Serum concentrations of per-/polyfluoroalkyl substances and risk of type 2 diabetes: A case-control study

Abstract

Per-/polyfluoroalkyl substances (PFASs), as a group of synthetic chemicals, have been extensively detected in human samples. Recently, epidemiological investigations have reported relationships between exposure to PFASs with risk of type 2 diabetes mellitus (T2DM), but with contradictory results. In this study, a case-control study was conducted to explore associations between serum PFASs and T2DM risk among 252 T2DM cases and 252 controls, who were both diagnosed according to fasting glucose and glycosylated hemoglobin levels. Besides, dose-response relationships were analyzed to clarify effects of PFAS exposure on T2DM risk at different exposure levels. Multivariable logistic regression models showed that compared to the lowest tertiles, elevated odds of T2DM risk were observed in the middle tertiles of perfluorohexane sulfonic acid (PFHxS) [odds ratio (OR): 4.09; 95% confidence interval (CI): 2.23, 7.50; p < 0.01] and perfluorohexane sulfonic acid (PFHpA) (OR: 1.87; 95% CI: 1.06, 3.29; p = 0.03), but not in the highest tertiles, and the restricted cubic spline regression models presented inverted U-shaped dose-response relationships for exposure to PFHxS and PFHpA with T2DM risk, indicating non-monotonic dose-response effect and low-dose effect. Most other PFASs were inversely associated with risk of T2DM, especially at higher exposure levels. Our findings suggested that there are associations between exposure to PFASs and risk of T2DM. Further mechanism research is worthy to be conducted to elucidate the mode of action of different PFASs on T2DM at different exposure levels.