Endocrine Disruptors Cited as Diabetes Risk in Southeast Asia

Miriam E Tucker

November 25, 2015

The potential contribution of environmental endocrine-disrupting chemicals to the type 2 diabetes epidemic in Southeast Asia needs to be better characterized and addressed, four scientists from the region and the United Kingdom stress in a new commentary.

The study was published online November 10 in Lancet Diabetes & Endocrinology by Robert Gifford, PhD, a research fellow at the University of Edinburgh, Scotland, and University of Peradeniya, Sri Lanka, and colleagues.

Increasing evidence supports a possible link between exposure to endocrine-disrupting chemicals, such as pesticides and solvents, and the development of endocrine and metabolic disorders, including obesity and type 2 diabetes. In vitro data have shown that such chemicals can disrupt energy metabolism, beta-cell glucose sensing, and skeletal-muscle insulin sensitivity and trigger hepatitis.

Although most of these data come from high-income countries, the use of endocrine-disrupting chemicals is more widespread and less regulated in Southeast Asia, while at the same time, the region has the highest mortality from diabetes in the world, the authors say.

"There is a desperate need for relevant research from Southeast Asia to be published to help governments, industry, and other policymakers examine whether the current trends are contributing to the increase in diabetes," Dr Gifford told Medscape Medical News.

A Number of Factors Exacerbating the Problem

A number of factors in Southeast Asia could be exacerbating the endocrine-disruptor exposure problem. These include both human-caused exposure from dumping and suboptimal storage of chemicals and acts of nature such as monsoon rains that spread the chemicals, particularly in high-population areas.

Moreover, Dr Gifford and colleagues note, economic forces have contributed to the escalating use of some of these chemicals in industries such as manufacturing and farming.

However, as of now the evidence for cause and effect is not sufficient to give advice on what substances to avoid, he said.

In 2009, the US Endocrine Society issued a statement concluding that comprehensive research was needed to identify means of exposure and mechanisms of endocrine disruption. They recommended the urgent adoption of policies to reduce exposure and recently strengthened this advice.

In 2012, the World Health Organization issued a report echoing the conclusions of the Endocrine Society.

However, neither publication addressed the association between endocrine-disrupting chemicals and diabetes, nor did they include any data from Southeast Asia.

"We are concerned that the current mainstream literature on [endocrine-disrupting chemicals] has a paucity of discussion of diabetes when this is such a great global health concern. Furthermore, we are concerned there is a lack of evidence from developing countries, like [those in] Southeast Asia, where the effects of such diseases are felt more acutely," Dr Gifford said.

The authors are currently undertaking a pilot prospective study in Sri Lanka and hope to publish the results next year, and one or two other groups are doing related work.

"We hope to take this forward collaboratively; however, there are too many chemicals and too few studies," Dr Gifford lamented.

"It is our observation that clinicians in Southeast Asia are well placed and highly capable of producing the kind of data that would affect real progress in understanding endocrine-disrupting chemical etiology and diabetes."

"So we are really keen to involve them in trying to understand the effects of industrialization, globalization, and the 'green revolution' in diabetes and obesity," the scientists conclude.

The authors have reported no relevant financial relationships.

Lancet Diabetes Endocrinol. Published online November 10, 2015. Full text


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