Table 2.

Examples of shared T2DM/AD pathophysiologic pathways associated with environmental exposures

Exposure	Shared Pathway	Outcomes
Air Pollution	Pulmonary inflammation resulting in systemic spread (elevated pro-inflammatory biomarkers including CRP, IL-6, TNF-α, and fibrogen)	↑ Systemic Inflammation; ↑ Oxidative Stress; ↑ Insulin Resistance
	Spread of ultrafine particles into the bloodstream	↑ Systemic Inflammation; ↑ Oxidative Stress; ↑ Vascular Dysfunction
	Alterations in endothelial function	↑ Insulin Resistance; ↑ Inflammation
	Endoplasmic reticulum stress/alterations in insulin transduction	↑ Protein Misfolding; ↑ Insulin Resistance
	Brown adipose tissue (BAT)-mediated thermogenesis	↑ Mitochondrial dysfunction; ↑ Oxidative Stress
Pesticides	Induction of inflammatory processes in the central system nervous, cardiac and pancreatic tissues; increase the secretion of pro-inflammatory cytokines (TNF-α, IL-6, etc.)	↑ Systemic Inflammation; ↑ Oxidative Stress; ↑ Insulin Resistance
	Induction of free radicals, lipid peroxidation, and impaired antioxidant status	↑ Systemic Inflammation; ↑ Oxidative Stress; ↑ Insulin Resistance
	Glucose metabolism disruptions/Hyperglycemia	↑ Insulin Resistance
	Dysfunction of insulin-secreting cells	↑ Insulin Resistance

Abbreviations: AD=Alzheimer’s disease; T2DM=Type 2 Diabetes Mellitus;