Dioxin and diabetes mellitus: an analysis of the combined NIOSH and Ranch Hand data
K Steenlanda, G Calverta, N Ketchumb, J Michalekb
a National Institute
for Occupational Safety and Health (NIOSH), Cincinnati, Ohio, USA, b Air Force
Research Laboratory, Brooks Air Force Base, Texas, USA
Correspondence to: Dr K Steenland nsteenland{at}cdc.gov
Accepted 7 June 2001
OBJECTIVES
To
reanalyze in a similar manner the two principal studies of TCDD
(tetrachlorodibenzo-p-dioxin) and diabetes
in an attempt to reconcile disparate results.
METHODSData from 990 United States Air Force veterans (Ranch Hand) and 1275 referents were
reanalyzed, and a NIOSH population of 267 chemical workers and 227 referents. The Ranch Hand veterans had lower concentrations of lipid
adjusted serum TCDD (median 12 parts per trillion (ppt)) than the NIOSH
workers (median 75 ppt) when examined in the late 1980s. An analysis
was conducted of the combined data sets, adopting a uniform approach to
outcome definition, data analysis, and covariate control.
RESULTSThe combined
exposed groups did not differ markedly from the combined non-exposed
groups for prevalence of diabetes (odds ratio (OR) 1.17, 95%
confidence interval (95% CI) 0.92 to 1.48), with no evidence of
heterogeneity of exposure effect between studies. Also virtually no
difference was found between combined exposed and non-exposed groups in
mean fasting serum glucose (difference in log serum glucose 0.002, 95%
CI 
0.006 to 0.010), and there was little evidence in either study of
a dose-response trend for fasting serum glucose. An increasing trend
was found (p=0.0001) in prevalence of diabetes with increased TCDD (at
the time of examination or at time of last exposure) among the Ranch
Hand population, with excess risk largely confined to the highest 8% of the exposed group (>78 ppt serum TCDD), which had an OR of 3.21 (95% CI 1.81 to 5.72) versus those with <10 ppt TCDD. However, no
such positive dose-response was found in the NIOSH population.
CONCLUSIONSThere was
little overall evidence that the exposed workers were at higher risk
than the non-exposed workers of diabetes or abnormal fasting glucose.
However, the Ranch Hand subjects showed a positive dose-response for
diabetes, whereas the more highly exposed NIOSH subjects did not. The
reason for the difference in diabetes dose-response trends between the
two studies is unknown.
Keywords: dioxin; diabetes; TCDD
© 2001 by Occupational and Environmental Medicine
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