The effect of low-level phthalate mixture on the prevalence of type 2 diabetes mellitus among adults in the US

Type 2 diabetes mellitus (T2DM) is an important public health issue owing to its rising global prevalence. Phthalates cause various health problems and are currently regulated in developed countries. However, studies on the impacts of low-level phthalate exposure under these regulations on T2DM are limited. This study investigated the impacts of combined and single exposures to phthalates and their alternatives on the prevalence of T2DM in 3,005 adults in the United States. The results indicated a positive joint effect of phthalate mixtures on the prevalence of T2DM. The joint effect was primarily attributed to Di-2-ethylhexyl phthalate (DEHP) metabolites, whereas the contributions of others were limited. This study suggests that, despite the stringent regulations on phthalates, low levels of phthalates, including DEHP, still have joint effects on T2DM. The findings highlight the importance of regulating hazardous phthalates and the need for safer alternatives to reduce public health risks.