Tobacco Use, Insulin Resistance, and Risk of Type 2 Diabetes: Results from the Multi-Ethnic Study of Atherosclerosis.
BACKGROUND
Tobacco use is associated with insulin resistance and incident diabetes. Given the racial/ethnic differences in smoking patterns and incident type 2 diabetes our objective was to evaluate the association between tobacco use and insulin resistance (IR) as well as incident type 2 diabetes mellitus in a contemporary multiethnic cohort.


RESULTS
We studied 5,931 Multi- Ethnic Study of Atherosclerosis (MESA) participants who at baseline were free of type 2 diabetes (fasting glucose ≥7.0 mmol/l (126 mg/dl) and/or use of insulin or oral hypoglycemic medications) categorized by self-reported tobacco status and reclassified by urinary cotinine (available in 58% of participants) as never, current or former tobacco users. The association between tobacco use, IR (fasting plasma glucose, insulin, and the homeostatic model assessment of insulin resistance (HOMA-IR)) and incident diabetes over 10 years was evaluated using multivariable linear regression and Cox proportional hazards models, respectively. Mean age of the participants was 62 (±10) years, 46% were male, 41% Caucasian, 12% Chinese, 26% African American and 21% Hispanic/Latino. IR biomarkers did not significantly differ between current, former, and never cigarette users (P >0.10) but showed limited unadjusted differences for users of cigar, pipe and smokeless tobacco (All P <0.05). Fully adjusted models showed no association between dose or intensity of tobacco exposure and any index of IR. When stratified into participants that quit smoking vs. those who continued smoking during the 10-year study there was no difference in serum glucose levels or frequency of diabetes. In fully adjusted models, there was no significant difference in diabetes risk between former or current cigarette smokers compared to never smokers [HR (95% CI) 1.02 (0.77,1.37) and 0.81 (0.52,1.26) respectively].


CONCLUSIONS
In a contemporary multi-ethnic cohort, there was no independent association between tobacco use and IR or incident type 2 diabetes. The role smoking plays in causing diabetes may be more complicated than originally thought and warrants more in-depth large contemporary multi-ethnic studies.
Diabetes and Obesity Center, University of Louisville School of Medicine, Louisville, Kentucky, United States of America.|Division of Cardiology, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, United States of America.|American Heart Association-Tobacco Regulatory and Addiction Center, Louisville, Kentucky, United States of America.
Rachel J
http://orcid.org/0000-0003-3877-0636
RJ
Keith
American Heart Association-Tobacco Regulatory and Addiction Center, Louisville, Kentucky, United States of America.|Ciccarone Center for the Prevention of Heart Disease, John Hopkins Medical, Baltimore, Maryland, United States of America.
Mahmoud
M
Al Rifai
Department of Medicine, University of Colorado, Aurora, Colorado, United States of America.
Christopher
C
Carruba
Diabetes and Obesity Center, University of Louisville School of Medicine, Louisville, Kentucky, United States of America.|American Heart Association-Tobacco Regulatory and Addiction Center, Louisville, Kentucky, United States of America.
Natasha
N
De Jarnett
Ciccarone Center for the Prevention of Heart Disease, John Hopkins Medical, Baltimore, Maryland, United States of America.
John W
JW
McEvoy
Diabetes and Obesity Center, University of Louisville School of Medicine, Louisville, Kentucky, United States of America.|Division of Cardiology, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, United States of America.|American Heart Association-Tobacco Regulatory and Addiction Center, Louisville, Kentucky, United States of America.
Aruni
A
Bhatnagar
American Heart Association-Tobacco Regulatory and Addiction Center, Louisville, Kentucky, United States of America.|Ciccarone Center for the Prevention of Heart Disease, John Hopkins Medical, Baltimore, Maryland, United States of America.
Michael J
MJ
Blaha
Diabetes and Obesity Center, University of Louisville School of Medicine, Louisville, Kentucky, United States of America.|Division of Cardiology, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, United States of America.|American Heart Association-Tobacco Regulatory and Addiction Center, Louisville, Kentucky, United States of America.|Ciccarone Center for the Prevention of Heart Disease, John Hopkins Medical, Baltimore, Maryland, United States of America.
Andrew P
AP
Defilippis
D050197:Atherosclerosis / Q000208:ethnology*; D015415:Biomarkers / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012727:Sex Characteristics; D012907:Smoking; D064424:Tobacco Use / Q000009:adverse effects* / Q000453:epidemiology*
D015415:Biomarkers