The potential for persistent organic pollutants (POPs), including dioxins and dioxin-like polychlorinated biphenyls (DL-PCBs), to increase the risk of incident diabetes in adults has been extensively studied. However, there is substantial variability in the reported associations both between and within studies. Emerging data from rodent studies suggest that dioxin disrupts glucose homeostasis in a sex-specific manner. Thus, we performed a review and meta-analysis of relevant epidemiological studies to investigate sex differences in associations between dioxin or DL-PCB exposure and type 2 diabetes incidence. Articles that met our selection criteria (n = 81) were organized into the following subcategories: data stratified by sex (n = 13), unstratified data (n = 45), and data from only 1 sex (n = 13 male, n = 10 female). We also considered whether exposure occurred either abruptly at high concentrations through a contamination event (“disaster exposure”) or chronically at low concentrations (“non-disaster exposure”). There were 8 studies that compared associations between dioxin/DL-PCB exposure and diabetes risk in males versus females within the same population. When all sex-stratified or single-sex studies were considered in the meta-analysis (n = 18), the summary relative risk (RR) for incident diabetes among those exposed relative to reference populations was 1.78 (95% CI = 1.37–2.31) and 1.95 (95% CI = 1.56–2.43) for female and males, respectively. However, when we restricted the meta-analysis to disaster-exposed populations, the RR was higher in females than males (2.86 versus 1.59, respectively). In contrast, in non-disaster exposed populations the RR for females was lower than males (1.40 and 2.02, respectively). Our meta-analysis suggests that there are sex differences in the associations between dioxin/DL-PCBs exposure and incident diabetes, and that the mode of exposure modifies these differences.

The relationship between persistent organic pollutants (POPs), including dioxins and dioxin-like polychlorinated biphenyls (DL-PCBs), and diabetes incidence in adults has been extensively studied. However, significant variability exists in the reported associations both between and within studies. Emerging data from rodent studies suggest that dioxin exposure disrupts glucose homeostasis in a sex-specific manner. Thus, we performed a meta-analysis of relevant epidemiological studies to investigate whether there are sex-specific associations between dioxin or DL-PCB exposure and type 2 diabetes incidence. Articles were organized into the following subcategories: data stratified by sex (16%), unstratified data (56%), and data from only 1 sex (16% male, 12% female). We also considered whether exposure occurred either abruptly at high levels through a contamination event (disaster exposure) or chronically at background levels (non-disaster exposure). Only 8 studies compared associations between dioxin/DL-PCB exposure and diabetes risk in males versus females within the same population. When all sex-stratified or single sex studies were considered in the meta-analysis, the summary odds ratio (OR) for increased diabetes risk was similar between females and males (1.78 and 1.95, respectively) when comparing exposed to reference populations, suggesting that this relationship is not sex-specific. However, when we considered disaster-exposed populations separately, the association differed substantially between sexes, with females showing a much higher OR than males (2.86 and 1.59, respectively). Moreover, the association between dioxin/DL-PCB exposure and diabetes was stronger for females than males in disaster-exposed populations. In contrast, both sexes had significantly increased ORs in non-disaster exposure populations and the OR for females was lower than males (1.40 and 2.02, respectively). Our review emphasizes the importance of considering sex differences, as well as the mode of pollutant exposure, when exploring the relationship between pollutant exposure and diabetes in epidemiological studies.