Association between Smoking Behavior and Insulin Resistance Using Triglyceride-Glucose Index among South Korean adults.

Context Insulin resistance is a determinant of diabetes. With the increasing popularity of electronic smoking, the number of dual-smokers (smoking both cigarettes and electronic cigarettes [e-cigarettes]) is increasing. However, few studies have assessed the association between insulin resistance and smoking behavior, including dual smoking. Objective To investigate the association between smoking behaviors and insulin resistance. Design Prospective, cross-sectional study. Setting General community. Patients or other participants A total of 11,653 participants (4,721 males and 6,932 females) aged ≥19 years from the 2016-2018 Korea National Health and Nutrition Examination Survey. Main outcome measure Participants were divided based on their smoking behaviors: dual-smokers (both cigarettes and e-cigarettes), single-smokers (cigarette smokers), previous smokers, and non-smokers. Insulin resistance was determined based on the triglyceride-glucose index. Multiple logistic regression analysis was performed to investigate the association between smoking behavior and insulin resistance. Results Among the participants, 205 males (3.9%) and 40 females (0.5%) were dual-smokers, and 1,581 males (29.9%) and 350 females (4.5%) were single-smokers. Both male and female smokers (dual and single) had higher odds of being in a group with higher insulin resistance than non-smokers (male, dual: OR=2.19, 95% CI=1.39-3.44; single: OR=1.78, 95% CI=1.43-2.22; female, dual: OR=2.32, 95% CI=1.01-5.34; single: OR=1.76, 95% CI=1.28-2.42). Conclusions This study suggests that both single and dual smoking may increase the risk of insulin resistance in the general population. Education on the adverse effects of smoking behaviors may be an important strategy to improve the health of the population.