title: Arsenic exposure, diabetes prevalence, and diabetes control in the Strong Heart Study.
abstract: This study evaluated the association of arsenic exposure, as measured in urine, with diabetes prevalence, glycated hemoglobin, and insulin resistance in American Indian adults from Arizona, Oklahoma, and North and South Dakota (1989-1991). We studied 3,925 men and women 45-74 years of age with available urine arsenic measures. Diabetes was defined as a fasting glucose level of 126 mg/dL or higher, a 2-hour glucose level of 200 mg/dL or higher, a hemoglobin A1c (HbA1c) of 6.5% or higher, or diabetes treatment. Median urine arsenic concentration was 14.1 µg/L (interquartile range, 7.9-24.2). Diabetes prevalence was 49.4%. After adjustment for sociodemographic factors, diabetes risk factors, and urine creatinine, the prevalence ratio of diabetes comparing the 75th versus 25th percentiles of total arsenic concentrations was 1.14 (95% confidence interval: 1.08, 1.21). The association between arsenic and diabetes was restricted to participants with poor diabetes control (HbA1c ≥8%). Arsenic was positively associated with HbA1c levels in participants with diabetes. Arsenic was not associated with HbA1c or with insulin resistance (assessed by homeostatic model assessment to quantify insulin resistance) in participants without diabetes. Urine arsenic was associated with diabetes control in a population from rural communities in the United States with a high burden of diabetes. Prospective studies that evaluate the direction of the relation between poor diabetes control and arsenic exposure are needed.
authors.affiliation: Departments of Environmental Health Sciences and Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Room W7513D, Baltimore, MD 21205, USA.
authors.forename: Matthew O
authors.initials: MO
authors.lastname: Gribble
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
authors.forename: Jason G
authors.initials: JG
authors.lastname: Umans
authors.forename: Nawar M
authors.initials: NM
authors.lastname: Shara
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Francesconi
authors.forename: Walter
authors.initials: W
authors.lastname: Goessler
authors.forename: Ciprian M
authors.initials: CM
authors.lastname: Crainiceanu
authors.forename: Ellen K
authors.initials: EK
authors.lastname: Silbergeld
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
authors.forename: Ana
authors.initials: A
authors.lastname: Navas-Acien
mesh_terms: D000368:Aged; D001130:Arizona / Q000453:epidemiology; D001152:Arsenicals / Q000009:adverse effects* / Q000652:urine; D001786:Blood Glucose / Q000032:analysis; D003404:Creatinine / Q000652:urine; D003920:Diabetes Mellitus / Q000139:chemically induced / Q000453:epidemiology* / Q000628:therapy; D004781:Environmental Exposure / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009658:North Dakota / Q000453:epidemiology; D009825:Oklahoma / Q000453:epidemiology; D016012:Poisson Distribution; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors; D013023:South Dakota / Q000453:epidemiology
chemical_list: D001152:Arsenicals; D001786:Blood Glucose; D003404:Creatinine; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human