The risk of type 2 diabetes and its association with NO2 pollution (An update systematic review and meta-analysis of cohort studies)
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Abstract
The purpose of this review was to examine the relationship between NO2 exposure and the increase likelihood of Diabetes Mellitus (DM) or Type 2 Diabetes (T2D). We conducted the systematic review of cohort studies published between 2015-2025 by carrying out searches in several electronic databases. Nine cohort were included in this meta-analysis. The pooled HR was 1.09 (95% CI = 1.04-1.15) for the impact of NO2 exposure towards the increasing likelihood of DM. In conclusion, the risk of T2D was increasing because the exposure of NO2.
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27. Sun Q, Yue P, Deiuliis JA, Lumeng CN, Kampfrath T, Mikolaj MB, et al. Ambient Air Pollution Exaggerates Adipose Inflammation and Insulin Resistance in a Mouse Model of Diet-Induced Obesity. Circulation 2009; 119: 538–546.
28. Yan YH, Chou CC, Lee CT, Liu JY, Cheng TJ. Enhanced insulin resistance in diet-induced obese rats exposed to fine particles by instillation. Inhal Toxicol 2011; 23: 507–519.
2. Zhou B, Rayner AW, Gregg EW, Sheffer KE, Carrillo-Larco RM, Bennett JE, et al. Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants. The Lancet 2024; 404: 2077–2093.
3. Tinajero MG, Malik VS. An Update on the Epidemiology of Type 2 Diabetes. Endocrinol Metab Clin North Am 2021; 50: 337–355.
4. Strati M, Moustaki M, Psaltopoulou T, Vryonidou A, Paschou SA. Early onset type 2 diabetes mellitus: an update. Endocrine 2024; 85: 965–978.
5. Balti EV, Echouffo-Tcheugui JB, Yako YY, Kengne AP. Air pollution and risk of type 2 diabetes mellitus: A systematic review and meta-analysis. Diabetes Res Clin Pract 2014; 106: 161–172.
6. Burkart K, Causey K, Cohen AJ, Wozniak SS, Salvi DD, Abbafati C, et al. Estimates, trends, and drivers of the global burden of type 2 diabetes attributable to PM2·5 air pollution, 1990–2019: an analysis of data from the Global Burden of Disease Study 2019. Lancet Planet Health 2022; 6: e586–e600.
7. Restrepo CE. Nitrogen Dioxide, Greenhouse Gas Emissions and Transportation in Urban Areas: Lessons From the Covid-19 Pandemic. Front Environ Sci; 9. Epub ahead of print 9 June 2021. DOI: 10.3389/fenvs.2021.689985.
8. He MZ, Kinney PL, Li T, Chen C, Sun Q, Ban J, et al. Short- and intermediate-term exposure to NO2 and mortality: A multi-county analysis in China. Environmental Pollution 2020; 261: 114165.
9. Sade MY, Shi L, Colicino E, Amini H, Schwartz JD, Di Q, et al. Long-term air pollution exposure and diabetes risk in American older adults: A national secondary data-based cohort study. Environmental Pollution 2023; 320: 121056.
10. Samanta DrS. Relation between Anthropogenic Air Pollution and Diabetes Mellitus. International Journal of Scientific Research in Engineering and Management. 2025; 09: 1–9.
11. Wu Y, Zhang S, Qian SE, Cai M, Li H, Wang C, et al. Ambient air pollution associated with incidence and dynamic progression of type 2 diabetes: a trajectory analysis of a population-based cohort. BMC Med 2022; 20: 375.
12. Vasishta S, Adiga U. Air pollution and its role in the rising burden of type 2 diabetes in India: urgent call for action. Environmental Science and Pollution Research 2025; 32: 13527–13538.
13. Bai L, Chen H, Hatzopoulou M, Jerrett M, Kwong JC, Burnett RT, et al. Exposure to Ambient Ultrafine Particles and Nitrogen Dioxide and Incident Hypertension and Diabetes. Epidemiology 2018; 29: 323–332.
14. Fan C, Wang W, Wang S, Zhou W, Ling L. Multiple dietary patterns and the association between long-term air pollution exposure with type 2 diabetes risk: Findings from UK Biobank cohort study. Ecotoxicol Environ Saf 2024; 275: 116274.
15. Fan C, Wang W, Xiong W, Li Z, Ling L. Beverage consumption modifies the risk of type 2 diabetes associated with ambient air pollution exposure. Ecotoxicol Environ Saf 2025; 290: 117739.
16. Hu X, Yang T, Xu Z, Jin J, Wang J, Rao S, et al. Mediation of metabolic syndrome in the association between long-term co-exposure to road traffic noise, air pollution and incident type 2 diabetes. Ecotoxicol Environ Saf 2023; 258: 114992.
17. Li H, Cai M, Li H, Qian ZM, Stamatakis K, McMillin SE, et al. Is dietary intake of antioxidant vitamins associated with reduced adverse effects of air pollution on diabetes? Findings from a large cohort study. Ecotoxicol Environ Saf 2022; 246: 114182.
18. Paul LA, Burnett RT, Kwong JC, Hystad P, van Donkelaar A, Bai L, et al. The impact of air pollution on the incidence of diabetes and survival among prevalent diabetes cases. Environ Int 2020; 134: 105333.
19. Shin M-K, Kim K-N. Association between long-term air pollution exposure and development of diabetes among community-dwelling adults: Modification of the associations by dietary nutrients. Environ Int 2023; 174: 107908.
20. Sade MY, Shi L, Colicino E, Amini H, Schwartz JD, Di Q, et al. Long-term air pollution exposure and diabetes risk in American older adults: A national secondary data-based cohort study. Environmental Pollution 2023; 320: 121056.
21. Li ZH, Zhong WF, Zhang XR, Chung VC, Song WQ, Chen Q, et al. Association of physical activity and air pollution exposure with the risk of type 2 diabetes: a large population-based prospective cohort study. Environmental Health 2022; 21: 106.
22. arasin N, Amnuaylojaroen T, Saokaew S, Sittichai N, Tabkhan N, Dilokthornsakul P. Outdoor air pollution exposure and the risk of type 2 diabetes mellitus: A systematic umbrella review and meta-analysis. Environ Res 2025; 269: 120885.
23. Wang B, Xu D, Jing Z, Liu D, Yan S, Wang Y. Mechanisms in endocrinology: effect of long-term exposure to air pollution on type 2 diabetes mellitus risk: a systemic review and meta-analysis of cohort studies. European Journal of Endocrinology. 2014 Nov;171(5):R173-82.
24. Rajagopalan S, Brook RD. Air Pollution and Type 2 Diabetes. Diabetes 2012; 61: 3037–3045.
25. Brook RD, Rajagopalan S, Pope III CA, Brook JR, Bhatnagar A, Diez-Roux AV, et al. Particulate Matter Air Pollution and Cardiovascular Disease. Circulation 2010; 121: 2331–2378.
26. Halliwell B, Hu ML, Louie S, Duvall TR, Tarkington BK, Motchnik P, et al. Interaction of nitrogen dioxide with human plasma Antioxidant depletion and oxidative damage. FEBS Lett 1992; 313: 62–66.
27. Sun Q, Yue P, Deiuliis JA, Lumeng CN, Kampfrath T, Mikolaj MB, et al. Ambient Air Pollution Exaggerates Adipose Inflammation and Insulin Resistance in a Mouse Model of Diet-Induced Obesity. Circulation 2009; 119: 538–546.
28. Yan YH, Chou CC, Lee CT, Liu JY, Cheng TJ. Enhanced insulin resistance in diet-induced obese rats exposed to fine particles by instillation. Inhal Toxicol 2011; 23: 507–519.
| Files | ||
| Issue | Vol 11 No 3 (2026): Summer 2026 | |
| Section | Review Article(s) | |
| Keywords | ||
| Air pollution; Diabetes mellitus; Nitrogen dioxide (NO2); Type 2 diabetes | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Delimasari T, Tursina E, Hikmah A, Fatony R. The risk of type 2 diabetes and its association with NO2 pollution (An update systematic review and meta-analysis of cohort studies). JAPH. 2026;11(3):463-480.
