First, evidence supports the independent and direct effect of tobacco use on insulin resistance.27 This association may be mediated by adiponectin, a secretory adipokine produced by the adipocytes and significant in regulating lipid metabolism and fatty acid oxidation.9 Adiponectin has also been shown to negatively correlate with insulin resistance, with lower levels observed among tobacco users.28 In addition to the adiponectin effect, smoking has also been indirectly linked to insulin resistance through visceral adiposity. Here, ADIPOQ is linked to Insulin resistance.