Environmental Changes over Decades and Their Potential Role in Rising Diabetes Cases

Over the past several decades, the world has witnessed profound environmental transformations that have fundamentally altered how we live, work, and interact with our surroundings. These changes, ranging from rapid urbanization to increased chemical exposures, have created a complex web of factors that may be contributing to one of the most pressing public health challenges of our time: the dramatic rise in diabetes cases worldwide. Type 2 diabetes, which makes up over 90% of all diabetes instances, is influenced by both hereditary and environmental factors, and understanding the environmental dimension of this epidemic is crucial for developing effective prevention and intervention strategies.

The incidence of diabetes mellitus, especially type 2 diabetes, has been increasing worldwide at an alarming rate. Combined diabetes incidence increased from 3.98 per 1,000 in 1990–1994 to 60.98 per 1,000 in 2020–2024, while prevalence doubled from 6.26% to 12.00%. This staggering increase cannot be explained by genetic factors alone, as the human genome does not change rapidly enough to account for such dramatic shifts over just a few decades. Instead, researchers are increasingly focusing on environmental changes as key drivers of this global health crisis.

The Scope of Environmental Change and Diabetes

The relationship between environmental factors and diabetes is multifaceted and complex. Although genetic predisposition is a significant contributor to the disease, environmental factors play a crucial role in its onset and progression, including dietary habits, physical activity levels, urbanization, socioeconomic status, and exposure to pollutants. These environmental elements do not operate in isolation but interact with each other and with genetic predispositions to create varying levels of diabetes risk across different populations and geographic regions.

The progression of diabetes epidemiology in the United States reflects various and multiple interactions between genetic predisposition, environmental factors, and societal changes, with a special focus on the rise in obesity rates, sedentary lifestyle patterns, and dietary modifications. This pattern is not unique to the United States but is being observed globally, particularly in regions undergoing rapid modernization and lifestyle transitions.

Major Environmental Changes Over Recent Decades

To fully understand the potential environmental contributors to rising diabetes rates, we must examine the specific changes that have occurred in our environment over the past 30-40 years. These changes span multiple domains, from the physical spaces we inhabit to the air we breathe and the chemicals we encounter daily.

Urbanization and the Loss of Green Spaces

One of the most visible environmental changes of recent decades has been the rapid expansion of urban areas at the expense of natural and green spaces. The aging of the population, the rise of the middle class, and the spread of urbanization are all factors that contribute to the rise of obesity, which is a major risk factor for type 2 diabetes.

Urbanization affects diabetes risk through multiple pathways. First, the built environment of cities often discourages physical activity. Wide roads designed for vehicles rather than pedestrians, lack of sidewalks and bike lanes, and reduced access to parks and recreational facilities all contribute to more sedentary lifestyles. Individuals who reside in walkable areas are more likely to walk more frequently, thus reducing their risk of obesity.

Second, urban environments typically provide easier access to processed foods and fast food restaurants while limiting access to fresh, healthy food options, particularly in lower-income neighborhoods. This creates “food deserts” where residents have limited opportunities to make healthy dietary choices.

Third, the loss of green spaces has psychological and physiological impacts. Green spaces provide opportunities for physical activity, stress reduction, and social interaction—all factors that can influence metabolic health. The replacement of parks and natural areas with concrete and buildings creates heat islands that may also affect metabolic function, particularly in vulnerable populations.

Environmental factors such as health services, safety, amenities, area conditions, public transport and green space play a crucial role in the transition from latent autoimmunity to clinically evident illness. This suggests that the urban environment itself may accelerate the progression from prediabetes to full-blown diabetes in susceptible individuals.

Air Pollution: An Emerging Diabetes Risk Factor

Perhaps one of the most significant environmental changes over recent decades has been the dramatic increase in air pollution, particularly in rapidly developing nations and urban centers worldwide. The evidence linking air pollution to diabetes risk has grown substantially in recent years, revealing mechanisms that were previously unknown.

The Science Behind Air Pollution and Diabetes

Chronic exposure to ozone is associated with cardiovascular and respiratory diseases and with metabolic disorders, such as type-2 diabetes. A significant positive correlation has been found between ozone exposure and type 2 diabetes incidence in urban populations, with univariate and multivariate linear regression analyses revealing that exposure to ground-level ozone significantly contributed to diabetes morbidity, mostly in ages ≥ 45 years.

The relationship between air pollution and diabetes extends beyond ozone. Air pollution is a leading cause of insulin resistance and incidence of type 2 diabetes mellitus, with the association between air pollution and diabetes being stronger for traffic associated pollutants, gaseous, nitrogen dioxide, tobacco smoke and particulate matter.

Research has identified specific mechanisms through which air pollutants affect metabolic health. The suggested mechanisms whereby air pollutants induce type 2 diabetes include increased inflammation, oxidative stress, and endoplasmic reticulum stress. These biological processes interfere with normal insulin signaling and glucose metabolism, creating conditions that favor the development of insulin resistance and eventually diabetes.

Particulate Matter and Insulin Resistance

Particulate matter, especially fine particles smaller than 2.5 micrometers (PM2.5), has received particular attention in diabetes research. PM2.5 exposure exaggerates insulin resistance and visceral inflammation/adiposity, providing a new link between air pollution and type 2 diabetes mellitus.

Studies have quantified these effects with remarkable precision. Among all participants, a 7.9 μg/m3 increment in particulate matter of less than 10 μm was associated with higher HOMA-IR (15.6%) and insulin (14.5%), with nitrogen dioxide associated with HOMA-IR, glucose, insulin, and leptin. These findings demonstrate that even relatively modest increases in air pollution exposure can have measurable effects on metabolic function.

The impact of air pollution on insulin sensitivity has been confirmed in longitudinal studies. Long-term exposure to air pollution was positively associated with the level and the rate of change of the homeostasis model assessment of insulin resistance and fasting insulin, suggesting associations of air pollution with impaired insulin sensitivity and a more pronounced deterioration of insulin sensitivity over time.

Vulnerable Populations and Air Pollution

Not everyone is equally affected by air pollution exposure. Participants who were older, male, unemployed, had prediabetes or diabetes, or were physically inactive were potentially more susceptible to the adverse air pollution effects on insulin sensitivity. This suggests that air pollution may exacerbate existing metabolic dysfunction and that individuals with prediabetes may be particularly vulnerable to its effects.

Effect estimates for individuals with prediabetes were much larger and highly statistically significant, whereas individuals who did not have diabetes or had diabetes showed rather weak associations, suggesting an association between long-term exposure to air pollution and insulin resistance in the general population that was attributable mainly to individuals with prediabetes.

Experimental Evidence

Animal studies have provided crucial insights into the biological mechanisms linking air pollution to diabetes. Exposure to ambient fine particulate matter exaggerates diet-induced insulin resistance, adipose inflammation, and visceral adiposity, with PM2.5-exposed mice exhibiting marked whole-body insulin resistance, systemic inflammation, and an increase in visceral adiposity.

Rodent studies suggest that increased exposure to air pollution may result in metabolic dysfunction and obesity via increased adipose tissue inflammation, hepatic lipid accumulation, and decreased glucose utilization in skeletal muscle, with prolonged exposure to combustion-related air pollutants potentially increasing oxidative stress and systemic inflammation, resulting in activation of stress kinases that lead to defective insulin receptor signaling.

Even human experimental studies have confirmed these effects. Higher PM2.5 exposures were associated with increased insulin resistance, even at relatively low levels of exposure, demonstrating that the relationship between air pollution and metabolic dysfunction is not limited to heavily polluted environments.

Transformations in Food Production and Dietary Patterns

The global food system has undergone revolutionary changes over the past several decades, with profound implications for metabolic health and diabetes risk. These changes encompass not only what we eat but also how food is produced, processed, and distributed.

The Rise of Processed Foods

One of the most significant dietary shifts has been the dramatic increase in consumption of ultra-processed foods high in refined sugars, unhealthy fats, and sodium. Generational shifts in lifestyle, particularly the transition from traditional diets to more processed and calorie-dense foods, decreased physical activity, and greater exposure to risk factors for obesity and diabetes have contributed to rising diabetes rates globally.

This dietary transition has been particularly pronounced in developing countries undergoing rapid economic development. The prevalence of diabetes increases in populations whose lifestyles have changed fast from more traditional to more modern forms of living, which are related to an increased risk of developing diabetes. Traditional diets rich in whole grains, vegetables, and minimally processed foods have been replaced by Western-style diets characterized by high consumption of refined carbohydrates, saturated fats, and added sugars.

The food industry’s development of hyperpalatable foods—products engineered to maximize taste appeal through combinations of sugar, fat, and salt—has created an environment where overconsumption is easy and healthy choices require conscious effort and often greater expense. This has contributed to the obesity epidemic, which is itself a major driver of type 2 diabetes.

Agricultural Chemicals and Food Additives

Beyond changes in dietary composition, the widespread use of pesticides, herbicides, and other agricultural chemicals represents another environmental change with potential implications for diabetes risk. While the food itself may appear similar to what previous generations consumed, the chemical residues present on and in modern produce and processed foods represent a novel exposure.

Food additives, preservatives, and artificial ingredients have also proliferated in the modern food supply. While many of these substances are considered safe at the levels typically consumed, their long-term metabolic effects and potential interactions with other environmental exposures remain areas of active research.

The industrialization of agriculture has also changed the nutritional profile of foods. Modern crop varieties, selected for yield and shelf life rather than nutritional content, may contain different levels of vitamins, minerals, and phytonutrients compared to traditional varieties. The depletion of soil nutrients through intensive farming practices may further reduce the nutritional value of produce.

Climate Change and Metabolic Health

Climate change represents one of the most far-reaching environmental transformations of recent decades, with implications that extend well beyond rising temperatures to affect virtually every aspect of human health and well-being.

Temperature Effects on Diabetes

Rising temperatures may lead to an accumulation of reactive substances due to chronic inflammation, thereby contributing to diabetes complications, with a significant correlation identified between environmental temperatures and diabetes mortality. This suggests that climate change may not only affect diabetes incidence but also worsen outcomes for those already living with the condition.

Extreme heat events, which have become more frequent and severe due to climate change, can directly affect glucose metabolism and insulin sensitivity. Heat stress activates inflammatory pathways and can impair the body’s ability to regulate blood sugar. For individuals with diabetes, extreme heat poses particular risks, as the condition can impair the body’s ability to regulate temperature.

Climate Change and Food Security

Climate change has altered agricultural patterns worldwide, affecting both the availability and nutritional quality of food. Changing precipitation patterns, more frequent droughts and floods, and shifting growing seasons have disrupted traditional agricultural systems and reduced crop yields in many regions.

These disruptions can affect diabetes risk in multiple ways. Food insecurity and reduced access to fresh, nutritious foods may drive increased consumption of cheaper, processed alternatives. Climate-related crop failures can lead to price spikes that make healthy foods less accessible, particularly for low-income populations. Changes in growing conditions may also affect the nutritional content of crops, potentially reducing their protective effects against metabolic disease.

Stress and Extreme Weather Events

The psychological stress associated with climate-related disasters—hurricanes, floods, wildfires, and droughts—can have metabolic consequences. Chronic stress activates the hypothalamic-pituitary-adrenal axis, leading to elevated cortisol levels that can promote insulin resistance and abdominal obesity. Displacement from homes, disruption of healthcare access, and economic hardship following climate disasters can all contribute to worsening metabolic health.

Climate change may also affect physical activity patterns. Extreme heat and poor air quality (often exacerbated by climate change through increased wildfires and ozone formation) can make outdoor exercise uncomfortable or dangerous, contributing to more sedentary lifestyles.

Chemical Exposures and Endocrine Disruption

The past several decades have seen an explosion in the production and use of synthetic chemicals, many of which have become ubiquitous in modern life. These chemicals are found in plastics, personal care products, household cleaners, furniture, electronics, and countless other consumer products.

Endocrine-Disrupting Chemicals

Exposure to environmental pollutants like air pollution and endocrine-disrupting chemicals has been linked to increased diabetes risk. Endocrine-disrupting chemicals (EDCs) are substances that can interfere with the body’s hormonal systems, including those involved in glucose metabolism and insulin signaling.

Common EDCs include bisphenol A (BPA) found in plastics and can linings, phthalates used in personal care products and flexible plastics, per- and polyfluoroalkyl substances (PFAS) used in non-stick cookware and water-resistant fabrics, and various pesticides and flame retardants. These chemicals can mimic, block, or interfere with natural hormones, potentially affecting insulin production, insulin sensitivity, and glucose metabolism.

The concern with EDCs is not just their individual effects but their cumulative impact. Humans are exposed to complex mixtures of these chemicals simultaneously, and their combined effects may be greater than the sum of their individual impacts. Additionally, exposure during critical developmental windows—in utero and during early childhood—may have lasting effects on metabolic programming that increase diabetes risk later in life.

Persistent Organic Pollutants

Persistent organic pollutants (POPs) are chemicals that resist degradation and accumulate in the environment and in human tissues over time. Many POPs, including certain pesticides and industrial chemicals, have been linked to metabolic dysfunction and diabetes risk. Even though some of these chemicals have been banned or restricted in many countries, their persistence means that exposure continues through contaminated food chains and environmental reservoirs.

The lipophilic nature of many POPs means they accumulate in fatty tissues, where they may interfere with adipocyte function and contribute to metabolic dysfunction. Some research suggests that POPs may impair mitochondrial function, promote oxidative stress, and interfere with insulin signaling pathways.

Understanding the Complex Links to Rising Diabetes Cases

The relationship between environmental changes and rising diabetes rates is not simple or linear. Instead, these environmental factors interact with each other and with genetic predispositions to create a complex web of risk that varies across populations and individuals.

Synergistic and Cumulative Effects

One of the most important concepts in understanding environmental contributions to diabetes is that of synergistic effects—where the combined impact of multiple exposures is greater than the sum of their individual effects. For example, air pollution exposure may have a greater impact on diabetes risk in individuals who are also physically inactive, obese, or exposed to endocrine-disrupting chemicals.

This period faced unprecedented changes in population-level risk factors, especially the rising prevalence of obesity and sedentary lifestyle patterns, with the near twenty-fold increase in type 2 diabetes incidence suggesting that current preventive strategies and lifestyle interventions have been insufficient in counteracting these environmental and behavioral risk factors.

The cumulative nature of environmental exposures is also crucial. Many environmental factors—from air pollution to chemical exposures—exert their effects over years or decades. The diabetes we see today may reflect environmental exposures that began 20, 30, or even 40 years ago, making it challenging to identify specific causes and to predict future trends.

Critical Windows of Exposure

Research increasingly suggests that certain periods of life may be particularly sensitive to environmental influences on diabetes risk. Prenatal exposure to air pollution, chemicals, or maternal stress may affect fetal metabolic programming in ways that increase diabetes risk decades later. Early childhood, puberty, and pregnancy represent other critical windows where environmental exposures may have outsized impacts on long-term metabolic health.

This concept of developmental origins of health and disease suggests that preventing diabetes may require protecting individuals from harmful environmental exposures throughout the life course, beginning before birth. It also means that the full impact of recent environmental changes may not yet be apparent, as cohorts exposed during critical developmental periods are still aging into the years of peak diabetes risk.

Gene-Environment Interactions

Gene-environment interactions play a crucial role in the prevalence of diabetes, with genetic predisposition to insulin resistance exacerbated by environmental factors, such as a sedentary lifestyle and a high-calorie diet. This means that environmental changes may have different impacts on different individuals depending on their genetic makeup.

Genetic variants linked with insulin resistance and diabetes provide an evolutionary advantage in ancestral environments, such as during famines, but become detrimental in modern environments characterized by an abundance of resources, highlighting the complex interplay among genetic and environmental factors contributing to the risk of developing diabetes.

This gene-environment interaction helps explain why diabetes rates have increased so dramatically even though the human genome has not changed. The same genetic variants that may have helped our ancestors survive periods of food scarcity now increase diabetes risk in environments characterized by caloric abundance, sedentary lifestyles, and exposure to novel chemicals and pollutants.

Socioeconomic and Environmental Justice Dimensions

Higher diabetes rates have been documented among African American, Hispanic, and Native American populations compared to non-Hispanic whites, with variations in disease onset, progression, and complications, and these disparities often intersect with socioeconomic factors, healthcare access, and cultural determinants of health.

Environmental exposures are not distributed equally across populations. Low-income communities and communities of color often face disproportionate exposure to air pollution, lack of green spaces, food deserts, and environmental hazards. This environmental injustice contributes to health disparities, including higher rates of diabetes in disadvantaged communities.

The built environment in lower-income neighborhoods often lacks infrastructure for physical activity, such as sidewalks, parks, and recreational facilities. These communities may also have limited access to healthy food options while having high concentrations of fast food restaurants and convenience stores selling processed foods. The cumulative effect of these environmental disadvantages, combined with limited access to healthcare and other resources, creates conditions that promote diabetes development.

The Role of Lifestyle Factors

While this article focuses on environmental changes, it’s important to recognize that environmental factors often influence diabetes risk by shaping lifestyle behaviors. The environment we live in affects our opportunities and choices regarding physical activity, diet, sleep, and stress management.

Individuals’ risk for type 2 diabetes is shaped by lifestyle factors such as participation in physical activity, with some studies suggesting that rates of outdoor physical activity may be lower in areas where air pollution is getting heavier, and the relationship between air pollution and type 2 diabetes might actually be mediated by physical activity.

This highlights the complex pathways through which environmental changes affect diabetes risk. Air pollution may contribute to diabetes both through direct biological effects on insulin sensitivity and through indirect effects on physical activity levels. Similarly, urbanization affects diabetes risk through changes in the built environment that discourage physical activity, through increased access to processed foods, and through direct exposures to urban pollutants.

Global Patterns and Regional Variations

The impact of environmental changes on diabetes rates varies considerably across different regions of the world, reflecting differences in the pace and nature of environmental change, as well as variations in genetic susceptibility, cultural practices, and healthcare systems.

Developing Nations and Rapid Transitions

The period effect reflects the impact of environmental, medical, and social factors on the incidence and mortality rates of type 2 diabetes during specific time periods, with the trend in risk ratios from 1990 to 2021 showing a significant increase across all SDI regions, particularly in the Low-middle SDI region.

Countries undergoing rapid economic development and urbanization have experienced some of the steepest increases in diabetes rates. China, India, and other Asian nations have seen dramatic rises in diabetes prevalence as traditional lifestyles give way to more Westernized patterns of diet and physical activity. These transitions often occur over just one or two generations, creating stark differences in diabetes rates between older and younger cohorts.

Individuals born after 1942-1951 generally showed a higher risk of developing and dying from type 2 diabetes compared to older people born before that, with this trend consistent across all SDI regions and the most pronounced increase observed in Low-middle SDI regions, potentially explained by generational shifts in lifestyle.

High-Income Countries: Stabilization and Disparities

Diabetes prevalence did not increase, or increased only by a small amount, in some high-income countries, consistent with reports showing flat or decreasing trends in prevalence in one or both sexes and evidence on the decline in diabetes incidence in high-income countries.

This stabilization in some high-income countries may reflect successful public health interventions, improved awareness of diabetes risk factors, and better management of obesity and other risk factors. However, significant disparities persist within these countries, with disadvantaged communities continuing to experience high and rising diabetes rates.

The Unique Challenge of Youth Diabetes

Recent years have witnessed a rising incidence of diabetes, particularly type 2 diabetes, among younger populations. Especially concerning is the accelerating incidence of type 2 diabetes among younger adults and adolescents, a trend that challenges traditional paradigms of disease onset and progression.

The emergence of type 2 diabetes in children and adolescents—a condition once considered exclusively adult-onset—represents one of the most alarming trends in diabetes epidemiology. This phenomenon likely reflects the cumulative impact of environmental changes, including childhood obesity driven by poor diet and physical inactivity, as well as potential effects of prenatal and early-life environmental exposures.

Implications for Prevention and Public Health

Understanding the environmental contributors to rising diabetes rates has important implications for prevention strategies and public health policy. While individual behavior change remains important, addressing environmental factors requires broader societal interventions.

Multi-Level Intervention Approaches

Effective diabetes prevention must address environmental factors at multiple levels—from individual behaviors to community design to national policies. This includes:

• Creating built environments that promote physical activity through walkable neighborhoods, bike lanes, and accessible parks and recreational facilities
• Improving access to healthy, affordable food through farmers markets, grocery stores in underserved areas, and policies that make healthy foods more affordable
• Reducing air pollution through stricter emissions standards, promotion of clean energy, and urban planning that reduces traffic congestion
• Regulating endocrine-disrupting chemicals and other environmental toxins through stronger chemical safety laws and product standards
• Addressing climate change through mitigation and adaptation strategies that protect public health
• Reducing environmental health disparities through targeted interventions in disadvantaged communities

The Importance of Early Intervention

The onset of diabetes can be delayed by making dietary and lifestyle adjustments, with type 2 diabetes prevented or delayed by adopting several non-pharmaceutical strategies, including managing a normal weight, practicing regular physical activity, altering a sedentary lifestyle, and quitting smoking.

Each kilogram of weight loss results in a 16% relative risk reduction and strongly correlates with a decreased progression to type 2 diabetes, with diet or exercise or a combination significantly linked to reductions in the probability of acquiring diabetes by 31%, 46%, and 42%, respectively.

These findings underscore the importance of early intervention, particularly in high-risk populations. However, making healthy choices requires supportive environments. Public health efforts must focus not just on educating individuals about healthy behaviors but on creating environments where healthy choices are the easy choices.

Addressing Environmental Justice

Given the disproportionate environmental burdens faced by disadvantaged communities, diabetes prevention efforts must prioritize environmental justice. This means directing resources and interventions to communities with the highest environmental exposures and greatest diabetes risk, ensuring that all communities have access to clean air, green spaces, healthy food, and safe places for physical activity.

Community-based participatory approaches that involve residents in identifying environmental health priorities and developing solutions can be particularly effective. These approaches recognize that communities themselves are experts on their own environments and health needs.

The Need for Continued Research

While the evidence linking environmental changes to diabetes risk has grown substantially, many questions remain. We need better understanding of:

• The specific mechanisms through which different environmental exposures affect diabetes risk
• How multiple environmental exposures interact to influence diabetes development
• Critical windows of susceptibility across the life course
• Genetic and other factors that modify individual susceptibility to environmental exposures
• The long-term effects of emerging environmental exposures, including novel chemicals and climate change impacts
• Effective interventions to reduce environmental diabetes risk at individual, community, and population levels

Policy Implications

Exposure to air pollutants is significantly associated with increased risk of type 2 diabetes mellitus, suggesting that environmental protection officials must take high priority steps to minimize air pollution, hence to decrease the incidence of type 2 diabetes mellitus.

Addressing environmental contributors to diabetes requires policy action across multiple sectors—not just health policy but also environmental protection, urban planning, transportation, agriculture, and chemical regulation. Health impact assessments that consider diabetes and other chronic disease risks should be incorporated into decision-making about environmental policies, urban development, and industrial activities.

International cooperation is also essential, as many environmental challenges—particularly climate change and chemical pollution—cross national boundaries. Global frameworks for addressing these issues must consider their implications for diabetes and other chronic diseases.

The Path Forward

The dramatic rise in diabetes cases over recent decades cannot be understood or addressed without considering the profound environmental changes that have occurred during this same period. From urbanization and air pollution to dietary shifts and chemical exposures, environmental factors have created conditions that promote diabetes development across populations worldwide.

The good news is that environmental factors, unlike genetic factors, are potentially modifiable. By creating healthier environments—with cleaner air, more opportunities for physical activity, better access to nutritious food, and reduced exposure to harmful chemicals—we can reduce diabetes risk at the population level.

However, achieving this vision requires sustained commitment and coordinated action across multiple sectors of society. It requires policies that prioritize health in all decision-making, investments in healthy community infrastructure, regulation of environmental hazards, and efforts to address environmental injustices that place disproportionate burdens on disadvantaged communities.

It also requires recognizing that diabetes prevention is not just an individual responsibility but a collective one. While personal choices about diet and physical activity matter, those choices are shaped by the environments in which we live. Creating environments that support health rather than undermine it is essential for turning the tide on the diabetes epidemic.

As we look to the future, the challenge is clear: we must address the environmental roots of the diabetes epidemic while continuing to provide excellent care for those already living with the condition. This dual approach—prevention through environmental improvement and treatment through medical care—offers the best hope for reducing the global burden of diabetes and improving health for current and future generations.

The environmental changes of recent decades have created a perfect storm for diabetes development. But by understanding these changes and their health impacts, we can chart a course toward healthier environments and healthier populations. The time for action is now, as the decisions we make today about our environment will shape diabetes rates for decades to come.

Additional Resources and Further Reading

For those interested in learning more about environmental factors and diabetes, several organizations provide valuable information and resources:

• The World Health Organization provides global data on diabetes prevalence and information on environmental health risks at https://www.who.int
• The American Diabetes Association offers comprehensive information on diabetes prevention and management at https://www.diabetes.org
• The Environmental Protection Agency provides information on air quality and environmental health at https://www.epa.gov
• The Centers for Disease Control and Prevention offers data and resources on diabetes prevention at https://www.cdc.gov/diabetes
• Diabetes and the Environment provides detailed information on environmental exposures and diabetes risk at https://www.diabetesandenvironment.org

By staying informed about the environmental dimensions of diabetes and supporting policies and practices that create healthier environments, we can all contribute to addressing this critical public health challenge. The fight against diabetes is not just a medical battle—it’s an environmental one as well, requiring changes in how we design our communities, regulate pollutants, produce our food, and address climate change. Together, these efforts can help create a future where diabetes rates decline rather than continue their alarming upward trajectory.