Epidemiology of air pollution and diabetes

• Diabetic patients may be more vulnerable to ambient air pollution exposure effects.
• Studies have linked air pollution exposure to type 2 diabetes development.
• Studies on insulin resistance, glycemic control, and gestational diabetes support this notion.

Air pollution affects a large proportion of the global population. Air pollutants are hypothesized to exert their effects via impaired endothelial function, elevated systemic inflammation, mitochondrial dysfunction, and oxidative stress, all of which are hallmarks of type 2 diabetes (T2D). Here we review epidemiological studies aimed at answering whether diabetes patients are more vulnerable to ambient (outdoor) air pollution exposure and whether air pollution is associated with diabetes development or other predisposing conditions for T2D. Current evidence suggests an association between air pollution exposure and T2D, but more critical analysis is warranted. Understanding the associations between air pollution exposure and the development of T2D is critical in our efforts to control sources of air pollution and their impact on the disease.