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Association between DDT or its byproducts and T2DM: a systematic review and meta-analysis

Weijian Tian,Shaohui Bai,Ting Xie,Haolu Zha,Zhouning Yan,Shengze Zhang,Nan Wu,Jianhui Yuan,Huanle Luo,Qian Xie,Ying Jiang

Published 2025 in Frontiers in Endocrinology

ABSTRACT

Background Currently, type 2 diabetes mellitus (T2DM) is among the fastest-growing global health emergencies of the century. Emerging evidence from epidemiological studies suggests a potential positive association between exposure to dichlorodiphenyltrichloroethane (DDT) or its byproducts and an increasing risk of T2DM. Objective We conducted a systematic review and meta-analysis to quantify the association between DDT or its byproducts and T2DM. Additionally, we aimed to identify the sources of heterogeneity contributing to the inconsistency of the results. Methods Data analysis: assess the quality of the included studies using the Risk Of Bias In Non-randomized Studies of Exposure tool, determine the source of heterogeneity using subgroup analysis, sensitivity analysis and meta regression model based on a fixed-effects model, and analyze the publication bias using funnel plots, Egger’s test, and Begg’s test. Results DDT and its byproducts were associated with the risk of developing T2DM (total OR: 1.13, 95% CI: 1.08-1.15, I2 = 40%). Subgroup analysis stratified by biomarkers showed a stronger association between p,p′-DDE and T2DM (OR = 1.13, 95% CI: 1.09-1.17, I²= 58.5%). The results of the funnel plot, Egger’s test, and Begg’s test showed publication bias and small study effect in studies included in the analysis (p<0.05), but the influence on the results was smaller. Conclusions The systematic review and meta-analysis offer quantifiable proof of a positive correlation between exposure to DDT or its byproducts and a higher risk of developing T2DM. Systematic Review Registration https://inplasy.com, identifier INPLASY20258004.

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