TY  - BOOK
AU  - Howard, Barbara V
AU  - Shara, Nawar M
AU  - Umans, Jason G
TI  - Arsenic exposure, diabetes prevalence, and diabetes control in the Strong Heart Study
SN  - 0002-9262
KW  - *Arsenicals/ae [Adverse Effects]
KW  - *Diabetes Mellitus/ep [Epidemiology]
KW  - *Environmental Exposure/ae [Adverse Effects]
KW  - Aged
KW  - Arizona/ep [Epidemiology]
KW  - Arsenicals/ur [Urine]
KW  - Blood Glucose/an [Analysis]
KW  - Creatinine/ur [Urine]
KW  - Diabetes Mellitus/ci [Chemically Induced]
KW  - Diabetes Mellitus/th [Therapy]
KW  - Environmental Exposure/sn [Statistics & Numerical Data]
KW  - Female
KW  - Hemoglobin A, Glycosylated/an [Analysis]
KW  - Humans
KW  - Indians, North American/sn [Statistics & Numerical Data]
KW  - Male
KW  - Middle Aged
KW  - North Dakota/ep [Epidemiology]
KW  - Oklahoma/ep [Epidemiology]
KW  - Poisson Distribution
KW  - Prevalence
KW  - Regression Analysis
KW  - Risk Factors
KW  - South Dakota/ep [Epidemiology]
KW  - MedStar Health Research Institute
KW  - Journal Article
KW  - Research Support, N.I.H., Extramural
N1  - Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006
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
UR  - http://dx.doi.org/10.1093/aje/kws153
ER  -