, Volume 49, Issue 8, pp 1770-1776
Date: 19 May 2006

Association of cigarette smoking and tar and nicotine intake with development of type 2 diabetes mellitus in men and women from the general population: the MONICA/KORA Augsburg Cohort Study



We examined sex-specific associations between cigarette smoking and incident type 2 diabetes mellitus in Germany.

Subjects, materials and methods

The study was based on 5,470 men and 5,422 women (aged 25–74 years) without diabetes who participated in one of the three population-based MONICA Augsburg surveys between 1984 and 1995. Incident cases of type 2 diabetes were assessed using follow-up questionnaires. Hazard ratios (HRs) were estimated from Cox proportional hazard models.


Up to 31 December 2002 a total of 409 cases of incident type 2 diabetes among men and 263 among women were registered. The number of cigarettes and the nicotine and tar consumption per day were associated with a significantly increased risk of type 2 diabetes among men, but not among women; this could be due to the low power of the study in women. After multivariable adjustment, the HRs for type 2 diabetes compared with never-smokers were 1.48, 2.03 and 2.10 for men smoking 1 to 14, 15 to 19 and ≥20 cigarettes/day (p for trend <0.0001) and 1.25, 1.34 and 1.37 for women smoking 1 to 9, 10 to 19 and ≥20 cigarettes/day (p for trend 0.0985). Compared with never-smokers, the HRs for increasing tar intake in men (1–167, 168–259 and ≥260 mg/day) were 1.45, 2.32 and 2.07 (p for trend <0.0001); the respective HRs in women (1–89, 90–194 and ≥195 mg/day) were 1.18, 1.57 and 1.24 (p for trend 0.1159).


Cigarette smoking is an important modifiable risk factor of type 2 diabetes particularly in men from the general population.