Endocrine-disrupting chemicals, risk of type 2 diabetes, and diabetes-related metabolic traits: A systematic review and meta-analysis

J Diabetes. 2016 Jul;8(4):516-32. doi: 10.1111/1753-0407.12325. Epub 2015 Sep 1.


Background: Elevated blood or urinary concentrations of endocrine-disrupting chemicals (EDCs) may be related to increased risk of type 2 diabetes (T2D). The aim of the present study was to assess the role of EDCs in affecting risk of T2D and related metabolic traits.

Methods: MEDLINE was searched for cross-sectional and prospective studies published before 8 March 2014 into the association between EDCs (dioxin, polychlorinated biphenyl [PCB], chlorinated pesticide, bisphenol A [BPA], phthalate) and T2D and related metabolic traits. Three investigators independently extracted information on study design, participant characteristics, EDC types and concentrations, and association measures.

Results: Forty-one cross-sectional and eight prospective studies from ethnically diverse populations were included in the analysis. Serum concentrations of dioxins, PCBs, and chlorinated pesticides were significantly associated with T2D risk; comparing the highest to lowest concentration category, the pooled relative risks (RR) were 1.91 (95% confidence interval [CI] 1.44-2.54) for dioxins, 2.39 (95% CI 1.86-3.08) for total PCBs, and 2.30 (95% CI 1.81-2.93) for chlorinated pesticides. Urinary concentrations of BPA and phthalates were also associated with T2D risk; comparing the highest to lowest concentration categories, the pooled RR were 1.45 (95% CI 1.13-1.87) for BPA and 1.48 (95% CI 0.98-2.25) for phthalates. Further, EDC concentrations were associated with indicators of impaired fasting glucose and insulin resistance.

Conclusions: Persistent and non-persistent EDCs may affect the risk of T2D. There is an urgent need for further investigation of EDCs, especially non-persistent ones, and T2D risk in large prospective studies.

Keywords: bisphenol A; diabetes; endocrine-disrupting chemical; meta-analysis; meta分析; phthalate; 内分泌干扰物; 双酚A; 糖尿病; 邻苯二甲酸盐.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Benzhydryl Compounds / blood
  • Benzhydryl Compounds / urine
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / blood*
  • Diabetes Mellitus, Type 2 / chemically induced
  • Diabetes Mellitus, Type 2 / urine*
  • Dioxins / blood
  • Dioxins / urine
  • Endocrine Disruptors / blood*
  • Endocrine Disruptors / poisoning
  • Endocrine Disruptors / urine*
  • Humans
  • Phenols / blood
  • Phenols / urine
  • Phthalic Acids / blood
  • Phthalic Acids / urine
  • Polychlorinated Biphenyls / blood
  • Polychlorinated Biphenyls / urine
  • Prospective Studies
  • Risk Assessment / methods
  • Risk Factors


  • Benzhydryl Compounds
  • Dioxins
  • Endocrine Disruptors
  • Phenols
  • Phthalic Acids
  • phthalic acid
  • Polychlorinated Biphenyls
  • bisphenol A