Objective: Cross-sectional evidence from the NHANES suggested higher urine antimony was associated with elevated diabetes prevalence in US adults. The long-term association between plasma antimony and incident diabetes is uncertain. We aimed to examine the relationship between plasma antimony and the incidence of type 2 diabetes among Chinese adults.
Methods: We quantified plasma antimony concentrations by inductively coupled plasma mass spectrometry (Agilent 7700x ICP-MS; Agilent Technologies, USA) among 1039 incident diabetes cases and 1039 controls (age and sex matched) nested in a prospective study, the Dongfeng-Tongji cohort. Both cases and controls were free of diabetes at baseline (2008-2010), incident diabetes were identified using the following criteria: fasting glucose ≥7.0 mmol/l; or hemoglobin A1c (HbA1c) ≥ 6.5%; or self-reported diagnosis or use of anti-diabetic medication during the follow-up visits in 2013. Conditional logistic regression models were used to assess the odds ratios (ORs) and corresponding 95% confidence intervals (CIs).
Result: The median plasma antimony concentrations in type 2 diabetes patients and controls were 0.14 μg/L and 0.16 μg/L, respectively. We found the plasma antimony concentrations were slightly higher in the control group (P=0.02). After adjustment of BMI, smoking status, drinking status, education, physical activity, hypertension, hyperlipidemia, family history of diabetes, and eGFR, the odds ratio (95% CIs) of type 2 diabetes across quartiles of antimony concentrations were as follows: 1.00, 0.79 (0.58-1.07), 0.77 (0.57-1.04), 0.60 (0.44-0.83, Ptrend=0.002). With the increase of one unit (1 μg/L) of plasma antimony, the diabetes risk would decrease 15%. When modeling the dose–response relationship using restricted cubic splines, we observed a negative linear association between antimony concentration (P for linear relation = 0.002) and type 2 diabetes.
Conclusions: Plasma antimony was negatively associated with incident type 2 diabetes in Chinese adults. More work is needed to explore the underlying mechanism of the antimony-diabetes relationship.