An Environmental Perspective of the American Diabetes Association’s 75th Scientific Sessions

written by Sarah Howard
Coordinator of the Diabetes-Obesity Spectrum Working Group

Over 18,000 people from around the globe gathered in Boston June 5-9, 2015, for the American Diabetes Association’s premier annual scientific conference. Thanks to CHE, I was able to attend, and here summarize information I found on the development of diabetes—including environmental factors (especially chemicals), developmental origins, and the natural history of the disease.

Environmental chemicals

While there were not any sessions on environmental chemicals per se, I did find ten posters on this topic (see below for links to abstracts and online e-posters). The one that struck me most was by Su Hyun Park, who found an association between levels of persistent organic pollutants (POPs) and beta cell dysfunction in 7-9 year old Korean children. Exposure to POPs, as well as to other chemicals, have been associated with beta cell dysfunction in other studies before, but there are few studies in humans, even fewer in children, and few at exposure levels found in the general population. (I told her I thought that hers was the most important poster of all 2373 of them and she laughed, but I stand by my opinion).

One reason I think Ms. Park’s poster is important is because of a symposium cryptically (to me) entitled, “Gained in the Post-translation—Modified Antigens Driving Islet Autoimmunity.” Here Dr. Eddie James and Dr. Bart Roep described how environmental factors that cause beta cell stress can actually trigger the autoimmunity that eventually leads to type 1 diabetes. They have figured out mechanisms by which stressed beta cells signal to the immune system and thus instigate an autoimmune attack. Both mentioned various environmental factors that could contribute to this stress, such as viruses, the gut microbiome, and inflammation. It seems to me that these mechanisms could also be a way that environmental chemicals could potentially contribute to type 1 diabetes development, by contributing to beta cell dysfunction (the association found by Ms. Park, although not yet confirmed to be causative). Of course this idea is hypothetical and remains to be researched—anyone need a dissertation topic? Feel free to use this one.

Another interesting finding is in the natural history of type 1 diabetes, as presented by researchers Dr. Ricardo Ferreira and Dr. Riita Lahesmaa, who separately found biomarkers of immune system changes that preceed the development of autoimmunity and autoantibodies in children at genetic risk of type 1 diabetes. As it stands, most studies look at the development of autoantibodies to predict type 1 diabetes, but with this research, we may be able to predict disease even earlier in life. Dr. Lahesmaa also found differences in gene expression in umbilical cord blood in babies from high versus low type 1 diabetes incidence areas (in populations with similar genetic backgrounds). Thus we have more evidence that the development of type 1 diabetes may begin very early in life, even in utero.

There were additional posters on the role of environmental chemicals in type 2 diabetes and obesity (listed below). Researchers found various chemicals to be associated with type 2 diabetes or obesity, including manganese, in a U-shaped fashion; Ah-R ligands such as dioxin; and some heavy metals. Genetic background may modify some chemical exposures, for example, the association between air pollution and type 2 diabetes was strongest in people with the highest genetic risk.

Additional environmentally related topics included much discussion of the microbiome (e.g., I learned that changing the gut microbiome in female mice susceptible to type 1 diabetes can affect testosterone levels), developmental origins of diabetes and obesity (e.g., the “two-hit” hypothesis—how a combination of early life famine and later life economic development in China increased risk of type 2 diabetes), the role of hormones like adiponectin, and much more. It was a fascinating conference.

Below are the ten posters on various environmental chemicals, as well as posters on other environmental factors, incidence, and developmental origins of diabetes and obesity. I’ve included some of my tweets about the abstracts, from @sarhoward #2015ADA (I found Twitter was a useful way to get this type of scientific information out to the general public and to people with diabetes).

It was so inspiring to meet the scientists, patient-activists, and educators who attended this meeting—some of the highlights for me included meeting Kathryn Ham (at right), an 86-year-old woman who has lived with type 1 diabetes for 78 years; Sebastian Sasseville, who climbed Mt. Everest, raced across the Sahara, and ran across Canada with type 1 diabetes; and Dana Lewis and Scott Leibrand, who developed their own artificial pancreas system (diyps.org). It is incredible what regular people who happen to have diabetes can do.

Abstracts and Posters

Abstracts/posters are searchable online. One-sentence summaries are my tweets.

Environmental Chemicals

Persistent Organic Pollutants

Association between the Level of POPs Exposure and Insulin Secretion among Children Ages 8 to 9. Su Hyun Park, Hyesook Park, Young Sun Hong
Su Hyun Park found persistent organic pollutants associated with lower beta cell function in kids!! 1386-P

Causal Factors for Development of Diabetes Mellitus over the Course of 10 Years in the Korean Genome and Epidemiology Study: Serum Aryl-hydrocarbon Receptor Binding Activity. Hong Kyu Lee, Wook-Ha Park, Youngmi K. Pak, Nam H. Cho
“…AhR ligands (i.e. persistent organic pollutants like dioxins) might be important causative agents for diabetes…” 1529-P

Causal Factors for Development of Diabetes Mellitus over the Course of 10 Years in the Korean Genome and Epidemiology Study: Serum Mitochondrial Function Inhibiting Activity. Hong Kyu Lee, Wook-Ha Park, Youngmi K. Pak, Nam H. Cho
Mitochondrial dysfunction, which is linked to persistent organic pollutants, is linked to type 2 diabetes development. 1575-P

Metals

Heavy Metals in Urine and Diabetes in United States Adults =20 Years of Age. Andy Menke, Catherine Cowie
Metals molybdenum, antimony, tungsten, uranium associated with higher risk of diabetes in US adults (NHANES). 1647-P

Blood Lead Level Associates with Higher Body Mass Index and Prevalence of Obesity in Chinese Women. Yingli Lu, Ningjian Wang, Chi Chen, Xiaomin Nie, Bing Han, Qin Li, Yi Chen, Chunfang Zhu, Yingchao Chen, Fangzhen Xia, Xiaoqi Pu, Zhen Cang, Chaoxia Zhu, Meng Lu, Ying Meng, Hui Guo, Dongping Lin
Blood lead levels associated with obesity in Chinese women. 309-LB

U-Shaped Association between Plasma Manganese Concentration and Type 2 Diabetes in Adults. Zhilei Shan, Sijing Chen, Liangkai Chen, Liegang Liu
U-shaped association between manganese and T2 diabetes. 1633-P

Ecological Study between the Incidence of Type 1 Diabetes and Geochemical Data in Sardinia: Negative Correlation with Zinc and Copper. Marco Songini, Clara Targhetta, Carla Mannu, Alessandro Sanna, Marian J.. Rewers, Graziella Bruno, Paolo Valera, Patrizia Zavattari
Zinc and copper in stream samples may be protective against type 1 diabetes in Sardinia, other elements not associated. 1737-P

Air Pollution

An Interleukin-6 Polymorphism May Modify Air Pollutants and Diabetes Association. Ikenna C. Eze, Medea Imboden, Ashish Kumar, Arnold Von Eckardstein, Daiana Stolz, Margaret Gerbase, Nino Künzli, Thierry Rochat, Christian Schindler, Florian Kronenberg, Nicole Probst-Hensch
Air pollution may be linked to T2 diabetes via inflammation. 178-LB

Modification of Ambient Air Pollution and Diabetes Association by Genetic Risk Score of Type 2 Diabetes Variants. Ikenna C. Eze, Medea Imboden, Ashish Kumar, Arnold Von Eckardstein, Daiana Stolz, Margaret W. Gerbase, Nino Künzli, Thierry Rochat, Florian Kronenberg, Christian Schindler, Nicole Probst-Hensch
Air pollution link with T2 diabetes strongest in people with highest genetic risk. 179-LB

Other Chemicals

Environmental Contaminant Perfluorooctane Sulfonate and Kidney Function by Diabetes Status. Baqiyyah Conway, Karen Innes, Tina Costacou, John Arthur
No e-poster avail. Abstract online. 24-LB

Other Environmental Factors

Low Vitamin D Levels in Patients with Painful Diabetic Peripheral Neuropathy: A Potential Role in Pathogenesis? Pallai Rappai Shillo, Dinesh Selvarajah, Marni Greig, Iain D. Wilkinson, Ganesh Rao, Solomon Tesfaye
No e-poster avail. Abstract online.
Low vitamin D associated with painful diabetic neuropathy. 627-P

Arterial Stiffness in Type 1 Diabetes Mellitus: The Potential Role of FGF-23 and Vitamin D. Jose-Miguel Gonzalez-Clemente, Gemma Llaurado Cabot, Olga Gimenez-Palop, Eugenio Berlanga Escalera, Montserrat Gonzalez Sastre, Albert Cano Palomares, Inma Simon Muela, Ana Megia Colet, Joan Vendrell Ortega
Low vitamin D levels associated with arterial stiffness in T1 diabetes patients. 479-P

Effect of Vitamin D Supplementation on Frequency of Partial Clinical Remission Period in Children and Adolescents with Newly Diagnosed Type 1 Diabetes. Kathryn S. Obrynba, Robert Hoffman
Vitamin D did not improve remission in type 1 diabetes. 1416-P

(Note: there are many more posters on vitamin D, as well as nutrition and other vitamins; search them)

Gene Expression Profiles of Laser-Captured Human Islets from Newly Diagnosed Live Diabetic Patients and Nondiabetic Organ Donors. Lars Krogvold, Nataliya Lenchik, Bjørn Edwin, Trond Buanes, Kristian F. Hanssen, Clayton E. Mathews, Ivan Gerling, Knut Dahl-Jørgensen
1824-P

Heterogeneity in Type 1 Diabetics Is Defined by Contrasting C-Peptide Declines, Autoreactive T Cell Burdens, and Metabolomic Differences. Willem M. Kühtreiber, Douglas Burger, Peter E. Reinhold Iii, Sophie L.L. Washer, Menghan Zhao, Elise Hsu, Denise L. Faustman
Early vs late type 1 diabetes onset may have different etiologies, Faustman lab. 1801-P

Obesity-induced Insulin Resistance and Altered Gut Microbiota in Mice Lacking Interleukin-27. Hirotsugu Suwanai, Tomonobu Sawada, Hiroki Yoshida, Takashi Kadowaki, Kohjiro Ueki
No e-poster avail. Abstract online. 2167-P

Clc-5 Deficient Mice, a Novel Murine Model for Investigating the Role of Gut Microbiota in Obesity and Metabolic Syndrome. Ying Dong, Shi Jin, Xuhang Li
No e-poster avail. Abstract online. 289-LB

Developmental exposures and later-life disease

Is Exposure to Famine in Childhood and Economic Development in Adulthood Associated with Diabetes? Two-Hit Hypothesis from Spect-China Study. Ningjian Wang, Xiaojin Wang, Bing Han, Qin Li, Yi Chen, Chunfang Zhu, Yingchao Chen, Fangzhen Xia, Xiaoqi Pu, Zhen Cang, Chaoxia Zhu, Meng Lu, Ying Meng, Hui Guo, Chi Chen, Dongping Lin, Weiping Tu, Bin Li, Ling Hu, Bingshun Wang, Michael D. Jensen, Yingli Lu
Famine while in utero and childhood associated with diabetes in later life in China. 61-LB

Elective Cesarean Section and Risk of Childhood Type 1 Diabetes–A Nationwide Cohort Study. Tine D. Clausen, Thomas Bergholt, Frank Eriksson, Steen Rasmussen, Niels Keiding, Ellen Loekkegaard
No e-poster avail. Abstract online.
Paternal type 1 diabetes gives higher risk of T1D in kids than maternal T1D. Both much higher than elective C-sections. 1721-P

The Association between Breastfeeding and Insulin Sensitivity among Youth with Diabetes. Natalie S. The, Archana P. Lamichhane, Christina M. Shay, Shanshan Wang, Dana Dabelea, Jean M. Lawrence, Jamie L. Crandell, Tessa L. Crume, Elizabeth Mayer-Davis
No e-poster avail. Abstract online.
Breastfeeding not associated with insulin sensitivity in later life, finds US SEARCH for diabetes in youth study. 1618-P

Antibiotic Use in Early Childhood and the Development of Type 1 Diabetes Autoimmunity: The TEDDY Study. Kaisa M. Kemppainen, Kendra Vehik, Ronald J. Canepa, Alexandria N. Ardissone, Austin G. Davis-Richardson, Olli G. Simell, Jorma Toppari, Anette G. Ziegler, Marian Rewers, Åke Lernmark, William A. Hagopian, Jin-Xiong She, Beena Akolkar, Desmond Schatz, Mark A. Atkinson, Martin J. Blaser, Jeffrey P. Krischer, Eric W. Triplett, Teddy Study Group
No e-poster avail. Abstract online.
Early life antibiotics NOT associated with T1 diabetes development, finds TEDDY study. 149-LB

Gestational Diabetes Mellitus and Risk for Developmental Delays in Offspring. Anny H. Xiang, Xinhui Wang, Mayra P. Martinez, Johanna C. Walthall, Kathleen Page, Thomas A. Buchanan, Darios Getahun
No e-poster avail. Abstract online.
Good news! Gestational diabetes NOT associated with learning/developmental disorders in offspring. 1437-P

Poster Tour: Epigenetic, Adipose, and Placental Pathways Underpinning Fetal Programming and Potential Interventions. Moderator: Theresa L. Powell, PhD

Diabetes Incidence

Prevalence of Prediabetes in U.S. Adolescents and Young Adults. Giuseppina Imperatore, Yiling J. Cheng, Deborah B. Rolka, Catherine Cowie, Ann L. Albright, Edward W. Gregg
No e-poster avail. Abstract online.
CDC: ~1 in 5 adolescents and ~1 in 4 young adults in US have pre-diabetes. Wow. 1382-P

The Rate of Growth in Diagnosed Diabetes Prevalence in U.S. Counties Slowed between 2004-2008 and 2008-2012. Linda S. Geiss, Ted Thompson, Karen Kirtland, Ji Lin, Sundar Shrestha, Ann L. Albright, Edward W. Gregg
No e-poster avail. Abstract online.
Rate of growth of diabetes slowing since 2008 in US, based on CDC data. 1674-P

Incidence of Childhood Type 1 Diabetes in Italy during 2004-2013. Valentino Cherubini, Rosaria Gesuita, Marisa Bechaz, Mariella Bruzzese, Giuseppe D’annunzio, Lucia Ferrito, Annapaola Frongia, Dario Iafusco, Antonio Iannilli, Lorenzo Iughetti, Fortunato Lombardo, Silvano Piffer, Sonia Toni, Stefano Tumini, Edlira Skrami, Flavia Carle, Ridi Study Group
Type 1 diabetes incidence in kids 2004-13 stable in central Italy but rose/fell in subgroups in other parts of Italy. 1556-P

The Incidence of Type 1 Diabetes Mellitus in Romanian Children Aged 0-14 Years Increased Constantly. Adrian Vlad, Viorel Serban, Bogdan Timar, Alexandra Sima, Mihaela Vlad, Laura Diaconu, Oana Albai, Alin Albai, Romulus Timar, Onrocad Study Group
No e-poster avail. Abstract online.
Type 1 diabetes incidence increasing in Romania, and varies seasonally. 1735-P

Unexpected Stability of Type 1 Diabetes Incidence in a U.S. Cohort, 1994-2010. Amanda K. Cartee, Lisa Owen, Joseph J. Larson, Brian D. Lahr, Joseph A. Murray, Yogish C. Kudva
Interesting: type 1 diabetes and celiac incidence in Minnesota since 1994. 1732-P

IDF Diabetes Atlas Estimates of Diabetes Prevalence in the North America and Caribbean Region in 2014. Ute Linnenkamp, Katherine Ogurtsova, Joao Diogo Da Rocha Fernandes, Leonor Guariguata, Nam H. Cho, Lydia E.Makaroff
Diabetes prevalence higher in mid-income than high income countries, in N. America/Caribbean. 1662-P