TY - JOUR
T1 - Arsenic exposure, diabetes prevalence, and diabetes control in the strong heart study
AU - Gribble, Matthew O.
AU - Howard, Barbara V.
AU - Umans, Jason G.
AU - Shara, Nawar M.
AU - Francesconi, Kevin A.
AU - Goessler, Walter
AU - Crainiceanu, Ciprian M.
AU - Silbergeld, Ellen K.
AU - Guallar, Eliseo
AU - Navas-Acien, Ana
PY - 2012/11/1
Y1 - 2012/11/1
N2 - This study evaluated the association of arsenic exposure, as measured in urine, with diabetes prevalence, glycated hemoglobin, and insulin resistance in American Indian adults from Arizona, Oklahoma, and North and South Dakota (1989-1991). We studied 3,925 men and women 45-74 years of age with available urine arsenic measures. Diabetes was defined as a fasting glucose level of 126 mg/dL or higher, a 2-hour glucose level of 200 mg/dL or higher, a hemoglobin A1c (HbA1c) of 6.5 or higher, or diabetes treatment. Median urine arsenic concentration was 14.1 g/L (interquartile range, 7.9-24.2). Diabetes prevalence was 49.4. After adjustment for sociodemographic factors, diabetes risk factors, and urine creatinine, the prevalence ratio of diabetes comparing the 75th versus 25th percentiles of total arsenic concentrations was 1.14 (95 confidence interval: 1.08, 1.21). The association between arsenic and diabetes was restricted to participants with poor diabetes control (HbA1c <8). Arsenic was positively associated with HbA1c levels in participants with diabetes. Arsenic was not associated with HbA1c or with insulin resistance (assessed by homeostatic model assessment to quantify insulin resistance) in participants without diabetes. Urine arsenic was associated with diabetes control in a population from rural communities in the United States with a high burden of diabetes. Prospective studies that evaluate the direction of the relation between poor diabetes control and arsenic exposure are needed.
AB - This study evaluated the association of arsenic exposure, as measured in urine, with diabetes prevalence, glycated hemoglobin, and insulin resistance in American Indian adults from Arizona, Oklahoma, and North and South Dakota (1989-1991). We studied 3,925 men and women 45-74 years of age with available urine arsenic measures. Diabetes was defined as a fasting glucose level of 126 mg/dL or higher, a 2-hour glucose level of 200 mg/dL or higher, a hemoglobin A1c (HbA1c) of 6.5 or higher, or diabetes treatment. Median urine arsenic concentration was 14.1 g/L (interquartile range, 7.9-24.2). Diabetes prevalence was 49.4. After adjustment for sociodemographic factors, diabetes risk factors, and urine creatinine, the prevalence ratio of diabetes comparing the 75th versus 25th percentiles of total arsenic concentrations was 1.14 (95 confidence interval: 1.08, 1.21). The association between arsenic and diabetes was restricted to participants with poor diabetes control (HbA1c <8). Arsenic was positively associated with HbA1c levels in participants with diabetes. Arsenic was not associated with HbA1c or with insulin resistance (assessed by homeostatic model assessment to quantify insulin resistance) in participants without diabetes. Urine arsenic was associated with diabetes control in a population from rural communities in the United States with a high burden of diabetes. Prospective studies that evaluate the direction of the relation between poor diabetes control and arsenic exposure are needed.
KW - American Indians
KW - arsenic
KW - diabetes
KW - glycated hemoglobin
KW - insulin resistance
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U2 - 10.1093/aje/kws153
DO - 10.1093/aje/kws153
M3 - Article
C2 - 23097256
AN - SCOPUS:84869013238
SN - 0002-9262
VL - 176
SP - 865
EP - 874
JO - American Journal of Epidemiology
JF - American Journal of Epidemiology
IS - 10
ER -