Long-term arsenic exposure and incidence of non-insulin-dependent diabetes mellitus: a cohort study in arseniasis-hyperendemic villages in Taiwan.

Tseng, Chin‐Hsiao; Tai, Tong-Yuan; Chong, Choon-Khim; Tseng, Ching‐Ping; Lai, Mei‐Shu; Lin, Boniface J.; Chiou, Hung Yi; Hsueh, Yu Mei; Hsu, Kuang-Hung; Chen, Chien‐Jen

doi:10.1289/ehp.00108847

Cited by 313 publications

(155 citation statements)

References 28 publications

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“…Historically, the evidence describing the association with arsenic exposure and prevalence of diabetes came from community-based studies in Taiwan and Bangladesh, where people were exposed to drinking water contaminated with arsenic. [1][2][3][4] More recently, evidence from the United States, Mexico and Canada have supported this association, [5][6][7][8][9] and a recent meta-analysis found that every 100 mcg/L increment of iAs in drinking water was associated with a 13% increase in the incidence of diabetes. [18] Additionally, there is emerging evidence that arsenic metabolism, as opposed to iAs exposure alone, may play a role in the diabetogenic effects of arsenic.…”

Section: Discussionmentioning

confidence: 94%

“…While the majority of the literature surrounding arsenic-induced DM has involved areas in Taiwan and Bangladesh where the arsenic content of drinking water is high, [1][2][3][4] there have been several other population-based studies in North America that have shown a similar association. [5][6][7][8][9] Here, we present a case of newlydiagnosed DM that was thought to be secondary to chronic arsenic exposure.…”

Section: Introductionmentioning

confidence: 99%

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A case of secondary diabetes mellitus associated with chronic arsenic toxicity

Moorman

Boros

Ciltea³

et al. 2016

CRIM

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Chronic arsenic exposure leads to systemic illness involving multiple organ systems, and has been associated with the development of diabetes mellitus (DM). While the majority of the literature surrounding arsenic-induced DM is from areas where the arsenic content of drinking water is high, population-based studies in North America have shown a similar association. Here, we present a case of newly-diagnosed DM thought to be secondary to chronic arsenic exposure. The patient was a previously healthy 54-year-old female who presented with progressive fatigue, weight loss and anorexia, and eventually developed colitis, cachexia, skin eruptions, and alopecia. She was also diagnosed with DM, and treatment was complicated by episodes of severe hyper-and hypoglycemia. She was evaluated for autoimmune, rheumatologic, oncologic, and infectious etiologies of her symptoms, all of which were negative. Also negative was an extensive workup for secondary causes of DM. During her final hospitalization, she underwent a workup for heavy metal toxicity, which revealed elevated serum (11 mcg/L, reference range < 5 mcg/L) and urine (233.5 mcg/gram creatinine, reference range < 50 mcg/gram creatinine) arsenic levels. A diagnosis of arsenic toxicity was made, and the patient underwent chelation therapy with British anti-Lewisite (BAL). This is an interesting case of DM that was thought to be secondary to chronic arsenic exposure. While BAL was effective at lowering arsenic levels, we were unable to observe clinical improvement due to the patient's death shortly after completion of therapy. In cases where other secondary causes of DM are ruled out, it may be prudent to evaluate for heavy metal toxicity to allow for early diagnosis and initiation of treatment. Further studies are needed to determine the efficacy of different treatment strategies for arsenic-induced DM, and whether resolution of arsenic toxicity will reverse the diabetogenic effects.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

A case of secondary diabetes mellitus associated with chronic arsenic toxicity

Moorman

Boros

Ciltea³

et al. 2016

CRIM

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“…In epidemiologic studies, high chronic exposure to inorganic As in drinking water was associated with diabetes [22,23,24,25]. High chronic exposure to inorganic As in occupational settings was also related to higher levels of glycated hemoglobin [26].…”

Section: Discussionmentioning

confidence: 99%

Adjusting for Urinary Creatinine Overestimates Arsenic Concentrations in Diabetics

Yassine¹,

Kimzey²,

Galligan³

et al. 2011

Cardiorenal Med

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Background/Aims: Arsenic (As) is linked to insulin resistance in animal studies, but the effect of low-level As exposure on the prevalence of diabetes in humans is uncertain. An optimal method to report inorganic As in humans has not been established. Measurements of As in spot urine are usually adjusted to creatinine (Cr). However, urinary Cr is an independent variable in diabetes. Our aims are to optimize reporting of urinary As in the setting of diabetes and insulin resistance. Methods: Urinary inorganic As was measured in 24-hour or first-void spot urine from diabetic (n = 31) and non-diabetic (n = 12) subjects and normalized to Cr or specific gravity (SG). The relation of normalized urinary inorganic As to glycemia and surrogate measures of insulin resistance was investigated. Blood pressure, waist circumference, and glycated hemoglobin were also assessed. Homeostasis model assessment was used to determine insulin resistance. Results: A strong correlation was found between spot urinary As adjusted to Cr (R² = 0.82) or SG (R² = 0.61) to 24-hour urinary As (p < 0.001), while non-adjusted urinary As did not correlate well (R² = 0.03, p = 0.46). Adjusting for Cr revealed significant differences in total 24-hour urinary As when comparing diabetic to normal subjects. In contrast, no differences were found when As was adjusted to SG using either 24-hour or spot urine. Moreover, adjusted urinary spot or 24-hour As measures did not correlate with measures of glycemia or insulin resistance. Conclusions: Urinary Cr is an independent variable in diabetes, therefore adjusting spot As for SG is preferred.

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“…Epidemiological studies of this disease have been reported by Lai et al (1994) and Tseng et al (2000) in Taiwan and Rahman et al (1998) in Bangladesh. Lai et al (1994) found that the prevalence of diabetes mellitus was two times higher in villages consuming water contaminated with inorganic arsenic than the general population of Taiwan.…”

Section: Endocrinementioning

confidence: 99%