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Background There are studies suggesting smoking may increase the risk of type 2 diabetes.Effects of smoking on insulin secretion and insulin resistance(IR)are,however,controversial.Methods This is a cross-sectional study.Since there were very few smokers among Hong Kong Chinese women,only men(n=1068) were analyzed in this report.Fasting and 2-hour plasma glucose and insulin were measured.Insulinogenic index as well as beta-cell function and IR based on homeostatic model assessment(HOMA)by computer model(HOMA Calculator v2.2)were calculated.Results Of the 1068 men,147 had newly diagnosed diabetes,131 newly diagnosed impaired glucose tolerance(IGT) and 790 were non-diabetic normal controls.Smokers had similar fasting and 2-hour insulin levels,insulinogenic index and HOMA derived beta-cell function as compared to non-smokers in the groups with diabetes,IGT or normal oral glucose tolerance test(OGTT).IR was also similar between smokers,ex-smokers and non-smokers in those with normal OGTT.In men with IGT or diabetes,after adjustment for age and body mass index,smokers were more insulin resistant as compared to non-smokers(IR,IGT: 1.59±1.07 vs 1.03±0.54,P<0.05;diabetes:1.96±1.36 vs 1.06±0.45,P<0.01).With Logistic regression analysis,comparing smokers and non-smokers,IR was independently associated with smoking(odds ratio(95% CI),IGT: 2.23(1.05,4.71);diabetes:3.92(1.22,12.58)).None of the other insulin parameters enter into the model among those with normal OGTT or comparing ex-smokers and non-smoker or smokers and ex-smokers.Conclusions In Chinese men,smoking did not show any direct association with insulin levels and pancreatic insulin secretion.Smoking men with IGT or diabetes appeared more insulin resistant than their non-smoking counterparts.