Underutilized and Under Threat: Environmental Policy as a Tool to Address Diabetes Risk
Purpose of Review
Diabetes is a burgeoning threat to public health in the USA. Importantly, the burden of diabetes is not equally borne across society with marked disparities based on geography, race/ethnicity, and income. The etiology of global and population-specific diabetes risk remains incompletely understood; however, evidence linking environmental toxicants acting as endocrine-disrupting chemicals (EDCs), such as particulate matter and arsenic, with diabetes suggests that environmental policies could play an important role in diabetes risk reduction.
Evidence suggests that disproportionate exposures to EDCs may contribute to subgroup-specific diabetes risk; however, no federal policies regulate EDCs linked to diabetes based upon diabetogenic potential. Nevertheless, analyses of European Union data indicate that such regulation could reduce diabetes-associated costs and disease burden.
Federal laws only regulate EDCs indirectly. The accumulating evidence linking these chemicals with diabetes risk should encourage policymakers to adopt stricter environmental standards that consider both health and economic impacts.
KeywordsDiabetes Pollution Toxicant Endocrine-disrupting chemical Environmental policy Environmental justice
Compliance with Ethical Standards
Conflict of Interest
Sabina Shaikh, Jyotsna S. Jagai, Colette Ashley, and Shuhan Zhou declare that they have no conflict of interest.
Robert M. Sargis reports honoraria from CVS.
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.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.American Diabetes Association. Standards of medical care in diabetes—2018. Diabetes Care. 2018;41(Suppl 1):S1–S153.Google Scholar
- 2.Centers for Disease Control and Prevention. National Diabetes Statistics, 2017 Washington, DC: Centers for Disease Control and Prevention; 2017 [Available from: https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf.
- 4.International Diabetes Federation. IDF Diabetes Atlas, 8th edition: International Diabetes Federation; 2017 [Available from: https://www.idf.org/e-library/epidemiology-research/diabetes-atlas/134-idf-diabetes-atlas-8th-edition.html.
- 5.•• Heindel JJ, Blumberg B, Cave M, Machtinger R, Mantovani A, Mendez MA, et al. Metabolism disrupting chemicals and metabolic disorders. Reprod Toxicol. 2016. This paper is the most comprehensive review to date of evidence linking endocrine-disrupting chemicals to metabolic disease.Google Scholar
- 9.•• Ruiz D, Becerra M, Jagai JS, Ard K, Sargis RM. Disparities in environmental exposures to endocrine-disrupting chemicals and diabetes risk in vulnerable populations. Diabetes Care. 2018;41(1):193–205. This paper reviews evidence suggesting that exposure to environmental toxicants may be a contributor to diabetes disparities CrossRefPubMedGoogle Scholar
- 20.Shunthirasingham C, Gawor A, Hung H, Brice KA, Su K, Alexandrou N, et al. Atmospheric concentrations and loadings of organochlorine pesticides and polychlorinated biphenyls in the Canadian Great Lakes Basin (GLB): spatial and temporal analysis (1992–2012). Environ Pollut. 2016;217:124–33.CrossRefPubMedGoogle Scholar
- 21.Kirkley AG, Carmean CM, Ruiz D, Ye H, Regnier SM, Poudel A, et al. Arsenic exposure induces glucose intolerance and alters global energy metabolism. Am J Physiol Regul Integr Comp Physiol 2017:ajpregu 00522 2016.Google Scholar
- 23.Fu J, Woods CG, Yehuda-Shnaidman E, Zhang Q, Wong V, Collins S, et al. Low-level arsenic impairs glucose-stimulated insulin secretion in pancreatic beta cells: involvement of cellular adaptive response to oxidative stress. Environ Health Perspect. 2010;118(6):864–70.CrossRefPubMedPubMedCentralGoogle Scholar
- 33.Lee DH, Lind PM, Jacobs DR Jr, Salihovic S, van Bavel B, Lind L. Polychlorinated biphenyls and organochlorine pesticides in plasma predict development of type 2 diabetes in the elderly: the prospective investigation of the vasculature in Uppsala Seniors (PIVUS) study. Diabetes Care. 2011;34(8):1778–84.CrossRefPubMedPubMedCentralGoogle Scholar
- 39.Centers for Disease Control and Prevention. CDC identifies diabetes belt 2011 [Available from: https://www.cdc.gov/diabetes/pdfs/data/diabetesbelt.pdf.
- 41.• Revesz R. Environmental law and policy; Foundation Press 2015. This book provides a comprehensive examination of US environmental law.Google Scholar
- 42.Environmental Protection Agency. How EPA regulates drinking water contaminants 2017 [Available from: https://www.epa.gov/dwregdev/how-epa-regulates-drinking-water-contaminants - make.
- 44.•• Nigra AE, Sanchez TR, Nachman KE, Harvey D, Chillrud SN, Graziano JH, et al. The effect of the Environmental Protection Agency maximum contaminant level on arsenic exposure in the USA from 2003 to 2014: an analysis of the National Health and Nutrition Examination Survey (NHANES). Lancet Public Health. 2017;2(11):e513–e21. Comparing those consuming public water to those consuming well water, this paper points to important inefficiencies in environmental policy that influence exposure to diabetes-associated chemicals.CrossRefPubMedGoogle Scholar
- 45.Callan ST, Thomas JM. Environmental economics and management. 6th edition ed. Mason, OH: South-Western Cengage Learning; 2013.Google Scholar
- 46.Pettit HE. Shifting the experiment to the lab: does EPA have a mandatory duty to require testing for endocrine disruption effects under the toxic substances control act? Environmental Law. 2000;30(2):413–46.Google Scholar
- 47.Environmental Protection Agency. What is superfund? 2017 [Available from: https://www.epa.gov/superfund/what-superfund.
- 48.Environmental Protection Agency. Arsenic: policy and guidance 2017 [Available from: https://clu-in.org/contaminantfocus/default.focus/sec/arsenic/cat/Policy_and_Guidance/.
- 49.Mercury-Containing and Rechargeable Battery Management Act, (1996).Google Scholar
- 50.Environmental Protection Agency. Bisphenol A action plan 2010 [Available from: https://www.epa.gov/sites/production/files/2015-09/documents/bpa_action_plan.pdf.
- 51.Environmental Protection Agency. Assessing and managing chemicals under TSCA: polybrominated diphenyl ethers (PBDEs) 2017 [Available from: https://www.epa.gov/assessing-and-managing-chemicals-under-tsca/polybrominated-diphenyl-ethers-pbdes.
- 52.Environmental Protection Agency. Polybrominated diphenyl ethers (PBDEs) action plan 2009 [Available from: https://www.epa.gov/sites/production/files/2015-09/documents/pbdes_ap_2009_1230_final.pdf.
- 53.Franco SJ. Age-adjusted percentage of adults aged ≥ 20 years with diabetes, by race and Hispanic ethnicity—National Health and Nutrition Examination Survey, United States, 1999–2002 and 2009–2012. 2015.Google Scholar
- 56.Indian Health Service. Factsheet: disparities: US Department of Health and Human Services; 2017 [Available from: https://www.ihs.gov/newsroom/factsheets/disparities/.
- 59.Environmental Protection Agency. Summary of Executive Order 12898—federal actions to address environmental justice in minority populations and low-income populations 1994 [Available from: https://www.epa.gov/laws-regulations/summary-executive-order-12898-federal-actions-address-environmental-justice.
- 60.Environmental Protection Agency. Carbon pollution emission guidelines for existing stationary sources: electric utility generating units. Federal Register. 2015;80 FR 64661.Google Scholar
- 62.Kassotis CD, Bromfield JJ, Klemp KC, Meng CX, Wolfe A, Zoeller RT, et al. Adverse reproductive and developmental health outcomes following prenatal exposure to a hydraulic fracturing chemical mixture in female C57Bl/6 mice. Endocrinology. 2016;157(9):3469–81.CrossRefPubMedPubMedCentralGoogle Scholar
- 64.Bureau of Land Management. Oil and gas, hydraulic fracturing on federal and Indian lands: rescission of a 2015 rule. Federal Register. 2017:82 FR 34464.Google Scholar
- 65.Bureau of Safety and Environmental Enforcement. Oil and gas and sulphur operations on the outer continental shelf—oil and gas production safety systems—revision. Federal Register. 2017:82 FR 61703.Google Scholar
- 66.Beauchamp TL, Childress JF. Principles of biomedical ethics. 6th ed. New York: Oxford University Press; 2009. xiii, pp.417Google Scholar
- 69.•• Trasande L, Lampa E, Lind L, Lind PM. Population attributable risks and costs of diabetogenic chemical exposures in the elderly. Journal of Epidemiology and Community Health. 2017;71(2):111–4. This analysis of data from the European Union suggests that reducing exposures to diabetes-associated chemicals may reduce both rates of disease and associated healthcare costs.CrossRefPubMedGoogle Scholar