Exposure to air pollution was reported to affect glucose metabolism, increasing the risk of diabetes mellitus. We conducted an epidemiological study on glucose metabolism and air pollution by exploring the levels of fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) with changes in ambient air quality, depending on the characteristics of the susceptible population. We carried out a cross-sectional analysis of a nationally representative sample of 10,014 adults (4267 in male and 5747 in

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... e) from the Korea National Health and Nutrition Examination Survey in 2012 and 2013 along with data from the Korean Air Quality Forecasting System. The analysis was performed using a generalized linear model stratified by sex, age, and presence of diabetes. We assessed the changes in FBG and HbA1c associated with exposures to particulate matter (PM10), fine particulate matter (PM2.5), and nitrogen dioxide (NO2) after controlling for confounders. There were 1110 participants with diabetes (557 in male and 553 in female). Overall, the FBG level increased by 7.83 mg/dL (95% confidence interval [CI]: 2.80-12.87) per interquartile range (IQR) increment of NO2, 5.32 mg/dL (95% CI: 1.22-9.41) per IQR increment of PM10 at a moving average of 0-6 days, and 4.69 mg/dL (95% CI: 0.48-8.91) per IQR increment of PM2.5 at a moving average of 0-5 days. HbA1c increased by 0.57% (95% CI: 0.04-1.09) per IQR increment of PM10 at a moving average of 0-60 days and 0.34% (95% CI: 0.04-0.63) per IQR increment of PM2.5 at a moving average of 0-75 days. The change in FBG and HbA1c increased more in the diabetic group, especially in males aged 65 years or more. There was a strong association between elevation in diabetes-related parameters and exposure to air pollution. Our study provides scientific evidence supporting that short- and mid-term exposure to air pollution is associated with changes in biological markers related to diabetes. This finding suggests that the impact of air pollution should be reflected in chronic disease management when establishing local health care policies.