Diabetes
Association between exposure to air pollution and acute complications of diabetes Wei-Ting Chen* Wei-Ting Chen Tsu-Hsuan Weng Yi-Ting Wu Daphne-Yih Ng Ya-Ching Tsao Kai-Min Yu Tzy-Shiuan Fu Fu-Huang Lin
Background: Long-term exposure to air pollution has been shown to impair endothelial function and trigger oxidative stress, leading to insulin resistance and glucose metabolism disorders. Acute diabetes complications, such as hyperglycemic hyperosmolar state (HHS), ketoacidosis (DKA), hypoglycemia, and diabetic coma, have a 10-20% mortality rate if untreated. This study aims to examine the relationship between air pollution and acute diabetes complications in Taiwan.
Method: This study employed a case-crossover study design to analyze air pollutant monitoring data from the Taiwan Environmental Protection Agency (TEPA) with data from patients hospitalized with acute complications of diabetes between 2016 and 2020. The day of admission (Lag 0) was designated as the case day, and the days 1-3 before the case day (Lag 1-3) were designated as the control days. The data were stratified by gender, age, region, and season to analyze the effect of air pollutant concentrations on the risk of patients with acute complications of diabetes mellitus by logistic regression.
Results: The total number of cases in this study was 5,420, with an average age of 69.86 years, and 54.3% were male. Among females, exposure to CO and NO2 increased the risk of HHS by 36.8% (OR=1.368) and 1.3%. Exposure to SO2 increased the risk of DKA by 79%, and exposure to NO2 increased the risk of hypoglycemia by 3.3%. Among the elderly aged 65 years or older, exposure to CO and NO2 increased the risk of HHS 50.1% and 1.5%, and exposure to NO2 increased the risk of hypoglycemia by 2%. When the study was stratified by season, it was observed that exposure to NO2 during springtime in Taipei increased the risk of HHS by 1.1%. Exposure to NO2 and PM2.5 increased the risk of diabetic coma by 4.5% and 1.3%, respectively.
Conclusion: CO and NO2 increase the risk of HHS, and SO2 raises the risk of DKA. CO, NO2, and PM2.5 are linked to diabetic coma, with women and the elderly most vulnerable.