Exposure to cholinesterase inhibiting insecticides and blood glucose level in a population of Ugandan smallholder farmers

Abstract

<jats:sec><jats:title>Objectives</jats:title><jats:p>The risk of diabetes mellitus may be elevated among persons exposed to some pesticides, including cholinesterase-inhibiting insecticides (organophosphates and carbamates). The objective of this study was to investigate how acetylcholinesterase activity was associated with mean blood glucose levels among smallholder farmers in Uganda.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We conducted a short-term follow-up study among 364 smallholder farmers in Uganda. Participants were examined three times from September 2018 to February 2019. At each visit, we measured glycosylated haemoglobin A (HbA<jats:sub>1c</jats:sub>) as a measure of long-term average blood glucose levels. Exposure to organophosphate and carbamate insecticides was quantified using erythrocyte acetylcholinesterase normalised by haemoglobin (AChE/Hb). For a subgroup of participants, fasting plasma glucose (FPG) was also available. We analysed HbA<jats:sub>1c</jats:sub> and FPG versus AChE/Hb in linear mixed and fixed effect models adjusting for age, sex, physical activity level, and consumption of fruits and vegetables, alcohol and tobacco.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Contrary to our hypothesis, our mixed effect models showed significant correlation between low AChE/Hb and low HbA<jats:sub>1c</jats:sub>. Adjusted mean HbA<jats:sub>1c</jats:sub> was 0.74 (95% CI 0.17 to 1.31) mmol/mol lower for subjects with AChE/Hb=24.3 U/g (35th percentile) compared with subjects with AChE/Hb=25.8 U/g (50th percentile). Similar results were demonstrated for FPG. Fixed effect models showed less clear correlations for between-phase changes in AChE/Hb and HbA<jats:sub>1c</jats:sub>.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our results do not clearly support a causal link between exposure to cholinesterase-inhibiting insecticides and elevated blood glucose levels (expressed as HbA<jats:sub>1c</jats:sub> and FPG), but results should be interpreted with caution due to the risk of reverse causality.</jats:p></jats:sec>

HemoDownloader: Open source software utility to extract data from HemoCue HbA1c 501 devices in epidemiological studies of diabetes mellitus

“…Hence, more than 1000 HbA 1c analyses were conducted during the study. Study findings have been reported elsewhere [5,6].…”

“…Point-of-care devices for the measurement of HbA 1c exist and have the potential to simplify data collection for studies of diabetes mellitus in such settings. Our partners and we recently carried out an epidemiological study on glycemic regulation in Uganda [5,6]. Our main outcome was HbA 1c , determined by the point-of-care device HemoCue HbA1c 501 (HemoCue AB, Ä ngelholm, Sweden, www.hemocue.com).…”

Organophosphate and carbamate insecticide exposure is related to lung function change among smallholder farmers: a prospective study

“…The PEXADU project population has a relatively high exposure to pesticides due to a lack of training on proper handling of pesticides and poor use of personal protective equipment. 14 Further studies are needed to investigate whether similar effects can be demonstrated in lower-exposed populations.…”

“…The study was conducted as part of the 'Pesticide Exposure, Asthma and Diabetes in Uganda' (PEXADU) project, 14 a shortterm cohort study among members of two organisations of smallholder farmers from the Wakiso District in central Uganda-one for conventional farmers, and one for farmers working towards organic certification. We recruited participants from these two organisations to minimise confounding from sociodemographic variables while maximising insecticide exposure contrast.…”

Precision and accuracy of FEV1 measurements from the Vitalograph copd-6 mini-spirometer in a healthy Ugandan population

“…Data was collected as a part of the "Pesticide Exposure, Asthma and Diabetes in Uganda" (PEXADU) project, which was a study on the possible associations between pesticide exposure, pulmonary function and diabetes in a cohort of smallholder farmers in Uganda [5][6][7]. Details regarding participant recruitment and inclusion/exclusion have been presented elsewhere [5][6][7]. In brief, we recruited 364 farmers from the Wakiso District in central Uganda with the help of two local farmer's organizations.…”