Recent research has drawn attention to the potential link between air pollution and diabetes, indicating that environmental factors may play a crucial role in its spread
Diabetes mellitus is a widespread and escalating health issue, affecting about 422 million individuals worldwide. Its two primary forms, type 1 and type 2 diabetes, are characterised by impaired glucose metabolism, leading to elevated blood sugar levels and a range of debilitating complications. Recent research has drawn attention to the potential link between air pollution and the development of diabetes, indicating that environmental factors may play a crucial role in the pathogenesis of this disease. To establish this connection, numerous epidemiological studies have investigated the impact of various air pollutants, including fine particulate matter (PM2.5), nitrogen dioxide (NO2), ozone (O3), and polycyclic aromatic hydrocarbons (PAHs), on diabetes incidence and progression. These studies have consistently shown a positive correlation between exposure to air pollution and the risk of diabetes. According to the Lancet, ‘The 2016 global and national burden of diabetes mellitus is attributable to PM2·5 air pollution’. As per the Global Burden of Disease study 2019, ‘approximately a fifth of the global burden of type 2 diabetes was attributable to PM2·5 exposure’, with an estimated 13.4 percent deaths due to type 2 diabetes contributed by ambient PM2·5, and 6·50 percent of deaths by household air pollution. The figure below indicates the percentage change in diabetes with a decrease in household air pollution exposure in all regions and on a global scale.
Source: Diabetes trends due to air pollution across regions
Impaired glucose tolerance and insulin resistance, both of which are key factors in the development of type 2 diabetes have been linked to prolonged exposure to extreme air pollution. Oxidative stress is the major contributing factor by which air pollution leads to diabetes. The air pollutants having harmful reactive oxygen species can induce oxidative stress and inflammation in the body. Thus disrupting insulin s and glucose uptake, causing insulin resistance. Adding on, air pollution has been linked to the development of obesity, a major risk factor for type 2 diabetes. The particulate matter including dust and dirt soot is known to hamper hormonal regulation, which can lead to weight gain and fat accumulation, especially in abdominal adipose tissue, which is closely related to insulin resistance.
[pullquote]Oxidative stress is the major contributing factor by which air pollution leads to diabetes.[/pullquote]
Numerous research studies have established a clear association between air pollution and diabetes, with findings demonstrating the detrimental impact of air pollution on public health and the economy. A study estimated an economic cost of US$ 327 billion due to the increased prevalence of diabetes and the increased cost per person with diabetes in the United States (US). Air pollution's role in diabetes is not limited to insulin resistance. It has also been implicated in pancreatic dysfunction, a hallmark of type 1 diabetes. This damage may trigger an autoimmune response in genetically predisposed individuals, accelerating the onset of type 1 diabetes. Additionally, air pollution can induce systemic inflammation and oxidative stress, which may further exacerbate beta-cell dysfunction. Geographical variation in diabetes prevalence corresponds with variations in air quality, thus, reinforcing the association between air pollution and diabetes. Urban areas, where air pollution is often elevated, consistently report higher diabetes rates compared to rural regions. This connection is especially pronounced in low- and middle-income countries, where rapid urbanisation has led to changes in lifestyle. Studies point to poor housing conditions and the lack of healthcare and proper nutrition as factors contributing to diabetes.
[pullquote]Geographical variation in diabetes prevalence corresponds with variations in air quality, thus, reinforcing the association between air pollution and diabetes.[/pullquote]
Air pollution's impact on diabetes extends beyond adults to include vulnerable populations such as children and pregnant women. Emerging evidence suggests that prenatal exposure to air pollution may increase the risk of gestational diabetes, a condition that can lead to adverse pregnancy outcomes. Additionally, children exposed to air pollution may be at a higher risk of developing type 1 diabetes, further emphasising the significance of early-life environmental exposures in diabetes pathogenesis. The consequences of the association between air pollution and diabetes are profound, extending to the realms of public health, economics, and environmental sustainability. Diabetes exerts a significant economic burden, not only in terms of healthcare costs but also lost productivity and reduced quality of life. Air pollution exacerbates this burden by contributing to the growing diabetes epidemic. Additionally, the environmental impacts of air pollution, including climate change, further compound the complexity of this issue.
[pullquote]Diabetes exerts a significant economic burden, not only in terms of healthcare costs but also lost productivity and reduced quality of life.[/pullquote]
Regulatory efforts to reduce air pollution, such as stricter emission standards for vehicles and industrial facilities, are essential for preventing new cases of diabetes. Lifestyle modifications, such as physical activity and a balanced diet, can help mitigate the impact of air pollution on individuals already living in polluted areas. Moreover, public health campaigns are needed to raise awareness about the risks of air pollution and encourage individuals to protect themselves from exposure. Public health policies, environmental regulations, and individual actions are all essential components of the effort to combat the diabetes epidemic in the context of an increasingly polluted world. Sustainable transportation options, urban planning that prioritises green spaces, public awareness campaigns, and individual mitigation strategies are key elements of a comprehensive approach.
Shoba Suri is a Senior Fellow at the Observer Research Foundation.
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Dr. Shoba Suri is a Senior Fellow with ORFs Health Initiative. Shoba is a nutritionist with experience in community and clinical research. She has worked on nutrition, ...
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