Exposure to the pesticide DDT and risk of diabetes and hypertension: Systematic review and meta-analysis of prospective studies

Int J Hyg Environ Health. 2022 Jan:239:113865. doi: 10.1016/j.ijheh.2021.113865. Epub 2021 Oct 23.


Background: Experimental evidence suggests that p,p'-DDE might be involved in the development of diabetes and hypertension (HTN); however, the evidence in humans is inconclusive.

Objective: To summarize the epidemiological evidence for the association of p,p'-DDT exposure and its breakdown products with the risk of diabetes and HTN from prospective studies.

Methods: We performed a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Eligible studies (prospective) were search in PubMed, Web of Science, EBSCO, and SciELO databases (July 11, 2020). Different search algorithms were used for diabetes and HTN. Pooled odds ratios (ORs) were estimated from meta-analysis with random effects for each exposure and outcome.

Results: A total of 23 prospective studies were included in this review, 16 assessed diabetes and seven HTN; very few measured p,p'-DDT. Exposure to p,p'-DDE was associated with a slightly increased risk of type 2 diabetes (T2D) (pooled OR = 1.44; 95%CI: 1.00, 2.07; p = 0.049) and HTN (pooled OR = 1.21; 95%CI: 1.07, 1.38). Dose-response meta-analysis suggested a non-linear relation between p,p'-DDE and T2D. Exposure to p,p'-DDE was not associated with gestational diabetes (pooled OR = 1.01; 95%CI: 0.94, 1.09); similarly, p,p'-DDT was not associated with T2D (pooled OR = 1.03; 95%CI: 0.79, 1.35).

Conclusions: Evidence from prospective studies suggests that exposure to p,p'-DDE, the main breakdown product of p,p'-DDT, might increase the risk of developing T2D; such increase may be apparent only at low levels. Exposure to p,p'-DDE may also increase the risk of having HTN; however, further evidence is required.

Keywords: Diabetes mellitus; Dose-response; Hypertension; Meta-analysis; Type 2 diabetes; p,p’-DDE; p,p’-DDT.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • DDT
  • Diabetes Mellitus, Type 2* / epidemiology
  • Dichlorodiphenyl Dichloroethylene
  • Humans
  • Hypertension* / epidemiology
  • Pesticides*
  • Prospective Studies


  • Pesticides
  • Dichlorodiphenyl Dichloroethylene
  • DDT