Tobacco use, insulin resistance, and risk of type 2 diabetes: Results from the multi-ethnic study of atherosclerosis

Rachel J. Keith, Mahmoud Al Rifai, Christopher Carruba, Natasha De Jarnett, John W. McEvoy, Aruni Bhatnagar, Michael Blaha, Andrew P. Defilippis

Research output: Contribution to journalArticle


Introduction: 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. Methods and Results: We studied 5,931 Multi- Ethnic Study of Atherosclerosis (MESA) participants who at base-line 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

Original languageEnglish (US)
Article numbere0157592
JournalPLoS One
Issue number6
StatePublished - Jun 1 2016


ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Keith, R. J., Al Rifai, M., Carruba, C., De Jarnett, N., McEvoy, J. W., Bhatnagar, A., Blaha, M., & Defilippis, A. P. (2016). Tobacco use, insulin resistance, and risk of type 2 diabetes: Results from the multi-ethnic study of atherosclerosis. PLoS One, 11(6), [e0157592].