Long-term environmental exposures and Diabetes Mellitus type 2 incidence in over 240,000 Dutch adults

Environmental exposures have been associated with type 2 diabetes (DM-2) prevalence, but associations for incidence remain inconclusive. This study examined the associations between environmental exposures (e.g. air pollution, greenness and traffic noise) and DM-2 incidence in a population where associations of these exposures with DM-2 prevalence have previously been established.

Data of 249,495 Dutch individuals who participated in the Public Health Monitor in 2012 were used, enriched with data on air pollution, greenness, road traffic noise, and obesogenic environment. The incidence of DM-2 was based on medication prescriptions from 2013 to 2022. Cox regression models were performed to investigate the association between the exposures and DM-2 incidence. Potential effect modification by age (<40 years, 40-64 years, 65-79 years and ≥80 years) and sex was examined.

No significant associations were observed between the exposures and DM-2 incidence in the total population. No significant associations were also observed across age groups and men and women, except that greenness was statistically significantly associated with a lower DM-2 incidence (Hazard Ratio per interquartile range (HR_IQR) = 0.96, 95% confidence interval (CI) = [0.92; 1.00]) in individuals aged 40-64 years.

In conclusion, a wide range of environmental exposures were not associated with DM-2 incidence. Therefore, our study on DM-2 incidence does not support the previously identified associations between environmental exposures and DM-2 prevalence.