Long-Term Exposure to Ambient Air Pollution and Type 2 Diabetes in Adults

  • Robin C. PuettEmail author
  • Lesliam Quirós-Alcalá
  • Jessica A Montresor-López
  • Nedelina Tchangalova
  • Anindita Dutta
  • Devon Payne-Sturges
  • Jeff D. Yanosky
Environmental Epidemiology (F Laden and J Hart, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Environmental Epidemiology


Purpose of Review

We identified 24 publications from January 2010 until September 2018 in the peer-reviewed literature addressing the relationship of long-term air pollution exposures and type 2 diabetes-related morbidity and mortality among adults. We examine key methodological issues, synthesize findings, and address study strengths and limitations. We also discuss biological mechanisms, policy implications, and future research needed to address existing knowledge gaps.

Recent Findings

In general, the studies included in this review employed rigorous methodology with large sample sizes, appropriate study designs to maximize available cohort study or administrative data sources, and exposure modeling that accounted for spatial patterns in air pollution levels. Overall, studies suggested increased risks of type 2 diabetes-related morbidity and mortality among adults associated with increased exposures; however, findings were not uniformly positive nor statistically significant.


Current research is particularly limited regarding the biological mechanisms involved and the relationship between ozone and diabetes. Additionally, more research is needed to distinguish clearly the effects of nitrogen oxides from those of other pollutants and to identify potential subpopulations with greater susceptibility for certain pollutant exposures. A better understanding of the potential link between long-term ambient air pollution exposures and type 2 diabetes may provide opportunities for the reduction of health risks and inform future interventions for environmental protection and diabetes management.


Air pollution Type 2 diabetes Chronic exposures 


Compliance with Ethical Standards

Conflict of Interest

Robin Puett received an honorarium and travel expenses to present part of this work at the Health Effects Institute Conference in April 2018. Lesliam Quiros-Alcala, Jessica Montresor-Lopez, Nedelina Tchangalova, Anindita Dutta, Devon Payne-Sturges and Jeff Yanosky each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Supplementary material

40471_2019_184_MOESM1_ESM.docx (42 kb)
ESM 1 (DOCX 41 kb)


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Robin C. Puett
    • 1
    Email author
  • Lesliam Quirós-Alcalá
    • 1
  • Jessica A Montresor-López
    • 1
  • Nedelina Tchangalova
    • 2
  • Anindita Dutta
    • 3
  • Devon Payne-Sturges
    • 1
  • Jeff D. Yanosky
    • 4
  1. 1.Maryland Institute for Applied Environmental HealthUniversity of Maryland School of Public HealthCollege ParkUSA
  2. 2.STEM LibraryUniversity of MarylandCollege ParkUSA
  3. 3.Department of MedicineUniversity of ChicagoChicagoUSA
  4. 4.Division of Epidemiology, Department of Public Health SciencesPennsylvania State University College of MedicineHersheyUSA

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