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Diabetologia. 2019 Oct;62(10):1811-1822. doi: 10.1007/s00125-019-4940-z. Epub 2019 Aug 27.

Environmental neglect: endocrine disruptors as underappreciated but potentially modifiable diabetes risk factors.

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Division of Endocrinology, Diabetes, and Metabolism Department of Medicine, University of Illinois at Chicago, 835 S. Wolcott, Suite E625; M/C 640, Chicago, IL, 60612, USA.
ChicAgo Center for Health and EnvironmenT (CACHET), University of Illinois at Chicago, Chicago, IL, USA.
Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Center of Excellence in Environmental Toxicology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.


Type 2 diabetes prevalence is increasing dramatically across the globe, imposing a tremendous toll on individuals and healthcare systems. Reversing these trends requires comprehensive approaches to address both classical and emerging diabetes risk factors. Recently, environmental toxicants acting as endocrine-disrupting chemicals (EDCs) have emerged as novel metabolic disease risk factors. EDCs implicated in diabetes pathogenesis include various inorganic and organic molecules of both natural and synthetic origin, including arsenic, bisphenol A, phthalates, polychlorinated biphenyls and organochlorine pesticides. Indeed, evidence implicates EDC exposures across the lifespan in metabolic dysfunction; moreover, specific developmental windows exhibit enhanced sensitivity to EDC-induced metabolic disruption, with potential impacts across generations. Importantly, differential exposures to diabetogenic EDCs likely also contribute to racial/ethnic and economic disparities. Despite these emerging links, clinical practice guidelines fail to address this underappreciated diabetes risk factor. Comprehensive approaches to stem the tide of diabetes must include efforts to address its environmental drivers.


Beta cell; Bisphenol A; Diabetes; Endocrine disruptor; Endocrine-disrupting chemical; Environmental justice; Glucose; Insulin; Life course development; Review


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