title: No adverse effect of outdoor air pollution on HbA1c in children and young adults with type 1 diabetes.
abstract: Evidence is growing that air pollutants deteriorate glucose metabolism and insulin sensitivity by oxidative stress and inflammation. This might affect HbA1c levels and insulin requirements in type 1 diabetes. There are no data available on this association.
  
  
  
  Air pollution values of respirable particulate matter (PM10), nitrogen dioxides (NO2), and accumulated ozone (O3-AOT40) were obtained from the federal environmental agency (Umweltbundesamt II) and assigned to place of residence of 840 participants from a nation-wide population-based type 1 diabetes registry (German Diabetes Center, Düsseldorf, Germany). Information on HbA1c, social status, treatment and co-morbidities was collected by self-administered questionnaires. Complete information was available for 771 patients aged 11-21 years at the time of study.
  
  
  
  In linear regression models, no adverse effects of air pollutants (PM10, NO2 or O3-AOT40 on HbA1c level were found, but O3-AOT40 was inversely associated with HbA1c (mmol/mol) in the crude (estimate per IQR: -1.86; 95% CI: (-3.27; -0.44); p=0.01) and the best model adjusting for lifestyle, socioeconomic factors, clinical information, and season (-1.50; (-2.82; -0.17); 0.034). After adding area of residency as random effect to the crude and the best model, the association was no longer significant (-1.64; (-3.84; 0.56); 0.14); (-1.56; (-3.67; 0.55); 0.14). Adjustment for further possible confounders did not affect the estimates seriously. None of the pollutants was associated with insulin dose (IU/kg body weight).
  
  
  
  Investigated pollutants had no adverse effect on metabolic control in children and young adults with type 1 diabetes in this cross-sectional study. The weak inverse association of accumulated ozone with HbA1c might be due to confounding by regional characteristics or regional aspects of care.
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Düsseldorf, Germany.
authors.forename: Teresa
authors.initials: T
authors.lastname: Tamayo
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Düsseldorf, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rathmann
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Düsseldorf, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Stahl-Pehe
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute of Medical Statistics, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Landwehr
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 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 Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany; German Center for Diabetes Research (DZD), Ulm, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Hermann
authors.affiliation: Institute for Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany; German Center for Diabetes Research (DZD), Ulm, Germany.
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Düsseldorf, Germany. Electronic address: joachim.rosenbauer@ddz.uni-duesseldorf.de.
authors.forename: Joachim
authors.initials: J
authors.lastname: Rosenbauer
mesh_terms: D000293:Adolescent; D000328:Adult; D000393:Air Pollutants / Q000032:analysis; D000397:Air Pollution / Q000032:analysis*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D009585:Nitrogen Dioxide / Q000032:analysis; D010126:Ozone / Q000032:analysis; D052638:Particulate Matter / Q000032:analysis; D055815:Young Adult
chemical_list: D000393:Air Pollutants; D006442:Glycated Hemoglobin; D009585:Nitrogen Dioxide; D010126:Ozone; D052638:Particulate Matter; C517652:hemoglobin A1c protein, human
keywords: Air pollutants; Child; Glycosylated hemoglobin A; Insulin; Type 1 diabetes mellitus; Young adult