BACKGROUND Patients with type 2 diabetes (T2D) may disproportionately suffer the adverse cardiovascular effects of air pollution, but relevant evidence on microvascular outcome is lacking. We aimed to examine the association between air pollution exposure and the risk of microvascular complications among patients with T2D. METHODS This prospective study included 17 995 participants with T2D who were free of macro- and micro-vascular complications at baseline from the UK Biobank. Annual average concentrations of particulate matter (PM) with diameters <2.5 μm (PM2.5), <10 μm (PM10), nitrogen dioxide (NO2) and nitrogen oxides (NOx) were assessed using land use regression models. Cox proportional hazards regression was used to estimate the associations of air pollution exposure with incident diabetic microvascular complications. The joint effects of the air pollutant mixture were examined using quantile-based g-computation in a survival setting. RESULTS In single-pollutant models, the adjusted hazard ratios (95% confidence intervals) for composite diabetic microvascular complications per interquartile range increase in PM2.5, PM10, NO2 and NOx were 1.09 (1.04-1.14), 1.06 (1.01-1.11), 1.07 (1.02-1.12) and 1.04 (1.00-1.08), respectively. Similar significant results were found for diabetic nephropathy and diabetic neuropathy, but not for diabetic retinopathy. The associations of certain air pollutants with composite microvascular complications and diabetic nephropathy were present even at concentrations below the World Health Organization limit values. Multi-pollutant analyses demonstrated that PM2.5 contributed most to the elevated risk associated with the air pollutant mixture. In addition, we found no interactions between air pollution and metabolic risk factor control on the risk of diabetic microvascular complications. CONCLUSIONS Long-term individual and joint exposure to PM2.5, PM10, NO2 and NOx, even at low levels, was associated with an increased risk of diabetic microvascular complications, with PM2.5 potentially being the main contributor.

中文翻译：

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2 型糖尿病患者长期暴露于环境空气污染与微血管并发症的风险：一项前瞻性研究。


背景 2 型糖尿病 (T2D) 患者可能不成比例地遭受空气污染对心血管的不利影响，但缺乏微血管结局的相关证据。我们的目的是研究空气污染暴露与 T2D 患者微血管并发症风险之间的关系。方法 这项前瞻性研究纳入了 17995 名患有 T2D 的参与者，他们来自英国生物银行，基线时没有大血管和微血管并发症。使用土地利用回归模型评估直径 <2.5 μm (PM2.5)、<10 μm (PM10)、二氧化氮 (NO2) 和氮氧化物 (NOx) 的年平均浓度。 Cox 比例风险回归用于估计空气污染暴露与糖尿病微血管并发症的关联。在生存环境中使用基于分位数的 g 计算来检查空气污染物混合物的联合影响。结果 在单一污染物模型中，PM2.5、PM10、NO2 和 NOx 每四分位间距增加，复合糖尿病微血管并发症的调整后风险比（95% 置信区间）分别为 1.09 (1.04-1.14)、1.06 (1.01-1.11) 、 1.07 (1.02-1.12) 和 1.04 (1.00-1.08)。糖尿病肾病和糖尿病神经病变也有类似的显着结果，但糖尿病视网膜病变则不然。某些空气污染物与复合微血管并发症和糖尿病肾病的关联即使在低于世界卫生组织限值的浓度下也存在。多污染物分析表明，PM2.5 对与空气污染物混合物相关的风险升高贡献最大。 此外，我们发现空气污染和代谢危险因素控制之间对于糖尿病微血管并发症的风险没有相互作用。结论 个人和关节长期接触 PM2.5、PM10、NO2 和 NOx，即使水平较低，也会增加糖尿病微血管并发症的风险，其中 PM2.5 可能是主要因素。