Tobacco, electronic cigarette, alcohol and cannabis use among individuals diagnosed with diabetes. A national survey in France (2025)

Highlights:
Knowledge on psychoactive substance use among persons with diabetes is scanty.
Persons with diabetes are less likely to smoke tobacco.
If they smoke, they are more tobacco dependent and smoke more cigarettes.
5.7% of never smokers with diabetes reported using electronic cigarettes.
Daily alcohol consumption is similar among persons with diabetes and those without diabetes.
Aims: To evaluate the prevalence of tobacco smoking, electronic cigarette, alcohol and cannabis use among individuals diagnosed with diabetes mellitus (wD) compared to those who were not (woD).
Methods: Data of the French Health Barometer 2021 were analyzed.
Results: A total of 24,496 individuals completed the survey; of whom 1772 (8.0%) reported living with diabetes. There were significantly fewer smokers among individuals wD (22.1% vs. 30.6%), but more former and fewer never smokers. Smoking more than 15 cigarettes/day was more common among those wD and they were more tobacco dependent than those woD. 28.7% of persons wD and 39.5% woD reported having already tried electronic cigarettes. Current or daily electronic cigarette use was similar. Among those who had tried e-cigarettes, 5.7% of respondents wD were never smokers (vs. 10.1% of those woD). Alcohol consumption and cannabis use were significantly less common among respondents wD than those woD, but the prevalence of daily alcohol consumption was similar.
Conclusions: Although smoking prevalence is lower among persons wD compared to those without, smokers wD smoke more and are more tobacco dependent. Tobacco smoking should be assessed and all smokers wD should be enrolled in a smoking cessation program. More data are needed regarding other substance use and its association with diabetes characteristics and self-management. [Author's abstract]