diabetes

What is it about?

Diabetes mellitus (DM) is a group of metabolic diseases whose causes are complex and not definitively understood. DM may originate from an interaction between genetic and lifestyle risk factors, including excessive caloric intake and diet quality, overweight and obesity, sedentary behaviors, as well as cigarette smoking. However, the possible role of environmental contaminants, and particularly, the effects of the exposure to chemicals during working activities on the disease development and progression remains unclear. Therefore, aim of this paper was to address the state of the art concerning the possible relationships between occupational exposure to specific chemical substances, i.e metals, hydrocarbons, pesticides and dioxins, or the involvement in particular industrial activities and DM development, clinical history and related-mortality. The analysis carried out on available literature data pointed out some positive findings supporting the possible role of the exposure to certain pesticides, i.e. organophosphates, organochlorines, and tetrachlorodibenzo-p-dioxin, employed in several occupational contexts, in affecting DM manifestations. However, some critical aspects, such as the great variety of chemicals and conditions of exposure present in different job activities, and the lack of data regarding the levels of the substances in occupational environments, as well as their concentrations in biological fluids of exposed subjects prevented the extrapolation of a definite exposure-disease causal relationship. In this context, this paper underlines the importance of future research aimed to understand the potential mechanisms of the diabetogenic action of different substances, the relationships between exposure concentrations and possible adverse health effects, as well as individual factors that may increase the susceptibility to DM. A deeper knowledge among all these aspects may be important to clearly evaluate risks related to the chemical exposure in the workplace as well as to plan adequate preventive and protective measures aimed to protect the health of exposed workers, particularly of those categories at increased risk for DM, and to build healthier job conditions for diabetic employees.

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Why is it important?

This paper is the first attempt to comprehensively assess the potential relationship between occupational exposure to chemical substances or specific industrial activities and risk of DM development and progression. This seems important from both an occupational and public health perspective considering the increasing global burden of the disease, that employees are affected in their full adulthood and that DM is associated with long-term complications which may impact quality of life and ability to work, thus inducing direct and indirect costs for the society. Although DM may originate from an interaction between genetic and lifestyle risk factors, the possible influence of environmental contaminants in its pathogenesis cannot be ruled out, as supported by a number of experimental studies. In this scenario, the innovative perspective of this paper is related to the provided analysis, specifically focused on the possible role of occupational chemical exposures in affecting the manifestation, clinical history and outcome of the disease. Although a great number of studies were evaluated, strong evidence and definitive conclusions concerning an exposure-disease causal-relationship can not be extrapolated. However, this paper offers the opportunity to point out some critical aspects important to guide future research. In this context, it underlines the importance to have additional studies aimed to adequately assess the relationship between doses of chemical exposure and DM effects, to define the mechanisms of action of the different chemical substances, to investigate the role of multiple chemical exposures as well to define susceptibility factors, i.e. physiological or pre-existing pathological conditions, which may affect the manifestation and complications of the disease. This review appears an important means able to give stimulus to reach an adequate assessment of the risks to develop DM in different occupational settings as well as to obtain an appropriate management of these risks through the adoption of suitable preventive measures and the encouragement of healthier lifestyle behaviours.

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