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Xi, Y. ; Breitner-Busch, S. ; Dong, Q. ; Wolf, K. ; Dallavalle, M. ; Nikolaou, N. ; Cyrys, J. ; Grallert, H. ; Linkohr, B. ; Rathmann, W.* ; Herder, C.* ; Schwettmann, L.* ; Thorand, B. ; Jumpertz von Schwartzenberg, R. ; Peters, A.

Longitudinal associations of long-term exposure to ambient air pollution, residential greenness, and air temperature with type 2 diabetes subphenotypes: Results from the KORA cohort study.

Environ. Int. 208:110043 (2026)
Publ. Version/Full Text Research data DOI PMC
Open Access Gold
Creative Commons Lizenzvertrag
OBJECTIVE: To examine the association between environmental exposures and specific type 2 diabetes (T2D) subphenotypes. RESEARCH DESIGN AND METHODS: We categorized T2D participants from the KORA F4 (2006-2008) and FF4 (2013-2014) study waves into three phenotypes using k-means clustering: Cluster A (insulin deficiency); Cluster B (age-related diabetes); and Cluster C (higher insulin resistance). The annual averages of fine particulate matter (PM2.5) and PM2.5 absorbance (PM2.5abs), annual air temperature mean (Tm) and standard deviations (Tsd), and greenness (NDVI), were assessed at participants' residences. Covariate-adjusted mixed multinomial logistic regression models were fitted to examine the effects of environmental exposures on diabetes subphenotypes. We also calculated joint odds ratios (ORs) to estimate the additive effects of exposure mixtures. RESULTS: The longitudinal analysis showed that interquartile range (IQR) increases in PM2.5 (OR = 1.29, 95 % confidence interval [CI]: 1.01, 1.64) and PM2.5abs (OR = 1.30, 95 % CI: 1.01, 1.67) were associated with higher odds of being in T2D Cluster C, compared to normoglycemic individuals. Furthermore, we found that IQR increases in PM2.5 and Tsd, alongside with decreases in NDVI and Tm increased the odds of being in Cluster B (joint OR = 1.41, 95 % CI: 1.03, 1.93) and Cluster C (joint OR = 1.55, 95 % CI: 1.02, 2.36), while the combination of PM2.5abs with other exposures increased the odds of Cluster C (joint OR = 1.54, 95 % CI: 1.01, 2.33). CONCLUSIONS: Our study contributes to an enhanced understanding of the associations between environmental exposures and diabetes, indicating increased risks for age-related and insulin-resistant diabetes.
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Publication type Article: Journal article
Document type Scientific Article
Keywords Air Temperature ; Ambient Air Pollution ; Green Space ; Long-term Exposure ; Type 2 Diabetes Subphenotypes; Insulin-resistance; Glucose-metabolism; Mellitus; Metaanalysis; Subgroups; Risk; Classification; Inflammation; Diagnosis; Disease
ISSN (print) / ISBN 0160-4120
e-ISSN 1873-6750
Journal Environment International
Quellenangaben Volume: 208, Issue: , Pages: , Article Number: 110043 Supplement: ,
Publisher Elsevier
Publishing Place The Boulevard, Langford Lane, Kidlington, Oxford Ox5 1gb, England
Reviewing status Peer reviewed
Institute(s) Institute of Epidemiology (EPI)
Institute of Diabetes Research and Metabolic Diseases (IDM)
Grants German Federal Ministry of Education and Research (BMBF) through the German Center for Diabetes Research (DZD e.V.)
Ministry of Culture and Science of the state North Rhine-Westphalia (Duesseldorf, Germany)
German Federal Ministry of Health (Berlin, Germany)
EXPANSE project - European Union
State of Bavaria
Helmholtz Zentrum Munchen-German Research Center for Environmental Health - German Federal Ministry of Education and Research (BMBF)