Recent evidence suggests that expression of tumor necrosis factor-alpha (TNF-alpha) by adipocytes is a molecular mediator of insulin resistance in obesity. We have therefore tested the hypothesis that variations within the regulatory region of the TNF-alpha gene, which might cause increased adipocyte or generalized TNF-alpha synthesis, are associated with NIDDM, a state in which insulin resistance is routinely observed. Neither the previously known variants within the TNF-alpha promoter at position -308 and -238, nor two newly identified polymorphisms at position -376 and -163, were found at a significantly higher frequency in Caucasian NIDDM patients compared to non-diabetic controls. No genetic variants were found in Pima Indians. These data make it unlikely that mutations within regulatory elements of the TNF-alpha gene are associated with an increase in the prevalence of NIDDM.