Prevalence of non-insulin-dependent diabetes mellitus and related vascular diseases in southwestern arseniasis-endemic and nonendemic areas in Taiwan.

Abstract

There is evidence indicating that ingestion of arsenic may predispose the development of diabetes mellitus in arsenic-endemic areas in Taiwan. However, the prevalence of diabetes and related vascular diseases in the entire southwestern arseniasis-endemic and nonendemic areas remains to be elucidated. We used the National Health Insurance Database for 1999-2000 to derive the prevalence of non-insulin-dependent diabetes and related vascular diseases by age and sex among residents in southwestern arseniasis-endemic and nonendemic areas in Taiwan. The study included 66,667 residents living in endemic areas and 639,667 in nonendemic areas, all ≥ 25 years of age. The status of diabetes and vascular diseases was ascertained through disease diagnosis and treatment prescription included in the reimbursement claims of clinics and hospitals. The prevalence of non-insulin-dependent diabetes, age-and gender-adjusted to the general population in Taiwan, was 7.5% (95% confidence interval, 7.4-7.7%) in the arseniasis-endemic areas and 3.5% (3.5-3.6%) in the nonendemic areas. Among both diabetics and nondiabetics, higher prevalence of microvascular and macrovascular diseases was observed in arseniasis-endemic than in the nonendemic areas. Age-and gender-adjusted prevalence of microvascular disease in endemic and nonendemic areas was 20.0% and 6.0%, respectively, for diabetics, and 8.6% and 1.0%, respectively, for nondiabetics. The corresponding prevalence of macrovascular disease was 25.3% and 13.7% for diabetics, and 12.3% and 5.5% for nondiabetics. Arsenic has been suggested to increase the risk of non-insulin-dependent diabetes mellitus and its related micro-and macrovascular diseases.

Diabetes mellitus among arsenic exposed and non-exposed young adults in Bangladesh

“…3 Several studies have reported an association with arsenic exposure and diabetes mellitus. [3][4][5][6][7][8] Association of arsenic exposure with non-communicable diseases including Worldwide prevalence of diabetes mellitus is increasing in alarming way and is becoming a top cause of death. Every six seconds a person dies due to diabetes and it is projected that by 2030 diabetes will be the 7th leading cause of death.…”

“…14 In different studies, higher prevalence of diabetes mellitus was found amongst the arsenic exposed population compared to that of an arsenic non-exposed population. [4][5][6][7] A study conducted in Bangladesh also revealed such association amongst the arsenic exposed population having keratosis due to chronic arsenic toxicity. 9 Arsenicosis, the illness due to chronic arsenic toxicity is reported to occur more commonly amongst the young adults.…”

TOTAL AND MAIN As SPECIES PRESENT IN CARDIOVASCULAR TISSUES OF PEOPLE LIVINGIN As CONTAMINATED AREAS

“…Vascular diseases, abnormal pigmentation, Raynand´s syndrome, acrocyanosis, hyperkeratosis, gangrene of fingers, ischemia of the tongue, diabetes, thrombosis, cerebral vascular disease, especially cerebral infarction, coronary artery occlusions, and other cardiovascular diseases (CVD) has been associated with As exposure [10][11][12][23][24][25][26][27][28] . Less common complications such as liver enlargement (hepatomegaly), splenn enlargement (splenomegaly) and fluid in the abdomen (ascitis) also has been cited 29 .…”

Environmental Arsenic Exposure and Diabetes

“…This is somewhat surprising because arsenic exposure has been linked to type 2 diabetes since 1950 when a case report documented a patient developing type 2 diabetes after receiving intravenous arsenical treatment for sexually transmitted diseases. 6 However, research efforts on the role of arsenic in diabetogenesis did not intensify until populationbased epidemiologic studies published in the 1990s from Taiwan [7][8][9] and Bangladesh 10 demonstrated that chronic exposure to high levels of arsenic from drinking water is associated with a higher prevalence of type 2 diabetes.…”

“…Also, extrapolating from chronic high-dose effects to chronic low-dose effects of arsenic exposure on type 2 diabetes was debatable since many of the drinking water wells in Taiwan and Bangladesh contained several hundred micrograms of arsenic per liter. 7,9,10 In this month's issue of JAMA, Navas-Acien et al 11 are the first authors to report a positive association between low-level arsenic exposure and the prevalence of type 2 diabetes in the United States. Using newly available urinary arsenic data from National Health and Nutrition Examination Survey, a population-based survey conducted by the Centers for Disease Control and Prevention that collects information on the health and nutrition of the US population, the authors report a 3.6-fold increase in the odds of diabetes for participants with the highest total urinary arsenic concentrations as compared with participants with the lowest total urinary arsenic concentrations.…”