Air pollution is a widespread environmental exposure with potential consequences for glucose regulation. The American Lung Association’s State of the Air 2026 report found that 44% of Americans live in counties receiving a failing grade for at least one measure of ozone or particle pollution. Communities of color bear a disproportionate share of this exposure.1 These findings provide an important context for evidence linking air pollution to dysglycemia and diabetes.
Long-term exposure to fine particulate matter with an aerodynamic diameter of 2.5 μm or less (PM2.5) has been associated with diabetes.2 In a longitudinal cohort of approximately 1.7 million US veterans, each 10 μg/m3 increase in PM2.5 was associated with a 15% higher hazard of incident diabetes after adjustment for measured confounders (HR, 1.15; 95% CI, 1.08-1.22).3 The observational design limits causal inference and does not establish an individual patient’s attributable risk.
Associations with glycemic biomarkers have also been reported during pregnancy and childhood. A study in pregnant participants identified associations between air pollution exposure and higher glycated hemoglobin (HbA1c).4 A study of children in Mexico City and a broader meta-analysis also identified associations between particulate pollution and higher HbA1c.5,6 These findings extend the evidence beyond adults with established diabetes, although they do not demonstrate progression to clinical diabetes.
For pulmonary clinicians, these findings support incorporating environmental exposure into the clinical history, then discussing feasible measures to reduce exposure. Counseling includes checking local air quality alerts, adjusting the timing and intensity of outdoor activity during pollution episodes, and improving indoor particle filtration. During wildfire smoke events, a well-fitting N-95 respirator can reduce particle inhalation when outdoor exposure is unavoidable.7
Recommendations should also account for patients’ housing, occupational demands, and access to cleaner indoor air. For example, patients living in poorly ventilated housing may benefit from guidance on using portable HEPA air cleaners. Those working in environments with airborne irritants may benefit from improved work conditions, such as wearing appropriate respiratory protection or discussing exposure-reduction strategies with their employers, if possible. Ultimately, these recommendations should be tailored to each patient’s circumstance to ensure that these strategies are both practical and achievable.
Patients with diabetes should continue individualized glycemic monitoring and established preventive care.8 The studies summarized here do not establish an exposure-based schedule for additional HbA1c testing or demonstrate that personal exposure reduction prevents diabetes complications. Exposure counseling can therefore accompany usual care while the long-term metabolic benefits of these interventions are clarified.
Key takeaways
- Air pollution exposure is associated with incident diabetes and adverse glycemic biomarkers; findings vary across populations and pollutants.
- Pulmonary clinicians can assess exposure and provide practical counseling while maintaining individualized diabetes care.
References
1. American Lung Association. State of the Air 2026: key findings. https://www.lung.org/research/sota/key-findings
2. Alderete TL, Chen Z, Toledo-Corral CM, et al. Ambient and traffic-related air pollution exposures as novel risk factors for metabolic dysfunction and type 2 diabetes. Curr Epidemiol Rep. 2018;5(2):79-91. doi:10.1007/s40471-018-0140-5
3. Bowe B, Xie Y, Li T, Yan Y, Xian H, Al-Aly Z. The 2016 global and national burden of diabetes mellitus attributable to PM2·5 air pollution. Lancet Planet Health. 2018;2(7):e301–e312. doi:10.1016/s2542-5196(18)30140-2
4. Lin Y, Chen R, Ge Y, et al. Exposure to low-level air pollution and hyperglycemia markers during pregnancy: a repeated measure analysis. Environ Sci Technol. 2024;58(36):15997-16005. doi:10.1021/acs.est.4c05612
5. Wu J, Knobel P, He MZ, et al. Air pollution, temperature, and HbA1c levels among children in Mexico City, Mexico. Ecotoxicol Environ Saf. 2025;307:119424. doi:10.1016/j.ecoenv.2025.119424
6. Tian L, Sun M, Lin L, et al. Effects of ambient air pollution on glycosylated hemoglobin: a systematic review and meta-analysis. Ecotoxicol Environ Saf. 2022;29(36):53954-53966. doi:10.1007/s11356-022-20728-7
7. US Environmental Protection Agency. Wildfires and indoor air quality (IAQ). September 2, 2026. Accessed September 10, 2026. https://www.epa.gov/emergencies-iaq/wildfires-and-indoor-air-quality-iaq
8. US Centers for Disease Control and Prevention. Your Diabetes Care Schedule. 2024; Accessed September 10, 2026. https://www.cdc.gov/diabetes/treatment/your-diabetes-care-schedule.html
