Is there an association between long-term exposure to particulate matter and events of severe hypoglycaemia in children and adolescents with type 1 diabetes?

Abstract

Background/Aim: Studies on long-term exposure to air pollution and the impact on diabetes outcomes in children and adolescents with type 1 diabetes (T1D) are rare. We aimed at investigating the impact of particulate matter <10 µm (PM10) and <2.5 µm (PM25) on event rates of severe hypoglycaemia in young individuals with T1D. Methods: We studied 55,283 children and adolescents with T1D <21yrs which were documented in German centres of the multicentre diabetes patient follow-up registry (DPV). Demographic and clinical data of the most recent treatment year between 2009 and 2018 was aggregated by patient. PM10- and PM2.5-yearly-averages prior to the respective treatment year were linked via the five-digit postcode areas of residency. Negative binomial regression models were used to study the association between PM-quartiles (Q1 lowest, Q4 highest concentration) and events of severe hypoglycaemia and hypoglycaemic coma per 100 patient years (PY). Models were adjusted for sex, age, diabetes duration, treatment year, migration background, type of treatment, degree of urbanisation and socioeconomic index of deprivation. Results: The included individuals with T1D had a median age of 15.8yrs (Q1:12.0-Q3:17.6; HbA1c 7.8% (7.1-9.0), 53% males, 45% insulin pump). Event rates of severe hypoglycaemia and hypoglycaemic coma were significantly higher at high PM10-concentration ≥18.0 µg/m3 (Q4: 12.5 events/100 PY (95%confidence interval:11.4-13.8) and 3.0 events/100 PY (2.6-3.4)) compared to lower PM10-concentration <14.3 µg/m3 (Q1: 9.4 events/100 PY (8.5-10.4) and 1.5 events/100 PY (1.3-1.8)). Similar results were observed with PM2.5 (Q4 ≥12.9 µg/m3: severe hypoglycaemia 11.7 events/100 PY (10.6-13.0), hypoglycaemic coma 3.0 events/100 PY (2.6-3.4), Q1 <10.1 µg/m3: 9.6 events/100 PY (8.6-10.7), 1.4 events/100 PY (1.2-1.7)). Additional adjustment for HbA1c did not change the results. Conclusions: Our results indicated a positive association between long-term exposure to particulate matter and events of severe hypoglycaemia at PM levels well below the EU yearly limit values.