{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T23:08:58Z","timestamp":1793833738589,"version":"4.6.1"},"reference-count":49,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T00:00:00Z","timestamp":1614816000000},"content-version":"unspecified","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002468","name":"Dong-A University","doi-asserted-by":"publisher","award":["Research Fund 2020"],"award-info":[{"award-number":["Research Fund 2020"]}],"id":[{"id":"10.13039\/501100002468","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,1,25]]},"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To investigate the associations between heavy metal exposure and serum ferritin levels, physical measurements and type 2 diabetes mellitus (DM).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A retrospective cohort study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Changwon, the location of this study, is a Korean representative industrial city. Data were obtained from medical check-ups between 2002 and 2018.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>A total of 34\u2009814 male subjects were included. Of them, 1035 subjects with lead exposure, 200 subjects with cadmium exposure and the 33\u2009579 remaining were assigned to cohort A, cohort B and the control cohort, respectively. Data including personal history of alcohol and smoking, age, height, weight, the follow-up duration, haemoglobin A1c (HbA1c), fasting blood sugar (FBS), ferritin levels, and lead and cadmium levels within 1\u2009year after exposure were collected.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Primary outcome measure<\/jats:title>\n                  <jats:p>In subjects without diabetes, changes in FBS and HbA1c were analysed through repeated tests at intervals of 1\u2009year or longer after the occupational exposure to heavy metals.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In Cohort A, DM was diagnosed in 33 subjects. There was a significant difference in lead concentrations between the subjects diagnosed with DM and those without DM during the follow-up period (3.94\u00b12.92\u2009mg\/dL vs 2.81\u00b12.03\u2009mg\/dL, p=0.002). Simple exposure to heavy metals (lead and cadmium) was not associated with DM in Cox regression models (lead exposure (HR) 1.01, 95% CI: 0.58 to 1.77, p 0.971; cadmium exposure HR 1.48, 95% CI: 0.61 to 3.55, p=0.385). Annual changes in FBS according to lead concentration at the beginning of exposure showed a positive correlation (r=0.072, p=0.032).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Our findings demonstrated that simple occupational exposure to heavy metals lead and cadmium was not associated with the incidence of DM. However, lead concentrations at the beginning of the exposure might be an indicator of DM and glucose elevations.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-039541","type":"journal-article","created":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T13:40:49Z","timestamp":1614951649000},"page":"e039541","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":42,"title":["Relationship between heavy metal exposure and type 2 diabetes: a large-scale retrospective cohort study using occupational health examinations"],"prefix":"10.1136","volume":"11","author":[{"given":"Jun Ho","family":"Ji","sequence":"first","affiliation":[{"name":"Internal Medicine, Samsung Changwon Hospital, Changwon, Gyeonsangnam-do, The Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mi Hyeon","family":"Jin","sequence":"additional","affiliation":[{"name":"Biostatistics, Samsung Changwon Hospital, Changwon, Gyeonsangnam-do, The Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung-Hun","family":"Kang","sequence":"additional","affiliation":[{"name":"Internal Medicine, Gyeongsang National University College of Medicine, Jinju, Gyeongsangnam-do, The Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soon Il","family":"Lee","sequence":"additional","affiliation":[{"name":"Internal Medicine, Dankook University College of Medicine, Cheonan, Chungcheongnam-do, The Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suee","family":"Lee","sequence":"additional","affiliation":[{"name":"Internal Medicine, Dong-A University Medical Center, Busan, The Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-Hyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Internal Medicine, Dong-A University Medical Center, Busan, The Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8321-4113","authenticated-orcid":false,"given":"Sung Yong","family":"Oh","sequence":"additional","affiliation":[{"name":"Internal Medicine, Dong-A University Medical Center, Busan, The Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,3,4]]},"reference":[{"key":"2025101814015600000_11.3.e039541.1","doi-asserted-by":"publisher","DOI":"10.1210\/er.2009-0002"},{"key":"2025101814015600000_11.3.e039541.2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2015.303003"},{"key":"2025101814015600000_11.3.e039541.3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0123742"},{"key":"2025101814015600000_11.3.e039541.4","doi-asserted-by":"publisher","DOI":"10.2337\/db15-0316"},{"key":"2025101814015600000_11.3.e039541.5","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.envres.2012.11.005","article-title":"Cadmium exposure in relation to insulin production, insulin sensitivity and type 2 diabetes: a cross-sectional and prospective study in women","volume":"121","author":"Barregard","year":"2013","journal-title":"Environ Res"},{"key":"2025101814015600000_11.3.e039541.6","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jtemb.2016.12.008","article-title":"Trace elements in early phase type 2 diabetes mellitus-A population-based study. 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