**KUDOS** Good, honest, ethical and open minded KI researcher OP-ED on the diabetes issue from snus.

OP-ED :The results do signal a real effect from snus use and risk of developing diabetes

http://www.svt.se/opinion/carlsson-och-magnusson-ki

Translation by Atakan Erik Befrits of INNCO.org and New Nicotine Alliance Sweden, FCTC 5.3 compliant civil society NGO’s representing over 20 million successful ex-smokers, with the help of +95% harm reduced consumer nicotine products. All mistakes are my own.

OP-ED · “A single study can never give the final answer to a research question. We would still like to say that the current study is an important addition to the existing knowledge on tobacco and type 2 diabetes” Associate professor Sofia Carlsson and Professor Cecilia Magnusson conclude.

Sofia Carlsson, Associate Professor, Institute of Environmental Medicine, Karolinska Institute

Cecilia Magnusson, Professor, Department of Public Health, Karolinska Institute

As Patrik Strömer writes on SVT Opinion, there may indeed be other explanations for the findings in our study, connecting snus use and type 2 diabetes, than the snus use itself causing diabetes.

For example, we can not rule out that snus users and non-users of snus differ with respect also to other factors that contribute to an increased risk of diabetes.

At the present time there are relatively few studies of snus and type 2 diabetes, and they partly do provide different results. One explanation for different results may be that the previous studies have not been large enough to study consumers who use quite large quantities of snus, which is where we primarily find an increased risk.

Smoking is an established risk factor for diabetes, and a problem in previous studies has been to separate snus effects from smoking as dual use is common.

Our study is the largest to date on snus and the risk of type 2 diabetes. We have thus been able to examine the effect of exclusive use of snus.

We have also, insofar as possible, taken into account other risk factors for type 2 diabetes such as overweight, physical inactivity, heredity, alcohol consumption, and education level.

The results show a so-called dose-response relationship, meaning that the risk of type 2 diabetes increases with the number of cans of snus consumed per week, which reinforces the interpretation that snus is indeed behind the increase in risk.

Finally, experimental studies show that nicotine can inhibit insulin sensitivity, which means that there is a possible biological explanation for that snus can cause diabetes.

Combined, these findings make us more inclined to believe that the results do indicate that snus use does indeed affect the risk for diabetes.

A single study can never give the final answer to a research question. Every one study instead contributes a new piece to the puzzle, and slowly extends the research frontier.

We remain confident in claiming that the current study is an important addition to the existing knowledge on tobacco and type 2 diabetes.

Although we cannot prove that snus causes type 2 diabetes, we think that the public and decision makers have the right to be informed of our research findings.

Good research is characterized by humility and critical reasoning, media headlines sometimes do not reflect this adequately, and we therefore welcome these subsequent discussions.

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