Centre for Chronic Disease Control, New Delhi, India
Centre for Chronic Disease Control, New Delhi, India.
BMJ Open Diabetes Res Care. 2023 Oct;11(5). doi: 10.1136/bmjdrc-2023-003333.
Exposure to fine particulate matter has been associated with several cardiovascular and cardiometabolic diseases. However, such evidence mostly originates from low-pollution settings or cross-sectional studies, thus necessitating evidence from regions with high air pollution levels, such as India, where the burden of non-communicable diseases is high.
We studied the associations between ambient PM levels and fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c) and incident type 2 diabetes mellitus (T2DM) among 12 064 participants in an adult cohort from urban Chennai and Delhi, India. A meta-analytic approach was used to combine estimates, obtained from mixed-effects models and proportional hazards models, from the two cities.
We observed that 10 μg/m differences in monthly average exposure to PM was associated with a 0.40 mg/dL increase in FPG (95% CI 0.22 to 0.58) and 0.021 unit increase in HbA1c (95% CI 0.009 to 0.032). Further, 10 μg/m differences in annual average PM was associated with 1.22 (95% CI 1.09 to 1.36) times increased risk of incident T2DM, with non-linear exposure response.
We observed evidence of temporal association between PM exposure, and higher FPG and incident T2DM in two urban environments in India, thus highlighting the potential for population-based mitigation policies to reduce the growing burden of diabetes.
接触细颗粒物已与多种心血管和心脏代谢疾病相关。然而，此类证据主要来自污染较低的环境或横断面研究，因此需要来自污染水平较高的地区（如印度）的证据，因为印度的非传染性疾病负担很高。
我们研究了印度城市钦奈和德里的一项成人队列中 12064 名参与者的环境 PM 水平与空腹血糖（FPG）、糖化血红蛋白（HbA1c）和 2 型糖尿病（T2DM）发病之间的关联。使用混合效应模型和比例风险模型，从这两个城市获得的估计值采用荟萃分析方法进行组合。
我们发现，每月平均 PM 暴露增加 10 μg/m，FPG 增加 0.40 mg/dL（95%CI 0.22 至 0.58），HbA1c 增加 0.021 单位（95%CI 0.009 至 0.032）。此外，每年平均 PM 增加 10 μg/m，T2DM 发病风险增加 1.22 倍（95%CI 1.09 至 1.36），呈非线性暴露反应。
我们观察到在印度两个城市环境中，PM 暴露与较高的 FPG 和 T2DM 发病之间存在时间关联的证据，从而强调了实施基于人群的缓解政策以减轻日益增长的糖尿病负担的潜力。
