Published online Nov 15, 2021. doi: 10.4239/wjd.v12.i11.1818
Peer-review started: February 25, 2021
First decision: May 3, 2021
Revised: May 27, 2021
Accepted: September 22, 2021
Article in press: September 22, 2021
Published online: November 15, 2021
Processing time: 262 Days and 22.9 Hours
Organophosphate is a commonly used pesticide in the agricultural sector. The main action of organophosphate focuses on acetylcholinesterase inhibition, and it therefore contributes to acute cholinergic crisis, intermediate syndrome and delayed neurotoxicity. From sporadic case series to epidemiologic studies, organophosphate has been linked to hyperglycemia and the occurrence of new-onset diabetes mellitus. Organophosphate-mediated direct damage to pancreatic beta cells, insulin resistance related to systemic inflammation and excessive hepatic gluconeogenesis and polymorphisms of the enzyme governing organophosphate elimination are all possible contributors to the development of new-onset diabetes mellitus. To date, a preventive strategy for organophosphate-mediated new-onset diabetes mellitus is still lacking. However, lowering reactive oxygen species levels may be a practical method to reduce the risk of developing hyperglycemia.
Core Tip: Organophosphate may induce acute hyperglycemia by damaging pancreatic cells and result in new-onset diabetes mellitus after chronic exposure to organophosphate compounds. Organophosphate-mediated new-onset diabetes mellitus might be mediated by a polymorphism of paraoxonase-1, which is associated with organophosphate elimination in hepatocytes. Pancreatic beta cell damage, excessive gluconeogenesis, hepatic steatosis, systemic inflammation and possibly sarcopenia all contribute to insulin resistance and therefore hyperglycemia.