香京julia种子在线播放

Diabetes, a persistent medical condition, interferes with how the body processes food into energy. It often emerges in individuals with obesity, which impairs glucose management and heightens insulin resistance, elevating diabetes risk (1). Approximately 90% of type 2 diabetes cases are linked to excess weight or obesity, and the prevalence of obesity-induced impaired glucose tolerance is projected to climb to 420 million globally by 2025 (2). The simultaneous presence of diabetes and obesity, known as diabesity, can intensify cardiometabolic disorders and is emerging as a significant global health challenge amid the obesity crisis (3). Understanding the modifiable risk factors is essential for the large-scale control and prevention of diabesity.

Environmental hazards, particularly fine particulate matter (PM2.5), pose significant global health risks. Research indicates that PM2.5 exposure correlates with higher risks of both obesity (4, 5) and diabetes (6, 7). Yet, the impact of PM2.5 on diabesity remains unexplored. Animal studies suggest that PM2.5 exposure can trigger insulin resistance and systemic inflammation (8, 9), leading to obesity (10) and disrupted glucose tolerance, changes in adipokine levels, and mitochondrial dysfunction, eventually causing diabetes (11). Recent findings from the UK Biobank also demonstrate a more pronounced link between PM2.5 exposure and diabetes among obese individuals. Despite this, global studies specifically addressing the impact of air pollution on diabetes mellitus are lacking.

While well-established risk factors like obesity, lack of physical activity, and hereditary traits are recognized (12, 13), emerging evidence suggests a critical impact of environmental contributors, particularly air pollution, on the development of type 2 diabetes mellitus (T2DM). A comprehensive review and meta-analysis involving over 1.7 million individuals from 16 different studies has identified a robust link between sustained exposure to fine particulate matter (PM2.5) and a heightened risk of T2DM. Notably, an increase of 10 µg/m3 in PM2.5 levels corresponds to a 9% rise in the incidence of T2DM (14, 15). This highlights the urgency of exploring the underlying mechanisms connecting air pollution and T2DM, and the imperative to devise effective preventive measures.

However, previous studies didn’t analyze the overall disease burden of diabetes burden attributable to air pollution. Thus, this study assesses how air pollution affects the global burden of diabetes burden by analyzing mortality and disability-adjusted life years (DALYs) trends across various demographics and socio-economic indicators from 1990 to 2021. Future trends are also projected using the autoregressive integrated moving average (ARIMA) model, supported by earlier studies (12, 13). These insights aim to support the prevention of diabetes burden and the management of environmental pollution.

This study examined the diabetes burden worldwide resulting from air pollution between 1990 and 2021, identifying a significant upward trend during this timeframe. The most impacted demographic included individuals over the age of 60, with males showing higher rates. Projections indicate that while mortality rates might decrease in regions with a low Social Development Index (SDI), standardized mortality rates are expected to rise in lower-middle SDI areas. Moreover, diabetes mortality and age-standardized death rates associated with air pollution are projected to remain elevated in Russia, Mexico, and many African nations, with a notably sharper increase in age-standardized mortality rates expected in South Asia and Africa compared to other regions. To our knowledge, this research is the first to thoroughly assess diabetes burden from air pollution.

In 2017, PM2.5 exposure contributed to 4.58 million deaths and 142.52 million DALYs worldwide (30). While age-standardized rates (ASRs) of deaths and DALYs saw a decline, the decrease was modest on a global scale, with certain regions like Latin America, Africa, South Asia, the Middle East, and Oceania experiencing an increase in the absolute burden as the global population rose from 5.3 billion in 1990 to 7.6 billion in 2017. With rapid industrialization and urbanization, the health impact of ambient PM2.5 in low- and middle-income areas has become increasingly apparent. Concurrently, Cookstove Intervention Programs expanded, reducing household PM2.5 burdens in developing nations, though only 60% of the global population had access to clean fuels (31–34). Significantly, five Asian nations (India, China, Pakistan, Indonesia, and Bangladesh) represented the highest burdens, accounting for over 50% of all deaths and DALYs related to PM2.5.

According to the World Health Organization, as economic conditions and sanitation improved, non-communicable diseases (NCDs) represented over 60% of the global disease burden and contributed to more than 70% of deaths in 2017 (35). Major diseases linked to PM2.5 were among the top 10 causes of death worldwide in 2016 (36). The leading three conditions for PM2.5-associated DALYs were ischemic heart disease (IHD), cerebrovascular disease, and lower respiratory infections (LRI), followed by chronic obstructive pulmonary disease (COPD), diabetes, and lung cancer, all of which ranked in the top 20 causes of global DALYs (37). Our findings indicated an increase in deaths and DALYs from PM2.5-related NCDs particularly among those over 70, while the 14-69 age group largely contributed to DALYs in conditions like stroke, IHD, and diabetes, posing significant challenges for public health and socio-economic development by impacting the labor force.

Studies have shown that economic growth has often led to substantial environmental pollution which adversely affects glucose metabolism, promoting insulin resistance and Type 2 Diabetes Mellitus (T2DM, 39). Meta-analyses have established a positive association between significant air pollutants (like PM2.5, PM10, NO2, and NOX) and T2DM (38). From 2000 to 2015, PM2.5 levels escalated from 31.2 μg/m3 to 97.0 μg/m3 in 15 Chinese provinces and regions (39). Additionally, research has linked a 10 μg/m3 increase in PM2.5 exposure to a 10% heightened risk of developing T2DM (40). Consequently, there is an urgent need to address the issue of diabetes mellitus caused by air pollution.

Furthermore, our studies have shown that East Asia, Southeast Asia, and South Asia bear the greatest burden, with the highest numbers of deaths and DALYs, highlighting that densely populated and rapidly industrializing countries like India and China face disproportionately high disease burdens from PM2.5, exacerbated by significant rural-urban economic disparities and uneven public health resources. Between 2000 and 2010, health welfare costs and losses in labor productivity due to air pollution accounted for 6.5% of China’s GDP annually, and 8.5% of India’s GDP in 2013, while Bangladesh incurs around $6.5 billion annually in related costs. In response, the Chinese government implemented the Air Pollution Prevention and Control Action Plan, revised the Law on the Prevention and Control of Atmospheric Pollution, and took steps such as switching to natural gas for heating, regulating power plants, and limiting vehicle emissions (41–43). Similarly, the Indian government initiated the National Clean Air Program aimed at enhancing air quality monitoring, boosting pollution control capabilities, and reducing PM2.5 and PM10 levels by 20–30% by 2024. These proactive measures toward eco–friendly development are expected to mitigate public health losses from PM2.5, enhance economic dynamism through improved labor productivity and energy efficiency, and assist these countries in breaking out of detrimental cycles toward sustainable development.

Air pollution, especially PM2.5, ozone (O₃), and nitrogen oxides (NOx), can reduce vitamin D synthesis by blocking UVB radiation necessary for its production in the skin. This effect is particularly pronounced in highly polluted urban areas, where low UV exposure contributes to higher rates of vitamin D deficiency. Additionally, pollution–induced inflammation and oxidative stress can impair insulin sensitivity, increasing the risk of diabetes. Both reduced vitamin D levels and increased systemic inflammation from air pollutants may synergistically elevate the risk of type 2 diabetes, highlighting the need for effective environmental and health interventions (44).

Building on our findings, actionable policy recommendations are essential to mitigate the diabetes burden attributable to air pollution. Governments should prioritize stricter air quality regulations and promote cleaner energy alternatives to reduce particulate matter exposure, particularly in high–risk regions. Integrating air pollution mitigation strategies with existing public health programs targeting diabetes prevention could amplify their impact. Additionally, improving urban planning to decrease air pollution in densely populated areas and raising public awareness about the health risks associated with air pollution are critical. Future policies should also emphasize tailored interventions for vulnerable populations, such as the elderly and individuals in lower SDI regions.

In the context of our study findings, the recent public health measures and policy developments in countries like China and India provide insightful examples. China’s Air Pollution Prevention and Control Action Plan and India’s National Clean Air Program (NCAP) aim to significantly reduce PM2.5 and PM10 levels. These initiatives demonstrate a proactive approach to mitigating air pollution and its associated health impacts, including diabetes mellitus. By incorporating these national efforts into our discussion, we can better illustrate the potential for public health policies to influence and possibly reduce the burden of diseases exacerbated by environmental pollutants (45–47).

Our research encounters several notable constraints. Primarily, there is a deficiency of primary data from less developed areas, particularly in Sub–Saharan Africa, where assessments are predominantly based on mathematical modeling, leading to wide ranges of uncertainty. Additionally, air pollution comprises a complex mixture of various components, each possessing unique physicochemical properties and toxic effects that vary significantly across different regions and seasons.

This study offers an in–depth analysis of the global burden of diabetes mellitus attributed to air pollution from 1990 to 2021, observing a significant increase over the years. Individuals aged over 60 were the most impacted, with men facing a greater burden. Looking ahead, only regions with a low Socio–Demographic Index (SDI) are expected to see a decrease in mortality rates, whereas those in lower–middle SDI regions will likely witness an increase in standardized mortality rates. On a national scale, countries such as Russia, Mexico, and most of Africa are anticipated to continue experiencing elevated diabetes mortality rates and ASMR due to air pollution up to 2030 and 2050. Both South Asia and Africa are projected to encounter substantial rises in ASDR compared to other areas.

This underscores the urgent necessity for policymakers to devise and refine preventive measures tailored to specific populations to reduce the diabetes burden associated with air pollution in the future.