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In reply to ‘Influence of smoking and snus on the prevalence and incidence of type 2 diabetes amongst men: the northern Sweden MONICA’

1 Carlsson et al. question our results in current smokers and snus users by focusing on ex-users of tobacco, small subgroups producing results with wide confidence intervals (CI) that are difficult to interpret (due in part to mixed exposures). These issues do not detract from our primary conclusions: smoking is associated with increased risk for diabetes, snus use is not. 2 Carlsson et al. complain that our power to detect significantly increased risks was low, because smoking and snuff use were classified into nine subgroups . This is incorrect. We reported odds ratios (ORs) in Tables 2–6 for no more than four categories of tobacco users and two of ex-users. 3 Carlsson et al. complain that the power of our study was lowbecausewe split tobaccousers into toomany groups, but they proceed to advise us to further subdivide the groups by the amount of consumption. In fact, we presented results for snus consumption in four separate places (text, p. 105 and 106). Regarding consumption of cigarettes and diabetes risk, Carlsson et al. state that we found an increased risk only in subjects having consumed >20 cigarettes day . They have misquoted their own manuscript, in which the number was 25+ cigarettes day (2). In addition, Carlsson et al. performed their cigarette consumption analyses by combining both former and current smokers (Table 1, p. 106), which is illogical. 4 Carlsson et al. call our use of ORs instead of incidence rates a little unusual and in our view not the most optimal analysis . They are mistaken. We did not have a date of diagnosis or duration of tobacco exposure for all subjects. Our use of ORs was therefore both appropriate and optimal. 5 Carlsson et al. believe that the discrepancy between the results of the two studies is more apparent than real . This is incorrect. Their study revealed four cases of diabetes amongst 131 exclusive snus users for an OR of 3.9 (CI: 1.1–14.3). Our study revealed six cases of diabetes amongst 314 exclusive snus users for an OR of 1.06 (CI: 0.43–2.64). This discrepancy is real. We agree with Carlsson et al. that the issue of snus use and diabetes risk requires more study.