70 years after the mushroom cloud: Radiation exposure may increase diabetes risk

Edited and written by Yimaitong, please do not reprint without authorization
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Introduction: Since World War II, the prevalence of diabetes in Japan has increased significantly due to changes in life>
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However, this study based on a special historical background suggests that exposure to radiation may increase the risk of diabetes, especially in younger age groups
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 Recent epidemiological studies have shown that childhood cancer survivors who receive high-dose radiation therapy have an increased risk of developing diabetes, especially those who receive systemic or abdominal radiation therapy
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However, the effect of low- and moderate-dose radiation (<4 Gy) on diabetes risk remains unclear
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 In this study, investigators from Japan conducted a comprehensive review of all data provided by clinical program participants in the Japanese AHS cohort
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During approximately 50 years of follow-up, the association of pancreatic radiation dose with diabetes incidence was investigated, and the effect of city (Hiroshima and Nagasaki), gender, and age at the time of atomic bombing (ATB) on outcomes was assessed
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AHS Cohort Study Project AHS is a long-term clinical research project to investigate the long-term effects of radiation exposure on Hiroshima and Nagasaki atomic bomb survivors through biennial health checks
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The study was conducted in 1958 and consisted of a core group and 3 matched control groups
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The core group included all individuals (approximately 5000 survivors) who were irradiated within 2 km of the blast center and who reported symptoms of acute radiation exposure
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 A total of 9,131 subjects were included in the study, approximately 70% (n=6,331) were Hiroshima residents and 65% (n=5,937) were women
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From 1969 to 2015, these participants without diabetes at baseline were observed through biennial clinical examinations
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Hazard ratios (HRs) were estimated using Cox proportional hazards models to assess the dose response between the incidence of diabetes and radiation
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 Exposure to radiation may increase diabetes risk During the study period, there were 1,417 new cases of diabetes
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The overall crude incidence of diabetes was 7.
01/1000 person-years
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After adjusting for city and ATB, there was a significant association between radiation dose and incidence of diabetes
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 The crude incidence of diabetes in men (9.
37/1000 person-years) was higher than that in women (5.
90/1000 person-years)
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The crude incidence rates for Hiroshima and Nagasaki were 7.
24 and 6.
58/1000 person-years, respectively
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In Hiroshima, with ATB of 10 and 30 years, each 1 Gy increase in pancreatic radiation dose was associated with a 47% and 13% increased risk of diabetes, respectively, with HRs of 1.
47 (95%CI, 1.
31-1.
66) and 1.
13 (95%CI, 0.
97, respectively) -1.
31)
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However, no similar radiation dose response was observed in Nagasaki
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Note: dots, 10 years old; triangles, 30 years old Figure 1 Analysis of the incidence of diabetes in Hiroshima (1969-2015) Note: dots, 10 years old; triangles, 30 years old Figure 2 Analysis of the incidence of diabetes in Nagasaki (1969-2015) 2015) Summary This study suggests that exposure to radiation may increase the risk of diabetes, especially among those who were younger at the time of the blast
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However, for reasons that are not yet clear, the results between the two cities were inconsistent
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Although some potential confounders were considered in the analysis, the influence of other unassessed factors, such as socioeconomic status, may remain
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 Yoshimi Tatsukawa, Kismet Cordova, Michiko Yamada, Waka Ohishi, Misa Imaizumi, Ayumi Hida, Richard Sposto, Ritsu Sakata, Saeko Fujiwara, Shuhei Nakanishi, Masayasu Yoneda, Incidence of Diabetes in the Atomic Bomb Survivors: 1969 -2015, The Journal of Clinical Endocrinology & Metabolism, Volume 107, Issue 5, May 2022, Pages e2148–e2155, https://doi.
org/10.
1210/clinem/dgab902