title: Is particle pollution in outdoor air associated with metabolic control in type 2 diabetes?
abstract: BACKGROUND
  There is growing evidence that air pollutants are associated with the risk of type 2 diabetes. Subclinical inflammation may be a mechanism linking air pollution with diabetes. Information is lacking whether air pollution also contributes to worse metabolic control in newly diagnosed type 2 diabetes. We examined the hypothesis that residential particulate matter (PM10) is associated with HbA1c concentration in newly diagnosed type 2 diabetes.
  
  
  METHODS
  Nationwide regional levels of particulate matter with a diameter of ≤ 10 µm (PM10) were obtained in 2009 from background monitoring stations in Germany (Federal Environmental Agency) and assigned to place of residency of 9,102 newly diagnosed diabetes patients registered in the DPV database throughout Germany (age 65.5 ± 13.5 yrs; males: 52.1%). Mean HbA1c (%) levels stratified for air pollution quartiles (PM10 in µg/m(3)) were estimated using linear regression models adjusting for age, sex, BMI, diabetes duration, geographic region, year of ascertainment, and social indicators.
  
  
  RESULTS
  In both men and women, adjusted HbA1c was significantly lower in the lowest quartile of PM10 exposure in comparison to quartiles Q2-Q4. Largest differences in adjusted HbA1c (95% CI) were seen comparing lowest quartiles of exposure with highest quartiles (men %: -0.42 (-0.62; -0.23)/mmol/mol: -28.11 (-30.30; -26.04), women, %: -0.28 (-0.47; -0.09)/mmol/mol: -0.28 (-0.47; -0.09)).
  
  
  CONCLUSIONS
  Air pollution may be associated with higher HbA1c levels in newly diagnosed type 2 diabetes patients. Further studies are warranted to examine this association.
authors.affiliation: Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Teresa
authors.initials: T
authors.lastname: Tamayo
authors.affiliation: Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rathmann
authors.affiliation: Institute for Environmental Medicine (IUF), Leibniz Center at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Ursula
authors.initials: U
authors.lastname: Krämer
authors.affiliation: Institute for Environmental Medicine (IUF), Leibniz Center at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Sugiri
authors.affiliation: Institute for Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Grabert
authors.affiliation: Institute for Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000368:Aged; D000393:Air Pollutants / Q000009:adverse effects*; D000397:Air Pollution / Q000009:adverse effects*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism*; D005260:Female; D005858:Germany; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D052638:Particulate Matter / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D000393:Air Pollutants; D006442:Glycated Hemoglobin; D052638:Particulate Matter; C517652:hemoglobin A1c protein, human