{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T07:37:09Z","timestamp":1777534629487,"version":"3.51.4"},"reference-count":24,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2020,6,24]],"date-time":"2020-06-24T00:00:00Z","timestamp":1592956800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Objective: To test the hypothesis that cadmium (Cd) exposure is associated with type 2 diabetes mellitus (T2DM). Materials and Methods: A two-phase health screening (physical examination and laboratory tests) was conducted in a lead smelter community following a Superfund Cleanup. Participants were African Americans aged &gt;19 years to &lt;89 years. Multiple logistic regression was used to analyze T2DM regressed on blood Cd level and covariates: body mass index (BMI), heavy metals (Ar, Cd, Hg, Pb), duration of residence, age, smoking status, and sex. Results: Of 875 subjects environmentally exposed to Cd, 55 were occupationally exposed to by-products of lead smelting and 820 were community residents. In addition, 109 T2DM individuals lived in the community for an average of 21.0 years, and 766 non-T2DM individuals for 19.0 years. T2DM individuals (70.3%) were &gt;50 years old. Blood Cd levels were higher among T2DM subjects (p &lt; 0.006) compared to non-T2DM individuals. Logistic regression of T2DM status identified significant predictors: Cd level (OR = 1.85; 95% CI: 1.14\u20132.99, p &lt; 0.01), age &gt;50 years (OR = 3.10; 95% CI: 1.91\u20135.02, p &lt; 0.0001), and BMI (OR = 1.07; CI: 1.04\u20131.09, 0.0001). In meta-analysis of 12 prior studies and this one, T2DM risk was OR = 1.09 (95% CI: 1.03\u20131.15, p &lt; 0.004) fixed effects and 1.22 (95% CI: 1.04\u20131.44, p &lt; 0.02) random effects. Discussion: Chronic environmental Cd exposure was associated with T2DM in a smelter community, controlling for covariates. T2DM onset &lt;50 years was significantly associated with Cd exposure, but &gt;50 years was not. Meta-analysis suggests that Cd exposure is associated with a small, but significant increased risk for T2DM. Available data suggest Cd exposure is associated with an increased propensity to increased insulin resistance.<\/jats:p>","DOI":"10.3390\/ijerph17124558","type":"journal-article","created":{"date-parts":[[2020,6,24]],"date-time":"2020-06-24T10:54:59Z","timestamp":1592996099000},"page":"4558","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Cadmium Is Associated with Type 2 Diabetes in a Superfund Site Lead Smelter Community in Dallas, Texas"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6485-4641","authenticated-orcid":false,"given":"Bert B.","family":"Little","sequence":"first","affiliation":[{"name":"School of Public Health and Information Sciences, University of Louisville, Louisville, KY 40292, USA"},{"name":"Department of Anthropology, University of Louisville, Louisville, KY 40292, USA"},{"name":"Parkland Hospital and Health System, Dallas, TX 75235, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Reilly","sequence":"additional","affiliation":[{"name":"School of Public Health and Information Sciences, University of Louisville, Louisville, KY 40292, USA"},{"name":"Nephrology Section, Birmingham School of Medicine, University of Alabama, Birmingham, AL 35233, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brad","family":"Walsh","sequence":"additional","affiliation":[{"name":"Parkland Hospital and Health System, Dallas, TX 75235, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giang T.","family":"Vu","sequence":"additional","affiliation":[{"name":"School of Public Health and Information Sciences, University of Louisville, Louisville, KY 40292, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,6,24]]},"reference":[{"key":"ref_1","unstructured":"Baselt, R.C., and Cravey, R.H. (2014). Disposition of Toxic Drugs and Chemicals in Man, Biomedical Publications."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/1745-6673-1-22","article-title":"The toxicity of cadmium and resulting hazards for human health","volume":"1","author":"Godt","year":"2006","journal-title":"J. Occup. Med. Toxicol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1007\/s10534-010-9329-x","article-title":"Cadmium stress: An oxidative challenge","volume":"23","author":"Cuypers","year":"2010","journal-title":"Biometals"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Sigel, A., Sigel, H., and Sigel, R. (2013). Toxicology of cadmium and its damage to mammalian organs. Cadmium: From Toxicity to Essentiality, Springer.","DOI":"10.1007\/978-94-007-5179-8"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Goering, P., Waalkes, M., and Klaassen, C. (1994). Handbook of Experimental Pharmacology, Toxicology of Metals, Biochemical Effects, Spring.","DOI":"10.1007\/978-3-642-79162-8_9"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1007\/s10534-010-9343-z","article-title":"Cadmium exposure in the population: From health risks to strategies of prevention","volume":"23","author":"Nawrot","year":"2010","journal-title":"Biometals"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.taap.2009.03.015","article-title":"Historical perspectives on cadmium toxicology","volume":"238","author":"Nordberg","year":"2009","journal-title":"Toxicol. Appl. Pharm."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1136\/oemed-2014-102279","article-title":"Low-level cadmium exposure and effects on kidney function","volume":"71","author":"Wallin","year":"2014","journal-title":"Occup. Environ. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/j.scitotenv.2017.05.224","article-title":"The role of cadmium in obesity and diabetes","volume":"601","author":"Tinkov","year":"2017","journal-title":"Sci. Total Environ."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1111\/dme.12103","article-title":"Association of lead, mercury and cadmium with diabetes in the Korean population: The Korea National Health and Nutrition Examination Survey (KNHANES) 2009\u20132010","volume":"30","author":"Moon","year":"2013","journal-title":"Diabet. Med."},{"key":"ref_11","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":"ref_12","doi-asserted-by":"crossref","unstructured":"Born\u00e9, Y., Fagerberg, B., Persson, M., Sallsten, G., Forsgard, N., Hedblad, B., Barregard, L., and Engstr\u00f6m, G. (2014). Cadmium exposure and incidence of diabetes mellitus-results from the Malm\u00f6 Diet and Cancer study. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0112277"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"18714","DOI":"10.1007\/s11356-016-7078-2","article-title":"Blood cadmium in Chinese adults and its relationships with diabetes and obesity","volume":"23","author":"Nie","year":"2016","journal-title":"Environ. Sci. Pollut. Res. Int."},{"key":"ref_14","first-page":"482","article-title":"Association between plasma metal levels and diabetes risk: A case-control study in China","volume":"30","author":"Li","year":"2017","journal-title":"Biomed. Environ. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.envres.2007.10.004","article-title":"Striking association between urinary cadmium level and albuminuria among Torres Strait Islander people with diabetes","volume":"106","author":"Satarug","year":"2008","journal-title":"Environ. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s40557-015-0071-2","article-title":"Association of cadmium with diabetes in middle-aged residents of abandoned metal mines: The first health effect surveillance for residents in abandoned metal mines","volume":"27","author":"Son","year":"2015","journal-title":"Ann. Occup. Environ. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"164","DOI":"10.2337\/db15-0316","article-title":"Metals in urine and diabetes in US adults","volume":"65","author":"Menke","year":"2016","journal-title":"Diabetes"},{"key":"ref_18","first-page":"50","article-title":"Elevated cadmium exposure associated with hypertension, diabetes and chronic kidney disease, in the population of cadmium-contaminated area","volume":"7","author":"Tangvarasittichai","year":"2015","journal-title":"Int. J. Toxicol. Pharmacol. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.envpol.2015.11.046","article-title":"Association of urinary metals levels with type 2 diabetes risk in coke oven workers","volume":"210","author":"Liu","year":"2016","journal-title":"Environ. Pollut."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"468","DOI":"10.2337\/diacare.26.2.468","article-title":"Urinary cadmium, impaired fasting glucose, and diabetes in the NHANES III","volume":"26","author":"Schwartz","year":"2003","journal-title":"Diabetes Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1016\/j.envres.2010.06.002","article-title":"Correlations of urinary cadmium with hypertension and diabetes in persons living in cadmium-contaminated villages in northwestern Thailand: A population study","volume":"110","author":"Swaddiwudhipong","year":"2010","journal-title":"Environ Res."},{"key":"ref_22","unstructured":"EPA (U.S. Environmental Protection Agency) (1991). Dallas Lead\u2014Historical Perspective."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"American Diabetes Association, 6 (2020). Glycemic Targets: Standards of Medical Care in Diabetes\u20142020. Diabetes Care, 43, 66\u201376.","DOI":"10.2337\/dc20-S006"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"113129","DOI":"10.18632\/oncotarget.21991","article-title":"Association between cadmium exposure and diabetes mellitus risk: A prisma-compliant systematic review and meta-analysis","volume":"8","author":"Wu","year":"2017","journal-title":"Oncotarget"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/12\/4558\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:42:27Z","timestamp":1760175747000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/12\/4558"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,24]]},"references-count":24,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,6]]}},"alternative-id":["ijerph17124558"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17124558","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,24]]}}}