LAUSR

ABSTRACT A recent meta‐analysis reported smoking to be associated with a 37% higher risk of type 2 diabetes in current smokers, rising to a 57% increase in heavy smokers, which declines on quitting. If the increase results from nicotine exposure, it is possible that using Swedish moist snuff (“snus”), which provides at least equivalent nicotine doses, might also increase diabetes risk. Following a recent publication reporting pooled results from five cohorts, we present a detailed meta‐analysis of data from 18 studies. Based on covariate‐adjusted estimates, no significant increased risk was seen in never smokers with RRs (95% CIs) of 1.08 (0.86–1.34), 0.93 (0.79–1.11) and 1.05 (0.94–1.18) for current, former and ever snus users. Significant increases were also not seen in the whole population, the corresponding RR estimates being 1.18 (0.94–1.48), 0.69 (0.49–0.96) and 0.95 (0.81–1.11). Nor was there an association of snus use with related endpoints, such as impaired glucose tolerance. However, dose‐response analyses showed a relationship, with the highest levels of snus exposure associated with a diabetes RR of 1.65 (1.25–2.18) in never smokers. The evidence relating snus to type 2 diabetes is somewhat limited, requiring further studies to confirm any possible relationship. HighlightsWe reviewed 18 studies that examined snus use and diabetes or related endpoints.Overall, current, ex or ever snus use showed no significant association with diabetes.This was true for never smokers and the whole population.Only heavy snus users who were never smokers had an increased risk of diabetes.Other diabetes‐related endpoints also failed to show any association with snus use.