Relationships between exposure to polyhalogenated aromatic hydrocarbons and organochlorine pesticides and the risk for developing type 2 diabetes: a systematic review and a meta-analysis of exposures to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)

A systematic review was performed to evaluate the association between environmental exposures to polyhalogenated aromatic hydrocarbons (PHAHs) and organochlorine (OC) pesticides and the risk for type 2 diabetes (T2D). Searches of EMbase, Google Scholar, Medline, and Scopus were performed. Reports were included if they were original human studies whose design included a control group and if the sample size was larger than 10 participants per group. The articles were excluded if the type of diabetes was unknown or Type 1. Odds ratios (OR), 95% confidence intervals (CI), and modified Naranjo scores for the effects of environmental contaminants were determined for each study. Of the 35 eligible studies, six were included in the meta-analysis; these focused specifically on 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Meta-analysis of these studies showed no significant increased OR for the development of T2D from exposure to TCDD. However, subgroup analysis showed significant elevated OR for the development of T2D if exposure is repeated and accompanied by exposure to other persistent pesticides (OR = 1.48; 1.10-1.90) but a decreased odds for T2D with exposure resulting from accidental exposure (OR = 0.46; 0.39-0.52). Our results suggest that there are significant risks of developing T2D in populations with recurring exposures to TCDD in concert with other persistent chlorinated pesticides. A mean Naranjo score of 2.0 was determined for all 35 articles; this score was 2.5 when examining only TCDD studies and 2.1 when examining studies that looked only at T2D. Each of these Naranjo scores suggests a possible association between the prevalence of T2D and exposure to PHAHs or OC pesticides.