TABLE 1

Epidemiological data linking EDC exposure to diabetes

ReferenceEDCPopulationAssociation with diabetesNotes
Morgan et al., Arch Environ Contam Toxicol 1980;9:349–382Pesticides2,620 pesticide exposed workers from 1971–1977Cause-of-death questionnaires addressed to survivors indicated possible association between DDT exposure and diabetes
Lai et al., Am J Epidemiol 1994;139:484–492Arsenic891 Taiwanese residents exposed to arsenic in 1988Abnormal OGTT, medical histories of diagnosed diabetes, and use of diabetes treatments significantly associated with arsenic exposureDose-response relationship between arsenic exposure and diabetes prevalence
Henriksen et al., Epidemiology 1997;8:252–258TCDD989 Air Force veterans of Operation Ranch Hand exposed to TCDDGlucose abnormalities, diabetes diagnosis, and use of diabetic medications associated with TCDD exposureSignificant hyperinsulinemia in exposed nondiabetic subjects
Pesatori et al., Occup Environ Med 1998;55:126–131TCDDLarge Italian cohort (>230,000) localized in the exposure zones of the 1976 Seveso accidentMortality study using Poisson regression to assess relative risk determined substantial TCDD exposure correlated to increased diabetes mortality in women
Vena et al., Environ Health Perspect 1998;106:645–653TCDD, HCDInternational study of 36 cohorts from 12 countries (1939–1992) (>25,000)Job record data and company questionnaires with biological and environmental measurements suggested possible correlation of TCDD exposure with diabetesStrongest association found when first exposure was 10–19 years previous to assessment and with duration of exposure of 10–19 years
Calvert et al., Occup Environ Med 1999;56:270–276TCDD281 former workers at two U.S. chemical plantsCross-sectional study significantly associated individuals with the highest serum lipid–adjusted TCDD concentrations with higher serum glucose levels
Cranmer et al., Toxicol Sci 2000;56:431–436TCDD69 individuals in Jacksonville, AR, living within 25 miles of the Vertac waste siteHigher fasting plasma insulin levels associated with individuals in the top 10% of TCDD concentrations (>15 ppt)No associations with TCDD and glucose levels, obesity, or total lipids
Bertazzi et al., Am J Epidemiol 2001;153:1031–1044TCDD15-year follow-up to the 1976 Seveso accidentMortality study associated an increase in reported diabetes with TCDD exposure in women
Beard et al., Environ Health Perspect 2001;111:724–730Pesticides1999 Australian pesticide sprayers employed from 1935–1996Mortality study and surviving morbidity questionnaire determined increased mortality due to diabetes associated with pesticide exposureDiabetes more commonly self-reported with occupational herbicide use
Fierens et al., Biomarkers 2003;8:529–53417 PCDD/Fs, dioxins, 4 PCBs, 12 PCB markers257 environmentally exposed BelgiansQuantification of serum fat from a population-based study determined significantly increased levels of dioxins, PCBs, and PCB markers in diabetic patientsDiabetes risk significantly increased for individuals in the top decile of dioxin concentrations
Glynn et al., Environ Health Perspect 2003;111:349–3557 PCBs, 5 OC pesticides205 Swedish womenAssociation study of lifestyle/medical factors and serum PCB levels indicated increased prevalence of diabetes with higher serum PCB concentrationsSerum PCB concentrations also associated with age, body, BMI, diet, and location of residence
Rylander et al., Environ Health 2005;4:28PCB-153, DDE380 male and female Swedish fishers with a Baltic Sea marine dietCross-sectional study significantly associated serum PCB-153 and DDE levels with an increased prevalence of diabetesAssociation stronger with PCB-153 for men and with DDE for women
Lee et al., Diabetes Care 2006;29:1638–16446 POPs detected in >80% of population2,016 adults from the 1999–2002 NHANESPrevalence of diabetes associated with increased lipid-adjusted serum concentrations of dioxins, PCBs, and organochlorinesStronger correlations with younger age, obesity, or Mexican American heritage
Vasiliu et al., Epidemiology 2006;17:352–359PCBs, PBBs1,384 individuals from the Michigan PBB cohortEnrollment questionnaires and serum samples associated serum PCB levels with an increased prevalence of diabetes in womenExposed overweight and obese men and women had an increased prevalence of diabetes
Codru et al., Environ Health Perspect 2007;115:1442–1447101 PCBs, DDE, HCB352 adult Native Americans (Mohawk)Standardized questionnaire and fasting serum samples positively associated the highest tertile of serum HCB levels with diabetesNonsignificant associations with PCBs and DDE with diabetes; mirex levels inversely associated with diabetes
Cox et al., Environ Health Perspect 2007;115:1747–1752OC pesticides1,303 adult Mexican Americans from the 1982–1984 HHANESSelf-reported diabetes significantly associated with lipid-adjusted serum DDT levels and serum glucose levels were elevated in individuals exposed to trans-nonachlor and HCH
Everett et al., Environ Res 2007;103:413–418HxCDD, PCB, DDT1,830 adults from the 1999–2002 NHANESDiabetes significantly associated with serum PCB 126, DDT, and HxCDD levels. PCB 126 and DDT levels significantly associated with undiagnosed diabetes (HbA1c >6.1%)
Stahlhut et al., Environ Health Perspect 2007;115:876–882PhthalatesU.S. men from the 1999–2002 NHANESInsulin resistance measured by HOMA-IR was associated with three phthalates (MBP, MBzP, MEP)Four phthalates (MBzP, MEHHP, MEOHP, MEP) associated with increased waist circumference
Lee et al., Diabetologia 2007;50:1841–1851OC pesticides, PCBs721 nondiabetic participants from the 1999–2002 NHANESFasting glucose levels and metabolic syndrome significantly associated with increased levels of OC pesticidesPCBs were significantly associated with waist circumference. OC pesticides significantly associated with elevated triacylglycerides
Lee et al., Diabetes Care 2007;30:1596–1598PCDD/Fs, PCBs, OC pesticides1,721 individuals from the 1999–2002 NHANESPrevalence of diabetes strongly associated with serum concentrations of PCBs and OC pesticidesPCDDs and PCDFs weakly associated with diabetes
Lang et al., JAMA 2008;300:1303–1310BPA1,455 U.S. adults from the 2003–2004 NHANESUrinary BPA concentrations associated with diabetes prevalence in a dose-dependent manner
Lim et al., Diabetes Care 2008;31:1802–18075 PDBEs, PBB637 adults from the 2003–2004 NHANESSerum concentrations of various brominated flame retardants correlated with increased prevalence of diabetes with varying dose dependencyPBDE-153 showed an inverted U-shaped association with metabolic syndrome
Jørgensen et al., Diabetologia 2008;51:1416–1422General POPs692 Greenland Inuits sampled from 1999–2002 living on a marine dietSignificant inverse association between POPs and stimulated insulin concentrations and HOMA-BNo association between POP concentration and glucose intolerance or insulin resistance
Wang et al., Diabetes Care 2008;31:1574–1579PCBs, PCDFs1,054 Taiwanese poisoned with PCB-laced rice-bran oil during late 1970sBlind morbidity follow-up interviews and chloracne diagnoses significantly associated PCB exposure with an increased prevalence of diabetes in women
Turyk et al., Environ Health Perspect 2009;117:1076–1082PCBs, DDEPopulation of sport fish consumers in the Great Lakes region from 1990s-2005Serum concentrations of DDE positively associated with increased diabetes prevalenceNo association with total PCB levels
Park et al., J Prev Med Public Health 2010;43:1–8OC pesticides50 South Korean nondiabetic subjects with metabolic syndromeCommunity-based health surveys and HOMA-IR measurements associated OC pesticide exposure with metabolic syndromeStrong dose dependence between heptachlor epoxide and HOMA-IR
Ukropec et al., Diabetologia 2010;53:899–906PCBs, HCB, DDE, DDT, HCH1,220 PCBRISK survey participants from Eastern SlovakiaAbnormal OGTTs and fasting glucose levels associated with serum levels of POPs suggesting dose-dependent increased risk of diabetes and prediabetesNo association between HCB and HCH levels and diabetes
  • HCB, hexachlorobenzene; HCD, higher chlorinated dioxins; HCH, hexachlorocyclohexane; HHANES, Hispanic Health and Nutrition Examination Survey; HOMA-B, homeostasis model assessment of β-cell function; HxCDD, hexachlorodibenzo-p-dioxin; MBP, monobutyl phthalate; MBzP, monobenzyl phthalate; MEOHP, mono(2-ethyl-5-oxohexyl) phthalate; MEP, monoethyl phthalate, NHANES, National Health and Nutrition Examination Survey; OC, organochlorine; OGTT, oral glucose tolerance test; PBB, polybrominated biphenyls; PCDDs, polychlorinated dibenzodioxins; PCDFs, polychlorinated dibenzofurans; PDBE, polybrominated diphenyl ethers.