Background
Insulin resistance contributes to the development of cardiovascular disease and type 2 diabetes mellitus. Smoking leads to an increase in triglyceride levels, which, in turn, increases insulin resistance. Although the number of e-cigarette users has increased in recent years, few studies have investigated the association between ecigarette use and insulin resistance. Therefore, this study aimed to determine the association between e-cigarette use and insulin resistance using the triglyceride-glucose (TyG) index in Korean adults.
Methods
This study included 4,404 healthy adults aged ≥20 years who participated in the Korea National Health and Nutrition Examination Survey between 2019 and 2020. Participants were categorized as never-smokers or ecigarette users, and the TyG index was categorized into low- and high-TyG index groups according to the median value (9.22). A logistic regression analysis was performed to determine the association between e-cigarette smoking and insulin resistance.
Results
E-cigarette users had a higher TyG index than never smokers (e-cigarette: mean=9.35; never: mean=9.18; P<0.001). The ecigarette users had a higher risk of being in the high TyG index group than never-smokers (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.03–1.84). In the subgroup analysis stratified by sex, age, and body mass index, a higher OR for a high TyG index was observed in men (OR, 1.46; 95% CI, 1.03–2.08) and individuals aged 60 years or older (OR, 3.74; 95% CI, 1.14–12.30).
Conclusion
Our findings suggest that e-cigarette use is significantly associated with insulin resistance.

Citations

• Comparison of e-Cigarette and Cigarette Use and Dual Use Associations With Disease: Updated Systematic Review and Meta-Analysis
  Stanton A. Glantz, Andre Luiz Oliveira da Silva
  Public Health Reports®.2026; 141(4): 509.     CrossRef
• E-cigarette aerosols as systemic metabolic disruptors: integrated mitochondrial, circadian, and neurobehavioral mechanisms
  Ardie Barry Sailis
  Toxicology Mechanisms and Methods.2026; 36(7): 1003.     CrossRef
• Association between electronic cigarette use and prediabetes, diabetes, and insulin resistance: a systematic review and meta-analysis
  Yusuff Adebayo Adebisi, Davide Campagna, Antonio Ceriello, Anas Ali Alhur, Najim Z. Alshahrani, Anoop Misra, Abdul Basit, Cristina Russo, Tadej Battelino, Noel Somasundaram, Muhammad Yazid Jalaludin, Yoshifumi Saisho, Magdalena Walicka, Venera Tomaselli,
  Internal and Emergency Medicine.2026; 21(5): 1879.     CrossRef
• Smoking Type and Metabolic Syndrome in Korean Adults: The 8th Korea National Health and Nutrition Examination Survey (2019–2021)
  Jisue Kim, Min-Jeong Oh
  Korean Journal of Family Practice.2026; 16(3): 177.     CrossRef
• Association Between Electronic Cigarette Use and Risk of Obstructive Sleep Apnea Among Korean Adults: A Cross-Sectional Nationwide Population-Based Study
  Wonseok Jeong, Min Ji Song, Ji Hye Shin, Ji Hyun Kim
  Journal of Clinical Medicine.2025; 14(11): 3616.     CrossRef
• Unveiling the risks of noncombustible nicotine or tobacco products
  Su-Min Jeong
  Korean Journal of Family Medicine.2025; 46(5): 297.     CrossRef