Phthalates exposure as environmental risk factor for type 2 diabetes mellitus

Phthalates exposure occurs in all areas, such as foods' plastic packaging, cosmetics, and others. Previous studies showed that phthalates are associated with the prevalence of T2DM. Type 2 Diabetes Mellitus (T2DM) is caused by a combination of defective insulin secretion by pancreatic β-cells and the insulin-resistance. This study aimed to investigate whether phthalate exposure is an environmental risk factor for T2DM. A case-control study was conducted among residents in the South Tangerang district from June 2020 to February 2021 using a purposive sampling technique. The cases were the patients   diagnosed T2DM with HbA1c>6.5% random blood sugar>200 mg/dL, with history T2DM treatment. The respondents' urines were collected and evaluated using liquid chromatography/mass spectrometry (LC/MS). A total of 47 cases and 47 controls were recruited in the study. The lowest monomethyl phthalate (MEP) and mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) were 5.37 µg/L and 2.02 µg/L, respectively. On multivariable regression analysis, the high urinary MEP level (>131.91 µg/L) was independently associated with T2DM (OR: 3.754, 95% CI: 1.559–8.811, p-value: 0.002). MEP is an environmental risk factor for T2DM and likely has a significant impact on human health than MEHHP.