Research indicates a strong association between environment and diabetes risk
Heather M. Jones is a freelance writer with a focus on health, parenting, disability, and feminism.
Jenny Sweigard, MD, is a board-certified physician involved in patient care, including general medicine and critical care medicine.
While type 2 diabetes has a large genetic component, the development of the condition is also influenced by environmental factors, including the characteristics of the neighborhood in which a person lives.
Researchers can't say for certain that any individual environmental factor directly causes type 2 diabetes, but studies have found links that suggest some factors play a role in its development.
Read on to learn about how environmental factors such as pollution, infrastructure, and access to healthy food may contribute to the development of type 2 diabetes.
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Type 2 diabetes is believed to result from an interaction of biological, behavioral, and environmental risk factors. Someone’s environment can influence other risk factors. For example, some biological risk factors for type 2 diabetes are abdominal obesity and high blood pressure. Behavioral risk factors include lack of physical activity and regularly eating a diet that contributes to raised blood sugar. Environmental factors such as the layout of a city or the availability of good quality food can contribute to these other risk factors.
On they other hand, an environment that supports healthy lifestyle choices can lessen some of the biological and behavioral risk factors.
The measurable totality of environmental (non-genetic) drivers of disease is called "the exposome." Environmental factors that contribute to the development of health conditions can be divided into classifications such as:
Within these environmental groups, more specific factors can be examined in terms of how they may contribute to type 2 diabetes.
There is some evidence that suggests higher air pollution, particularly exposure to nitrogen dioxide (NO2) and particle matter (PM2.5), may contribute to an increased risk for type 2 diabetes.
Air pollution has been shown to change endothelial (cells that line the blood vessels) function, elevate adipose (body fat) and systemic inflammation, and trigger insulin resistance. It is also associated with obesity and high blood pressure. This can contribute to type 2 diabetes risk.
Several meta-analyses have found associations between chemical pollutants (such as persistent organic pollutants, pesticides, and heavy metals) and an increased risk of type 2 diabetes.
Rates of type 2 diabetes are rising world-wide but are increasing particularly quickly in low and middle-income countries.
Over 60% of the global cases of diabetes are in Asia. The number of people aged 20 to 79 in Asia living with diabetes is expected to increase to approximately 180 million in 2025, compared to approximately 114 million in 2007.
Climate change negatively affects people with diabetes in a number of ways, including:
When discussing a location's access to healthy food, two terms are often mentioned:
The availability, accessibility, and affordability of healthy food influences dietary habits. One cohort study found that the risk of type 2 diabetes decreased by 37% among those with the highest access to healthy food compared with those with the least access.
The physical design of the environment in which a person spends the majority of their time can influence factors that impact type 2 diabetes risk.
Walkability
Walkability refers to how conducive and supportive for walking the location is. Some research has found a connection between living in an area with a higher level of walkability and a lower risk of type 2 diabetes. There is currently not enough data to show whether this lowered risk is caused by increased walkability or only associated with it. For instance, people who are more physically active may choose to live in areas with high walkability rather than walkability promoting physical activity.
Green Space
“Green space” describes outdoor areas, such as forests, parks, and nature spots, that have lots of vegetation and are accessible for physical activities like walking.
Three cross-sectional studies found that neighborhoods with more green space had a lower risk for type 2 diabetes. These studies used the quantity of green space rather than quality to assess. One study found the largest benefit was within areas with 40% to 60% green space land use.
Green space is also associated with stress reduction, which benefits blood glucose management.
Active Transportation
Active transportation consists of walking, biking, and other forms of physical activity used to get from point A to point B. Public transportation is sometimes included under active transportation because there is often walking or other physical activity before and after the ride.
People living in areas with higher levels of active transportation exhibit a reduced risk of cardiovascular disease, hypertension, and type 2 diabetes.
One cohort study that followed 8,576 men for four years found a 27% reduction in risk of developing type 2 diabetes in those who walked approximately twenty minutes to work than those who walked for under ten minutes.
Neighborhoods in which residents feel safe and socially supported, and that are aesthetically pleasing, encourage physical activity.
Research on the specifics of how housing and neighborhood conditions impact the risk for type 2 diabetes has been less clear-cut. More research is needed to determine how factors such as real estate value, population density, crime rates, and physical conditions influence type 2 diabetes risk.
Risk factors for type 2 diabetes don’t impact everyone equally. People who have a low income can be more vulnerable to environmental risk factors. People who belong to racialized groups and those who are recent immigrants are often deprived of access to active transportation support, recreational facilities, healthy food choices, and other environmental factors that affect the risk of developing type 2 diabetes.
There is no one cause of type 2 diabetes. It is believed to develop from an interaction of genetic and environmental factors.
Risk factors for type 2 diabetes include:
Some health conditions can also increase the risk of developing type 2 diabetes, such as:
Many of the risk factors for type 2 diabetes are preventable or modifiable, but that doesn't mean that avoiding them is easy.
Eating a balanced, diabetes-friendly diet, staying physically active, and achieving/maintaining a weight that is healthy for you are measures you can take that go a long way to lowering your risk of developing type 2 diabetes.
Environmental factors such as income, built environment, etc., are considered modifiable risk factors as well, but they are harder to change on an individual level. Getting involved in diabetes advocacy is one way to help improve the circumstances that lead to these risk factors.
Prolonged exposure to environmental stressors can have adverse health effects. This stress stimulates the production and release of cortisol and other substances the body produces as part of the stress response. Too much of these substances over time can damage the immune and body systems, increasing the risks or effects of health conditions including type 2 diabetes.
Stress can also prompt people to engage in unhealthy lifestyle habits such as smoking or being less thoughtful with their nutrition. This also contributes to an increased risk of type 2 diabetes.
People who experience a lower socioeconomic status often have higher stress levels, making them more vulnerable to existing risk factors associated with socioeconomic status.
Type 2 diabetes is believed to be caused by a combination of biological/genetic factors and environmental factors. Aspects of the environment in which we live can affect our risk of developing type 2 diabetes. This includes factors such as pollution, climate, the planning and infrastructure of our neighborhood, and our access to nutritious food options.
While it’s difficult to prevent exposure to all factors that can increase your risk of developing type 2 diabetes, there are some aspects of your environment that may be within your control. If you are choosing a neighborhood to move to, consider the design of the neighborhood, the walkability and amount of green space it offers, and how it may foster or hinder your ability to practice healthy lifestyle habits.
Type 2 diabetes has a large genetic component, with studies estimating its contribution at 15% to 45%. You can't control your genetics, but addressing the risk factors you can control, such as healthy eating and exercise, can go a long way to preventing or delaying the development of type 2 diabetes.
Type 2 diabetes often runs in families and is seen more often in people of African, Asian, Arab, Latino, Hispanic, Indigenous, Pacific Islander, or South Asian decedent.
If you can't avoid your stressors, try planning ahead with strategies to tackle them, and activities to relieve the stress when it does arise. Relaxation techniques such as breathing exercises, mindful meditation, and yoga can be great ways to help manage your stress levels.
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Heather M. Jones is a freelance writer with a strong focus on health, parenting, disability, and feminism.
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