Exposure to cholinesterase inhibiting insecticides and blood glucose level in a population of Ugandan smallholder farmers

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  • Martin Rune Hassan Hansen, Det Nationale Forskningscenter for Arbejdsmiljø
  • ,
  • Erik Jørs, Afdeling for Miljø- og Arbejdsmedicin, Odense Universitetshospital, Syddansk Universitet
  • ,
  • Annelli Sandbæk
  • Daniel Sekabojja, Uganda National Association of Community and Occupational Health
  • ,
  • John C Ssempebwa, School of Public Health, Makerere University
  • ,
  • Ruth Mubeezi, School of Public Health, Makerere University, Uganda
  • Philipp Staudacher, Swiss Federeal Institue of Aquatic Science and Technology (EAWAG), ETH, ETH Zurich, Inst Biogeochem & Pollutant Dynam, Schweiz
  • Samuel Fuhrimann, Utrecht University, Holland
  • Alex Burdorf, Department of Public Health, Erasmus University Medical Center Rotterdam, the Netherlands.
  • ,
  • Bo Martin Bibby
  • Vivi Schlünssen
The risk of diabetes mellitus may be elevated among persons exposed to some pesticides, including cholinesterase-inhibiting insecticides (organophosphates and carbamates). The objective of this study was to investigate how acetylcholinesterase activity was associated with mean blood glucose levels among smallholder farmers in Uganda.

We conducted a short-term follow-up study among 364 smallholder farmers in Uganda. Participants were examined three times from September 2018 to February 2019. At each visit, we measured glycosylated haemoglobin A (HbA1c) as a measure of long-term average blood glucose levels. Exposure to organophosphate and carbamate insecticides was quantified using erythrocyte acetylcholinesterase normalised by haemoglobin (AChE/Hb). For a subgroup of participants, fasting plasma glucose (FPG) was also available. We analysed HbA1c and FPG versus AChE/Hb in linear mixed and fixed effect models adjusting for age, sex, physical activity level, and consumption of fruits and vegetables, alcohol and tobacco.

Contrary to our hypothesis, our mixed effect models showed significant correlation between low AChE/Hb and low HbA1c. Adjusted mean HbA1c was 0.74 (95% CI 0.17 to 1.31) mmol/mol lower for subjects with AChE/Hb=24.3 U/g (35th percentile) compared with subjects with AChE/Hb=25.8 U/g (50th percentile). Similar results were demonstrated for FPG. Fixed effect models showed less clear correlations for between-phase changes in AChE/Hb and HbA1c.

Our results do not clearly support a causal link between exposure to cholinesterase-inhibiting insecticides and elevated blood glucose levels (expressed as HbA1c and FPG), but results should be interpreted with caution due to the risk of reverse causality.
TidsskriftOccupational and Environmental Medicine
Sider (fra-til)713-720
Antal sider8
StatusUdgivet - okt. 2020


  • pesticider, insekticid, Diabetes

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