Endocrine-disrupting chemicals and risk of diabetes: an evidence-based review

Diabetologia. 2018 Jul;61(7):1495-1502. doi: 10.1007/s00125-018-4621-3. Epub 2018 May 9.


The purpose of this study was to review the epidemiological and experimental evidence linking background exposure to a selection of environmental endocrine-disrupting chemicals (EDCs) with diabetes and impaired glucose metabolism. The review summarises the literature on both cross-sectional and prospective studies in humans, as well as experimental in vivo and in vitro studies. The findings were subjected to evidence grading according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification. We found >40 cross-sectional and seven prospective studies regarding EDCs and risk of diabetes. Taken together, there is moderate evidence for a relationship between exposure to dichlorodiphenyldichloroethylene (p,p'-DDE), a metabolite of the pesticide dichlorodiphenyltrichloroethane, and diabetes development. Regarding polychlorinated biphenyls (PCBs), it is likely that the rodent models used are not appropriate, and therefore the evidence is poorer than for p,p'-DDE. For other EDCs, such as bisphenol A, phthalates and perfluorinated chemicals, the evidence is scarce, since very few prospective studies exist. Brominated flame retardants do not seem to be associated with a disturbed glucose tolerance. Thus, evidence is accumulating that EDCs might be involved in diabetes development. Best evidence exists for p,p'-DDE. For other chemicals, both prospective studies and supporting animal data are still lacking.

Keywords: BPA; Bisphenol A; Chemicals; DDE; DDT; Diabetes; EDCs; Endocrine-disrupting chemicals; Pesticides; Review.

Publication types

  • Review

MeSH terms

  • Animals
  • Benzhydryl Compounds / toxicity
  • DDT / toxicity
  • Diabetes Mellitus / epidemiology
  • Dichlorodiphenyl Dichloroethylene / toxicity
  • Endocrine Disruptors / toxicity*
  • Glucose Tolerance Test
  • Humans
  • Phenols / toxicity


  • Benzhydryl Compounds
  • Endocrine Disruptors
  • Phenols
  • Dichlorodiphenyl Dichloroethylene
  • DDT
  • bisphenol A