Current Diabetes Reports

, Volume 13, Issue 6, pp 831–849 | Cite as

Environmental Chemicals and Type 2 Diabetes: An Updated Systematic Review of the Epidemiologic Evidence

  • Chin-Chi KuoEmail author
  • Katherine Moon
  • Kristina A. Thayer
  • Ana Navas-Acien
Diabetes Epidemiology (SH Golden, Section Editor)


The burden of diabetes is increasing globally. Identifying novel preventable risk factors is an urgent need. In 2011, the U.S. National Toxicological Program (NTP) conducted a workshop to evaluate the epidemiologic and experimental evidence on the relationship of environmental chemicals with obesity, diabetes, and metabolic syndrome. Although the evidence was insufficient to establish causality, the NTP workshop review identified an overall positive association between some environmental chemicals and diabetes. In the present systematic review, our objective was to summarize the epidemiological research published since the NTP workshop. We identified a total of 29 articles (7 on arsenic, 3 on cadmium, 2 on mercury, 11 on persistent organic pollutants, 3 on phthalates, and 4 on bisphenol A), including 7 prospective studies. Considering consistency, temporality, strength, dose–response relationship, and biological plausibility (confounding), we concluded that the evidence is suggestive but not sufficient for a relationship between arsenic and persistent organic pollutants and is insufficient for mercury, phthalates, and bisphenol A. For cadmium, the epidemiologic evidence does not seem to suggest an association with diabetes. Important research questions include the need for additional prospective studies and the evaluation of the dose–response relationship, the role of joint exposures, and effect modification with other comorbidities and genetic variants.


Systematic review Environmental chemicals Diabetes Arsenic Cadmium Mercury Persistent organic pollutants Bisphenol A Phthalates Type 2 diabetes Epidemiology 



Supported by grants from the National Institute of Environmental Health Sciences (R01ES021367, P30ES03819) and the National Heart Lung and Blood Institute (R01HL090863).

Compliance with Ethics Guidelines

Conflict of Interest

Chin-Chi Kuo declares that he has no conflict of interest.

Katherine Moon declares that she has no conflict of interest.

Kristina A. Thayer declares that she has no conflict of interest.

Ana Navas-Acien has received travel/accommodations expenses covered or reimbursed from the ADA for the ADA annual meeting.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Chin-Chi Kuo
    • 1
    • 2
    • 3
    Email author
  • Katherine Moon
    • 1
    • 2
    • 3
  • Kristina A. Thayer
    • 4
  • Ana Navas-Acien
    • 1
    • 2
    • 3
  1. 1.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Department of Environmental Health SciencesJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins Medical InstitutionsBaltimoreUSA
  4. 4.Office of Health Assessment and Translation, Division of the National Toxicology ProgramNational Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human ServicesResearch Triangle ParkUSA

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