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Occupation Influenced Diabetes

Updated: 15 hours ago

By Dallas Collins, PharmD Candidate 2024 and Adenike Atanda, PharmD, BCACP, CDCES, CTTS


According to the CDC’s National Diabetes Statistics Report, there was an upward trend from 2004 to 2019 of diagnosed diabetes in adults over 20 years of age. (1) There are also projections for an increase in the future. By 2050, it is projected that diabetes will impact over 29 million individuals.(2) According to the U.S Bureau of Labor Statistics, the current percentage of eligible civilians taking part of the workforce is over 60%.(3) So how does work relate to these growing statistics?


The Behavioral Surveillance System collected information on a variety of occupations that were able to fit into 23 categories from 2014 to 2018 across 36 states. Of the 23 occupations, the highest prevalence of diabetes was in the agriculture industry, protective services, and lastly social services. Notably the lowest are in the following categories: legal, entertainment, and lastly social sciences.(4)


Currently, of the top three occupations, the agriculture industry has been studied the most in determining why the prevalence of diabetes is higher in workers. Pesticides have become a subject of interest warranting additional research. In the U.S, the most used pesticides are, organophosphates, pyrethroids and carbamates.(5) A recent study has shown that exposure to pesticides as well as its intensity impacts the development of abnormal glucose regulation.(6) The human survey portion had a patient population comprised of individuals group of rural villages in India and focused on organophosphate exposure. Of these participants, blood sampling was done for a random subgroup. The exclusions of the participants were individuals under 35 or pregnant.(6) In this study, direct exposure was defined as individuals involved in spraying, mixing and field work in organophosphate based agriculture. Indirect exposure was defined as anyone not working in organophosphate based agriculture. The animal testing portion of this study administered the chosen organophosphate by mixing a portion into the food and water of mice.(6) There has been significant correlation between organophosphate plasma residues and HbA1C levels which was strongest in direct exposure. Direct pesticide exposure has a stronger association with development of new onset diabetes than indirect and has a positive correlation to organophosphate residue.


Organophosphates have previously been associated with acetylcholine esterase (AChE) inhibition, but this study showed there was significance between AChE activity and chronic exposure to organophosphates. As the organophosphate is degraded, the gluconeogenesis pathways is induced.(6) Another factor is also the chronic exposure to pesticides as it can disrupt the microbiome leading to dysfunctions in the intestines.(6) Chronic exposure of organophosphates can induce glucose intolerance and progress further to oxidative stress and hepatic damage.(6)


Although the relationship between law enforcement and social work with the development of diabetes has not been studied thoroughly, one common factor is the higher stress level of both.(7) Psychological stress plays a role in cortisol dysregulation which in turn can encourage the development of Type II diabetes.(8) Stress is also associated with activating the immune system which is relevant due to Type II diabetes being a chronic low-grade inflammatory state.(9) Being that many Type II diabetes patients are obese, the inflammatory factors of the visceral fat is important to understand. These adipokines include some factors such as CRP, IL-6, IL-1β, tumor necrosis factor, and hormone-like factors such as leptin, adiponectin, resistin, chemokines and acute phase proteins.(9) These inflammatory components impact the β cells of the pancreas and ultimately insulin sensitivity.(10) The levels of inflammatory factors have been negatively associated with response to glucose.(11)


As previously mentioned, the job categories with the lowest prevalence of diabetes fell into the categories of legal, entertainment and social sciences. These categories have not been studied as much, but a possibility could be tied to not having chronic exposure to hazardous chemicals, or shorter shift schedules. To expand on shift work, a previous study has suggested there is an association with the risk of developing diabetes increasing based on years of participating in shift work. In this study shift work was defined as any working hours outside of the normal 8am to 5pm scheduling. Their conclusion suggests that shift work for at least 10 years is associated with individuals developing diabetes due to lifestyle and chronic stress.(12)


In conclusion, our work environments can impact the development of diabetes from not only a physical perspective but also a psychological one. Our bodies response to the chemicals that we are exposed to can induce changes in its ability to appropriately regulate glucose. Stress, which many relate to in and out of work can impair our health as well if not appropriately managed. Chronic stress not only affects our mental status but can lead to the manifestation of physiological changes over time. In effort to support patients who work in fields with a high likelihood of developing diabetes encouraging self-management has been shown to reduce HBA1C. Patients should be coached on how to properly monitor their blood glucose, provided option for healthy eating to reduce risk factors. If a patient is known to be an agricultural worker, it may be beneficial to emphasize the importance of the appropriate PPE to limit their exposure. Now understanding the connection between occupation and diabetes, outreach programs could serve as resources for individuals at risk to limit the development and progression of diabetes.

 

1. National and State Diabetes Trends. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/library/reports/reportcard/national-state-diabetes-trends.html. Published May 17, 2022.

2. Boyle JP, Honeycutt AA, Narayan KMV, et al. Projection of diabetes burden through 2050: Impact of changing demography and disease prevalence in the U.S. American Diabetes Association. https://diabetesjournals.org/care/article/24/11/1936/24758/Projection-of-Diabetes-Burden-Through-2050Impact. Published November 1, 2001.

3. Charts related to the latest “The employment situation” news release | more chart packages. U.S. Bureau of Labor Statistics. June 2, 2023. Accessed June 3, 2023. https://www.bls.gov/charts/employment-situation/civilian-labor-force-participation-rate.htm.

4. Shockey TM, Tsai RJ, Cho P. Prevalence of diagnosed diabetes among employed US adults by demographic characteristics and occupation, 36 states, 2014 to 2018. Journal of occupational and environmental medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8669571/. Published April 1, 2021.

5. Insecticides.EPA.https://www.epa.gov/caddisvol2/insecticides#:~:text=The%20most%20commonly%20used%20insecticides,carbamates%20(see%20Figure%201).Published May 10, 2022.

6. Velmurugan G, Ramprasath T, Swaminathan K, et al. Gut microbial degradation of organophosphate insecticides-induces glucose intolerance via gluconeogenesis. Genome biology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5260025/. Published January 24, 2017.

7. Work styles - stress tolerance. O*NET OnLine. https://www.onetonline.org/find/descriptor/result/1.C.4.b..

8. Joseph JJ, Golden SH. Cortisol dysregulation: The bidirectional link between stress, depression, and type 2 diabetes mellitus. Annals of the New York Academy of Sciences. 2016;1391(1):20-34. doi:10.1111/nyas.13217

9. Donath MY, Böni-Schnetzler M, Ellingsgaard H, Ehses JA. Islet inflammation impairs the pancreatic β-cell in type 2 diabetes. Physiology. 2009;24(6):325-331. doi:10.1152/physiol.00032.2009

10. Tilg H, Moschen AR. Inflammatory mechanisms in the regulation of insulin resistance. Molecular Medicine. 2008;14(3-4):222-231. doi:10.2119/2007-00119.tilg

11. Böni-Schnetzler M;Thorne J;Parnaud G;Marselli L;Ehses JA;Kerr-Conte J;Pattou F;Halban PA;Weir GC;Donath MY; Increased interleukin (il)-1beta messenger ribonucleic acid expression in beta -cells of individuals with type 2 diabetes and regulation of il-1beta in human islets by glucose and autostimulation. The Journal of clinical endocrinology and metabolism. https://pubmed.ncbi.nlm.nih.gov/18664535/. Published July 29, 2008.

12. Guo Y, Liu Y, Huang X, et al. The effects of shift work on sleeping quality, hypertension and diabetes in retired workers. PLoS ONE. 2013;8(8). doi:10.1371/journal.pone.0071107

 

Dallas Collins

PharmD Candidate 2024

HSC College of Pharmacy

Fort Worth, TX




 

Adenike Atanda, PharmD, BCACP, CDCES, CTTS

Assistant Professor of Pharmacotherapy

University of North Texas

Health Science Center College of Pharmacy

Fort Worth, TX

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