International Journal of Public Health Science (IJPHS) Vol. 12, No. 1, March 2023, pp. 172~180 ISSN: 2252-8806, DOI: 10.11591/ijphs.v12i1.22280  172 Journal homepage: http://ijphs.iaescore.com Phthalates exposure as environmental risk factor for type 2 diabetes mellitus Munaya Fauziah 1 , Suhartono Suhartono 2 , Bagoes Widjanarko 1 , Muhammad Hussein Gasem 3 1 Doctoral Program of Public Health, Faculty of Public Health, Universitas Diponegoro, Semarang, Indonesia 2 Department of Environmental Health, Faculty of Public Health, Universitas Diponegoro, Semarang, Indonesia 3 Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia Article Info ABSTRACT Article history: Received Jul 25, 2022 Revised Nov 5, 2022 Accepted Nov 27, 2022 Phthalates exposure occurs in all areas, such as foods' plastic packaging, cosmetics, and others. Previous studies showed that phthalates are associated with the prevalence of T2DM. Type 2 Diabetes Mellitus (T2DM) is caused by a combination of defective insulin secretion by pancreatic β-cells and the insulin-resistance. This study aimed to investigate whether phthalate exposure is an environmental risk factor for T2DM. A case-control study was conducted among residents in the South Tangerang district from June 2020 to February 2021 using a purposive sampling technique. The cases were the patients diagnosed T2DM with HbA1c>6.5% random blood sugar>200 mg/dL, with history T2DM treatment. The respondents' urines were collected and evaluated using liquid chromatography/mass spectrometry (LC/MS). A total of 47 cases and 47 controls were recruited in the study. The lowest monomethyl phthalate (MEP) and mono (2-ethyl-5- hydroxyhexyl) phthalate (MEHHP) were 5.37 μg/L and 2.02 μg/L, respectively. On multivariable regression analysis, the high urinary MEP level (>131.91 μg/L) was independently associated with T2DM (OR: 3.754, 95% CI: 1.559–8.811, p-value: 0.002). MEP is an environmental risk factor for T2DM and likely has a significant impact on human health than MEHHP. Keywords: Case-control study Cosmetics Plastic packaging Phthalates Type 2 diabetes mellitus Urine This is an open access article under the CC BY-SA license. Corresponding Author: Munaya Fauziah Doctoral Program of Public Health, Faculty of Public Health, Universitas Diponegoro Prof. Sudarto Street No.13, Tembalang, Semarang, Central Java 50275, Indonesia Email: munayafauziah@students.undip.ac.id 1. INTRODUCTION Diabetes mellitus (DM) is a chronic metabolic disease characterized by elevated blood glucose (or blood sugar) levels, which cause damage to the heart, eyes, kidneys, blood vessels, and nerves [1], [2]. Adults have a higher risk of type 2 diabetes mellitus (T2DM) due to the body's insulin resistance or inadequate production [3]. All types of T2DM has similar main characteristic, disfunction or pancreatic beta cells. The disease of diabetes mellitus (DM) has a high death rate in most developed countries and has become an epidemic in many developing countries [4]. International Diabetes Federation (IDF) in 2017 showed that there is 4 million death in age less than 60 years old in the world. As in the basic health research (RISKESDAS) data in 2018, based on the blood sugar level examination, the prevalence of DM in the population aged>15 years in Indonesia was 10.9% in urban areas and 11.2% in rural areas [5], and these numbers are likely to increase. One of the Indonesian provinces with the highest DM prevalence is Banten. It is shown that, in 2013, Cilegon had 2.2% of its population who had DM, Tangerang for 1.8%, and South Tangerang for 1.7%.