Ambient particulate air pollution is associated with higher risk of microvascular complications and diabetic ketoacidosis among persons with type 1 diabetes mellitus in an observational survival study.

AIMS: The burden of Type 1 Diabetes Mellitus (DM, T1D) is growing and represents a major health care cost. This study investigated the relationship between ambient particulate matter (PM2.5) exposure and T1D complications. The research was motivated by the potential for air pollution's known inflammatory effects to exacerbate T1D's microvascular harms (i.e., damaged peripheral tissues from poor glucose control).

METHODS

In a cohort of 12, 925 Utah participants, competing-risk Cox proportional hazards regression analyzed the increased risk of PM2.5 exposure and diabetic ketoacidosis (DKA), along with kidney, ophthalmic, and neurological complications.

RESULTS

An interquartile range increase in one-year PM2.5 exposure was associated with increased risk of DKA by 28.8 % (95 % CI: 14.3, 45.2), ophthalmic complications by 33.5 % (95 % CI: 10.0, 62.0), and neurological complications by 35.1 % (95 % CI: 14.3, 59.6). No statistically significant effect was found for diabetic kidney complications. Acute exposures of 30, 60, and 90 days was also associated with increased risk of diabetic ketoacidosis, although less than one-year exposure.

CONCLUSIONS

We hypothesize these effects stem from PM2.5-induced oxidative stress and systemic inflammation, which may exacerbate metabolic disruptions already present in hyperglycemic individuals. Clients and providers may want to consider environmental factors, like air pollution, in T1D management.