Lond)"},{"issue":"1","key":"4430_CR31","doi-asserted-by":"publisher","first-page":"e20250047","DOI":"10.36416\/1806-3756\/e20250047","volume":"51","author":"RG Figueiredo","year":"2025","unstructured":"Figueiredo RG, Patino CM, Ferreira JC (2025) Cross-sectional studies: understanding applications, methodological issues, and valuable insights. J Bras Pneumol 51(1):e20250047. https:\/\/doi.org\/10.36416\/1806-3756\/e20250047","journal-title":"J Bras Pneumol"},{"issue":"9","key":"4430_CR32","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1093\/ntr\/nty231","volume":"21","author":"ME Piper","year":"2019","unstructured":"Piper ME, Baker TB, Benowitz NL, Kobinsky KH, Jorenby DE (2019) Dual Users Compared to Smokers: Demographics, Dependence, and Biomarkers. Nicotine Tob Res 21(9):1279\u20131284. https:\/\/doi.org\/10.1093\/ntr\/nty231","journal-title":"Nicotine Tob Res"},{"issue":"20","key":"4430_CR33","doi-asserted-by":"publisher","first-page":"1973","DOI":"10.2147\/COPD.S524978.PMID:40547288;PMCID:PMC12182251","volume":"17","author":"CY Kim","year":"2025","unstructured":"Kim CY, Park SH, Seong Y, Choi YJ, Park HJ, Cho JH, Byun MK (2025) Dual Use of Electronic Cigarettes and Cigarettes Elevates Risk of Chronic Obstructive Pulmonary Disease and Mental Health Issues: Insights from a Korean Health Survey. Int J Chron Obstruct Pulmon Dis 17(20):1973\u20131981. https:\/\/doi.org\/10.2147\/COPD.S524978.PMID:40547288;PMCID:PMC12182251","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"issue":"8","key":"4430_CR34","doi-asserted-by":"publisher","first-page":"2151","DOI":"10.1007\/s11739-024-03716-2","volume":"19","author":"YA Adebisi","year":"2024","unstructured":"Adebisi YA, Bafail DA, Oni OE (2024) Prevalence, demographic, socio-economic, and lifestyle factors associated with cigarette, e-cigarette, and dual use: evidence from the 2017\u20132021 Scottish Health Survey. Intern Emerg Med 19(8):2151\u20132165. https:\/\/doi.org\/10.1007\/s11739-024-03716-2","journal-title":"Intern Emerg Med"},{"key":"4430_CR35","doi-asserted-by":"publisher","first-page":"106860","DOI":"10.1016\/j.phrs.2023.106860","volume":"194","author":"Z Chen","year":"2023","unstructured":"Chen Z, Liu XA, Kenny PJ (2023) Central and peripheral actions of nicotine that influence blood glucose homeostasis and the development of diabetes. Pharmacol Res 194:106860. https:\/\/doi.org\/10.1016\/j.phrs.2023.106860","journal-title":"Pharmacol Res"},{"issue":"1","key":"4430_CR36","doi-asserted-by":"publisher","first-page":"53","DOI":"10.2337\/db23-0809","volume":"74","author":"A Hamilton","year":"2025","unstructured":"Hamilton A, Zhang Q, Gao R et al (2025) Nicotinic Signaling Stimulates Glucagon Secretion in Mouse and Human Pancreatic \u03b1-Cells. Diabetes 74(1):53\u201364. https:\/\/doi.org\/10.2337\/db23-0809","journal-title":"Diabetes"},{"issue":"2","key":"4430_CR37","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/j.metabol.2004.08.020","volume":"54","author":"H Yoshikawa","year":"2005","unstructured":"Yoshikawa H, Hellstr\u00f6m-Lindahl E, Grill V (2005) Evidence for functional nicotinic receptors on pancreatic beta cells. Metabolism 54(2):247\u2013254. https:\/\/doi.org\/10.1016\/j.metabol.2004.08.020","journal-title":"Metabolism"},{"issue":"1","key":"4430_CR38","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1007\/s00204-020-02920-1","volume":"95","author":"T Ma","year":"2021","unstructured":"Ma T, Wang X, Li L, Sun B, Zhu Y, Xia T (2021) Electronic cigarette aerosols induce oxidative stress-dependent cell death and NF-\u03baB mediated acute lung inflammation in mice. Arch Toxicol 95(1):195\u2013205. https:\/\/doi.org\/10.1007\/s00204-020-02920-1","journal-title":"Arch Toxicol"},{"key":"4430_CR39","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1016\/j.jhazmat.2017.10.057","volume":"344","author":"J Zhao","year":"2018","unstructured":"Zhao J, Zhang Y, Sisler JD, Shaffer J, Leonard SS, Morris AM, Qian Y, Bello D, Demokritou P (2018) Assessment of reactive oxygen species generated by electronic cigarettes using acellular and cellular approaches. J Hazard Mater 344:549\u2013557. https:\/\/doi.org\/10.1016\/j.jhazmat.2017.10.057","journal-title":"J Hazard Mater"},{"issue":"10","key":"4430_CR40","doi-asserted-by":"publisher","first-page":"320","DOI":"10.3389\/fendo.2019.00320.","volume":"4","author":"J Espinoza-Derout","year":"2019","unstructured":"Espinoza-Derout J, Shao XM, Bankole E, Hasan KM, Mtume N, Liu Y, Sinha-Hikim AP, Friedman TC (2019) Hepatic DNA Damage Induced by Electronic Cigarette Exposure Is Associated With the Modulation of NAD+\/PARP1\/SIRT1 Axis. Front Endocrinol (Lausanne) 4(10):320. https:\/\/doi.org\/10.3389\/fendo.2019.00320.","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"6","key":"4430_CR41","doi-asserted-by":"publisher","first-page":"e3002667","DOI":"10.1371\/journal.pbio.3002667.","volume":"22","author":"BV Ineichen","year":"2024","unstructured":"Ineichen BV, Furrer E, Gr\u00fcninger SL, Z\u00fcrrer WE, Macleod MR (2024) Analysis of animal-to-human translation shows that only 5% of animal-tested therapeutic interventions obtain regulatory approval for human applications. PLoS Biol 22(6):e3002667. https:\/\/doi.org\/10.1371\/journal.pbio.3002667.","journal-title":"PLoS Biol"},{"key":"4430_CR42","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/j.jclinepi.2022.02.011","volume":"146","author":"P Whaley","year":"2022","unstructured":"Whaley P, Piggott T, Morgan RL et al (2022) Biological plausibility in environmental health systematic reviews: a GRADE concept paper. J Clin Epidemiol 146:32\u201346. https:\/\/doi.org\/10.1016\/j.jclinepi.2022.02.011","journal-title":"J Clin Epidemiol"},{"issue":"2","key":"4430_CR43","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1007\/s11739-023-03467-6","volume":"19","author":"A Krysi\u0144ski","year":"2024","unstructured":"Krysi\u0144ski A, Russo C, Campagna D et al (2024) A multicenter prospective randomized controlled trial investigating the effects of combustion-free nicotine alternatives on cardiovascular risk factors and metabolic parameters in individuals with type 2 diabetes who smoke: the DiaSmokeFree study protocol. Intern Emerg Med 19(2):321\u2013332. https:\/\/doi.org\/10.1007\/s11739-023-03467-6","journal-title":"Intern Emerg Med"},{"issue":"15","key":"4430_CR44","doi-asserted-by":"publisher","first-page":"1764","DOI":"10.1093\/eurheartj\/ehaf1010","volume":"47","author":"T M\u00fcnzel","year":"2025","unstructured":"M\u00fcnzel T, Crea F, Rajagopalan S, L\u00fcscher T (2025) Nicotine and the cardiovascular system: unmasking a global public health threat. Eur Heart J 47(15):1764\u20131781. https:\/\/doi.org\/10.1093\/eurheartj\/ehaf1010","journal-title":"Eur Heart J"},{"issue":"12","key":"4430_CR45","doi-asserted-by":"publisher","first-page":"3078","DOI":"10.2337\/db12-1100","volume":"61","author":"M Bajaj","year":"2012","unstructured":"Bajaj M (2012) Nicotine and insulin resistance: when the smoke clears. Diabetes 61(12):3078\u20133080. https:\/\/doi.org\/10.2337\/db12-1100","journal-title":"Diabetes"},{"issue":"4","key":"4430_CR46","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1111\/j.1365-2796.1993.tb00680.x","volume":"233","author":"S Attvall","year":"1993","unstructured":"Attvall S, Fowelin J, Lager I, Von Schenck H, Smith U (1993) Smoking induces insulin resistance--a potential link with the insulin resistance syndrome. J Intern Med 233(4):327\u2013332. https:\/\/doi.org\/10.1111\/j.1365-2796.1993.tb00680.x","journal-title":"J Intern Med"},{"key":"4430_CR47","doi-asserted-by":"publisher","first-page":"31315024","DOI":"10.1016\/j.mce.2019.110507","volume":"495","author":"Z Li","year":"2019","unstructured":"Li Z, Xu W, Su Y, Gao K, Chen Y, Ma L, Xie Y (2019) Nicotine induces insulin resistance via downregulation of Nrf2 in cardiomyocyte. Mol Cell Endocrinol 495:31315024\u201332110507. https:\/\/doi.org\/10.1016\/j.mce.2019.110507","journal-title":"Mol Cell Endocrinol"},{"issue":"10","key":"4430_CR48","doi-asserted-by":"publisher","first-page":"e3371","DOI":"10.1371\/journal.pone.0003371","volume":"3","author":"JE Bruin","year":"2008","unstructured":"Bruin JE, Petre MA, Raha S, Morrison KM, Gerstein HC, Holloway AC (2008) Fetal and neonatal nicotine exposure in Wistar rats causes progressive pancreatic mitochondrial damage and beta cell dysfunction. PLoS ONE 3(10):e3371. https:\/\/doi.org\/10.1371\/journal.pone.0003371","journal-title":"PLoS ONE"},{"issue":"2","key":"4430_CR49","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1093\/toxsci\/kfn012","volume":"103","author":"JE Bruin","year":"2008","unstructured":"Bruin JE, Gerstein HC, Morrison KM, Holloway AC (2008) Increased pancreatic beta-cell apoptosis following fetal and neonatal exposure to nicotine is mediated via the mitochondria. Toxicol Sci 103(2):362\u2013370. https:\/\/doi.org\/10.1093\/toxsci\/kfn012","journal-title":"Toxicol Sci"},{"key":"4430_CR50","doi-asserted-by":"publisher","first-page":"1427752","DOI":"10.3389\/fpubh.2024.1427752","volume":"12","author":"JS Izquierdo-Condoy","year":"2024","unstructured":"Izquierdo-Condoy JS, Naranjo-Lara P, Morales-Lapo E et al (2024) Direct health implications of e-cigarette use: a systematic scoping review with evidence assessment. Front Public Health 12:1427752. https:\/\/doi.org\/10.3389\/fpubh.2024.1427752","journal-title":"Front Public Health"}],"container-title":["Internal and Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11739-026-04430-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11739-026-04430-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11739-026-04430-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T04:37:52Z","timestamp":1786163872000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11739-026-04430-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,13]]},"references-count":50,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["4430"],"URL":"https:\/\/doi.org\/10.1007\/s11739-026-04430-x","relation":{},"ISSN":["1828-0447","1970-9366"],"issn-type":[{"value":"1828-0447","type":"print"},{"value":"1970-9366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,13]]},"assertion":[{"value":"9 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Najim Z. Alshahrani, Davide Campagna, Antonio Ceriello, Anoop Misra, Anas Ali Alhur, Abdul Basit, Cristina Russo, Tadej Battelino, Noel Somasundaram, Muhammad Yazid Jalaludin, Yoshifumi Saisho, Venera Tomaselli, Dianna J. Magliano, Othmar Moser, Joanna Mitri, and Roger Chen declare no conflicts of interest relevant to this work. Magdalena Walicka has received honoraria for lectures from Sanofi, AstraZeneca, Teva, and Eli Lilly, and has received support for attending meetings from Sanofi, Novo Nordisk, and Berlin-Chemie. Yusuff Adebayo Adebisi has previously received funding through the Tobacco Harm Reduction Scholarship and the Kevin Molloy Fellowship, both awarded by Knowledge-Action-Change (KAC), an independent public health organisation based in the United Kingdom. KAC receives funding from Global Action to End Smoking (GA), an independent U.S. nonprofit 501(c)(3) grant-making organisation that supports health and science research, cessation education, and agricultural transformation initiatives. Riccardo Polosa is a full tenured Professor of Internal Medicine at the University of Catania (Italy) and Medical Director of the Institute for Internal Medicine at the same university. He has received EU and governmental competitive grants including U-BIOPRED, AIR-PROM, Integral Rheumatology & Immunology Specialists Network (IRIS), and several PNRR grants funded by NextGenerationEU of the European Commission. He has also received investigator-initiated grants from GA, Pfizer, GlaxoSmithKline, CV Therapeutics, NeuroSearch A\/S, Sandoz, Merck Sharp & Dohme, Boehringer Ingelheim, Novartis, Arbi Group Srl., Duska Therapeutics, and Forest Laboratories. He is the founder of the Center for Tobacco Prevention and Treatment (CPCT) and the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR) at the University of Catania. He has received consultancy fees from Pfizer, Boehringer Ingelheim, Duska Therapeutics, Forest Laboratories, CV Therapeutics, Sermo Inc., GRG Health, Clarivate Analytics, Guidepoint Expert Network, and GLG Group. He receives textbook royalties from Elsevier and EDRA. He is Chair of the European Technical Committee for Standardisation on \u201cRequirements and test methods for emissions of electronic cigarettes\u201d (CEN\/TC 437; WG4) and scientific advisor of the non-profit Foundation RIDE2Med.","order":1,"name":"Ethics","label":"Conflict of interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was a systematic review and meta-analysis of previously published, publicly available studies. No new primary data were collected. Ethical approval was therefore not required.","order":2,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This article does not contain any studies with humans or animals conducted by any of the authors.","order":4,"name":"Ethics","label":"Human and animal rights","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"For this type of study, formal consent is not required.","order":5,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Declarations"}}]}}