Trends in Endocrinology & Metabolism
ReviewEpidemiology of air pollution and diabetes
Section snippets
The diabetes epidemic and ubiquitous air pollution exposure
Air pollution is a ubiquitous exposure that affects large proportions of the global population [1]. Air pollutants are emitted from many sources, such as industrial facilities, cars, trucks, ships, and airplanes, but also from household combustion devices or during forest fires and volcanic eruptions. Ambient or outdoor air pollution (referred to as air pollution hereafter) comprises particulate matter (PM) (see Glossary) of various sizes [<10 μm in diameter, PM10; <2.5 μm, PM2.5; <100 nm,
Are diabetes patients more vulnerable to ambient air pollution exposure?
Mainly case-crossover and time-series study designs have been used to compare the effects of short-term exposure to air pollutants on all-cause mortality rates among the general population and diabetic patients. A total of seven studies have been conducted in American, Italian, Canadian, and European populations 25, 26, 27, 28, 29, 30, 31, 32 involving between 12 978 [25] and 2935 647 [30] subjects with diabetes (for an overview see Figure 1A, for details see Table 1). Diabetes was not the
Prospective cohort studies
As discussed above, diabetic patients might be more susceptible to air pollution effects. Prospective studies can elucidate whether air pollution exposure only leads to accelerated progression of the disease or whether it directly contributes to its development. Prospective studies follow participants without diabetes for several years and evaluate potential associations between air pollution exposure at baseline or average air pollution exposure during the whole follow-up period with newly
Is ambient air pollution exposure associated with predisposing conditions for diabetes?
Studies on diabetes-related traits, which might be altered in subjects who have a higher diabetes risk, can provide further insight into the association between air pollution exposure and diabetes as well as the potential biological mechanisms underlying any association. The results of such studies are summarized in Figure 3 (for study details see Table 4).
HbA1c is a marker of the average blood glucose levels in an individual during the previous 30–120 days. In 9102 newly diagnosed T2D patients
Concluding remarks and future perspectives
There appears to be evidence indicative of an association between long-term exposure to main air pollutants and the development of T2D and diabetes-related mortality in adults. The results from studies that have investigated precursors of diabetes in healthy individuals strengthen the support for a potential association. However, a firm conclusion regarding the association between ambient air pollution exposure and diabetes-related traits and gestational diabetes cannot be presently drawn due
Acknowledgments
The authors thank Dr Elaine Fuertes (Institute of Epidemiology I, Helmholtz Zentrum München, Germany) for editorial assistance in the preparation of the manuscript.
Glossary
- Black carbon (BC)
- a fraction of PM2.5 that is mainly emitted during open biomass burning and from diesel cars and trucks without soot particle filters.
- Confidence interval (CI)
- an interval estimation of a parameter to show the reliability of the estimates. Typically, 95% CIs are reported, which represent an interval that contains the true value with a 95% probability.
- Hazard ratio (HR)
- a measure of mortality risk between different groups corresponding to a certain period of time. It is defined as
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