Abstract
BackgroundThere is growing evidence that air pollutants are associated with the risk of type 2 diabetes. Subclinical inflammation may be a mechanism linking air pollution with diabetes. Information is lacking whether air pollution also contributes to worse metabolic control in newly diagnosed type 2 diabetes. We examined the hypothesis that residential particulate matter (PM10) is associated with HbA1c concentration in newly diagnosed type 2 diabetes.MethodsNationwide regional levels of particulate matter with a diameter of ≤10 µm (PM10) were obtained in 2009 from background monitoring stations in Germany (Federal Environmental Agency) and assigned to place of residency of 9,102 newly diagnosed diabetes patients registered in the DPV database throughout Germany (age 65.5±13.5 yrs; males: 52.1%). Mean HbA1c (%) levels stratified for air pollution quartiles (PM10 in µg/m3) were estimated using linear regression models adjusting for age, sex, BMI, diabetes duration, geographic region, year of ascertainment, and social indicators.FindingsIn both men and women, adjusted HbA1c was significantly lower in the lowest quartile of PM10 exposure in comparison to quartiles Q2–Q4. Largest differences in adjusted HbA1c (95% CI) were seen comparing lowest quartiles of exposure with highest quartiles (men %: −0.42 (−0.62; −0.23)/mmol/mol: −28.11 (−30.30; −26.04), women, %: −0.28 (−0.47; −0.09)/mmol/mol: −0.28 (−0.47; −0.09)).InterpretationAir pollution may be associated with higher HbA1c levels in newly diagnosed type 2 diabetes patients. Further studies are warranted to examine this association.
Highlights
There is growing evidence that air pollutants are associated with the risk of type 2 diabetes
Evidence is growing that air pollutants (nitrogen oxides (NOx), particulate matter (PM) with a diameter of #10 mm or 2.5 mm) may be associated with type 2 diabetes prevalence and incidence [5,6,7,8,9]
Diabetes risk was increased by 4%–15% per interquartile range (IQR) of particulate matter with a diameter of #10 mm (PM10) [5,7], by 25% per IQR increase in nitrogen oxides (NOx) [9], and by 11% for living in short distance (,50 m) to a major road [8]
Summary
There is growing evidence that air pollutants are associated with the risk of type 2 diabetes. Information is lacking whether air pollution contributes to worse metabolic control in newly diagnosed type 2 diabetes. Traffic-related air pollution was associated with diabetes-associated mortality in a current study [4]. Evidence is growing that air pollutants (nitrogen oxides (NOx), particulate matter (PM) with a diameter of #10 mm or 2.5 mm) may be associated with type 2 diabetes prevalence and incidence [5,6,7,8,9]. Inflammatory processes may increase the vulnerability to cardiovascular health effects (e.g. myocardial infarction) in persons with type 2 diabetes who are exposed to air pollution [5,15]
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