Beyond medication adherence: bisphenol exposure and its relationship with good glycemic control in type 2 diabetes.

BACKGROUND: The prevalence of type 2 diabetes (T2D) continues to rise alongside complications associated with chronic hyperglycemia. While antihyperglycemic medications are central to glycemic control, exposure to bisphenol-A (BPA) and bisphenol-S (BPS), used to coat food packages, may influence disease progression. This study aimed to test a dietary survey to estimate BPA and BPS among T2D individuals and evaluate BPA and BPS associations with levels of glycated hemoglobin (HbA1C). METHODS: Medication adherence of 382 T2D patients (63.68 ± 10.52 yrs., 7.43 ± 1.36% HbA1C) treated with oral anti-hyperglycemic therapy was assessed with electronic Drug Exposure Monitors. Dietary behavior was evaluated using the Connor dietary survey. Plasma BPA and BPS levels were measured using ELISA assay. Multivariate analyses examined variables related with HbA1C, accounting for modifiable (BMI, diet, physical activity, medication adherence, BPA/BPS levels) and non-modifiable factors (age, sex, race). RESULTS: The Connor dietary survey did not effectively estimate BPS or BPA levels. BPS, not BPA, was associated with HbA1C when adjusted by non-modifiable variables (β-coefficient = 0.14, P = 0.045), along with medication adherence (β-coefficient = -0.12, P = 0.048). However, when modifiable variables were included in the adjustment, cholesterol and saturated fats intake (β-coefficient = -0.14, P = 0.045), and medication adherence (β-coefficient = -0.16, P = 0.012) were associated with HbA1C. CONCLUSION: Levels of BPS are positively associated with HbA1c, even after accounting for non-modifiable factors, diet, and medication adherence, well-established determinants of glycemic control in T2D. Strategies aimed at reducing BPS exposure may complement antihyperglycemic therapy and diet to control HbA1C in T2D.