Environmental chemicals and type 2 diabetes: An updated systematic review of the epidemiologic evidence

Chin Chi Kuo, Katherine Moon, Kristina A. Thayer, Ana Navas-Acien

Research output: Contribution to journalArticlepeer-review

160 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)831-849
Number of pages19
JournalCurrent diabetes reports
Issue number6
StatePublished - Dec 2013
Externally publishedYes


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

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism


Dive into the research topics of 'Environmental chemicals and type 2 diabetes: An updated systematic review of the epidemiologic evidence'. Together they form a unique fingerprint.

Cite this