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Arsenic exposure, diabetes prevalence, and diabetes control in the Strong Heart Study.

by Howard, Barbara V; Umans, Jason G; Shara, Nawar M.
Citation: American Journal of Epidemiology. 176(10):865-74, 2012 Nov 15..Journal: American journal of epidemiology.ISSN: 0002-9262.Full author list: Gribble MO; Howard BV; Umans JG; Shara NM; Francesconi KA; Goessler W; Crainiceanu CM; Silbergeld EK; Guallar E; Navas-Acien A.UI/PMID: 23097256.Subject(s): Aged | Arizona/ep [Epidemiology] | *Arsenicals/ae [Adverse Effects] | Arsenicals/ur [Urine] | Blood Glucose/an [Analysis] | Creatinine/ur [Urine] | Diabetes Mellitus/ci [Chemically Induced] | *Diabetes Mellitus/ep [Epidemiology] | Diabetes Mellitus/th [Therapy] | *Environmental Exposure/ae [Adverse Effects] | Environmental Exposure/sn [Statistics & Numerical Data] | Female | Hemoglobin A, Glycosylated/an [Analysis] | Humans | Indians, North American/sn [Statistics & Numerical Data] | Male | Middle Aged | North Dakota/ep [Epidemiology] | Oklahoma/ep [Epidemiology] | Poisson Distribution | Prevalence | Regression Analysis | Risk Factors | South Dakota/ep [Epidemiology]Institution(s): MedStar Health Research InstituteActivity type: Journal Article.Medline article type(s): Journal Article | Research Support, N.I.H., ExtramuralOnline resources: Click here to access online Digital Object Identifier: http://dx.doi.org/10.1093/aje/kws153 (Click here) Abbreviated citation: Am J Epidemiol. 176(10):865-74, 2012 Nov 15.Local Holdings: Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006.Abstract: 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.

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