Secular trends in global burden of diabetes attributable to particulate matter pollution from 1990 to 2019

Increasing evidence suggests an association between fine particulate matter (PM_2.5) exposure and type 2 diabetes mellitus. However, there is still a lack of comparative evaluation regarding diabetes burden due to ambient and indoor PM_2.5 pollution at a global scale. This study attempts to provide a systematic and comprehensive profile for PM_2.5-attributable burden of diabetes and its spatiotemporal trends, globally and regionally. Comparative estimates of diabetes attributable to ambient PM_2.5 and household air pollution (HAP) from solid fuels for 204 countries and territories were derived from the Global Burden of Disease Study 2019. Globally, 292.5 (95% uncertainty interval: 207.1, 373.4) thousand deaths and 13.0 (9.1, 17.2) million disability-adjusted life years (DALYs) from diabetes were attributed to PM_2.5 pollution in 2019, wherein more than two-thirds (67.3% deaths and 69.7% DALYs) were contributed by ambient PM_2.5. Compared to 1990, age-standardized DALY rate (ASDR) in 2019 attributable to ambient PM_2.5 increased by 85.9% (APC: 2.21% [2.15, 2.27]), while HAP-associated ASDR decreased by 37.9% (APC: - 1.66% [- 1.82, - 1.50]). We observed a negative correlation between SDI and APC in ASMR (r_s =  - 0.5, p < 0.001) and ASDR (r_s = -0.4, p < 0.001) among 204 countries and territories. HAP-related diabetes experienced a sharp decline during 1990-2019, while global burden of diabetes attributable to ambient PM_2.5 was rising rapidly. The elderly and people in low-SDI countries suffered from the greatest burden of diabetes due to PM_2.5 pollution. More targeted interventions should be taken by governments to reduce PM_2.5 exposure and related diabetes burden.