Interestingly, smoking has also been related to the development of insulin resistance.8, 9, 10 Additionally, cytokines, such as interleukin-6 and tumor necrosis factor alpha soluble receptor, which are elevated in COPD, have been associated with the development of insulin resistance in liver and muscle tissues; as a result, COPD has been postulated as a risk factor for DM.11, 12, 13, 14. This evidence concerns the gene IL6 and Insulin resistance.