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Diabetes Care 28:2501-2507, 2005
© 2005 by the American Diabetes Association, Inc.

Metabolic Syndrome/Insulin Resistance Syndrome/Pre-Diabetes
Original Article

Smoking and Incidence of Diabetes Among U.S. Adults

Findings from the Insulin Resistance Atherosclerosis Study

Capri Gabrielle Foy, PHD, MS, Ronny A. Bell, PHD, Deborah F. Farmer, PHD, David C. Goff, Jr., MD, PHD and Lynne E. Wagenknecht, DRPH

From the Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina

Address correspondence and reprint requests to Capri G. Foy, PhD, MS, Piedmont Plaza II, 2000 W. First St., Office 250, Winston-Salem, NC 27104. E-mail: cfoy{at}wfubmc.edu

OBJECTIVE—The objective of this study was to determine the association between smoking and incident diabetes among U.S. adults.

RESEARCH DESIGN AND METHODS—The Insulin Resistance Atherosclerosis Study (IRAS) was a prospective study of the associations of insulin sensitivity and cardiovascular risk factors. We examined the relationship between smoking status categories (never, former, and current) and incident 5-year type 2 diabetes among 906 participants free of diabetes at baseline. We also considered the effect of pack-year categories (never, former <20 pack-years, former ≥20 pack-years, current <20 pack-years, and current ≥20 pack-years) upon diabetes incidence.

RESULTS—Of current smokers, 96 (25%) developed diabetes at 5 years, compared with 60 (14%) never smokers. After multivariable adjustment, current smokers exhibited increased incidence of diabetes compared with never smokers (odds ratio [OR] 2.66, P = 0.001). Similar results were found among current smokers with ≥20 pack-years with normal glucose tolerance (5.66, P = 0.001).

CONCLUSIONS—Smoking shares a robust association with incident diabetes, supporting the current Surgeon General’s warnings against cigarette smoking.

Abbreviations: FSIGT, frequently sampled intravenous glucose tolerance test • IGT, impaired glucose tolerance • IRAS, Insulin Resistance Atherosclerosis Study • NGT, normal glucose tolerance • WHO, World Health Organization


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