Exposure to ozone during outdoor activities puts people at a higher risk of developing type 2 diabetes, according to a new study published in Environmental Health Perspectives.

“The O3-related risk of developing diabetes was 1.5 times higher in the higher-outdoor activity group, and even in the lower activity group, there is an observably higher risk compared with those living in less polluted communities,” Beate Ritz, co-author of the study and professor of epidemiology and environmental health sciences at the UCLA, said in a statement.

Type 2 diabetes is a chronic condition that affects how the body processes blood sugar. At present, 462 million individuals worldwide are believed to be affected by type 2 diabetes, which also resulted in one million deaths in 2017 alone. Moreover, research has shown the condition to be the most prevalent among Indians.

If that wasn’t alarming enough, reports suggest that ozone concentration in India rose by more than a quarter in just about 15 years, between 1990 and 2016, due to rapid industrialization, growing power demands, and vehicles running on fossil fuels. At present, India is among the top 10 countries in the world in terms of ozone exposure.

According to past research, unless we drastically reduce emissions, more than 300,000 Indians are estimated to die due to ozone exposure every year by 2050. But given that scientists are only just exploring the link between ozone and diabetes, previous studies may not even have considered diabetes while arriving at the grossly disturbing numbers.

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But how does ozone exposure correlate to diabetes? Insulin is the hormone that controls levels of sugar in the blood — the researchers explained that ozone exposure might induce insulin resistance in people, contributing to diabetes.

Unfortunately, this means engaging in activities like gardening, boating, camping, or even playing chess outdoors puts people at a higher risk of developing type 2 diabetes. “Physical activity is well known and widely recognized for its health benefits, but the beneficial effects that outdoor physical activities have on human health may have to be weighed against the detrimental impacts of air pollution in areas affected by high pollution levels,” Ritz notes.

Physical inactivity, among others, was known as a risk factor for diabetes since lack of exercise is believed to make muscle cells lose their sensitivity to insulin. But according to the present study, ozone exposure independently increases the risk of developing diabetes and makes it difficult for people to perform physical activities outdoors, thereby compounding the risk to some extent.

“Sadly, what this makes clear is that even those… who are doing the right thing when it comes to health and wellness are at risk of diabetes because of poor air quality,” Jason G. Su, a researcher in environmental health sciences at the University of California, Berkeley, who co-authored the study, told the press.

Su believes the findings raise important issues about “public health protection,” and it’s high time policymakers take the health impact of this environmental concern into account. “Policies and strategies are needed to reduce ozone exposure in communities to guarantee that the health benefits from physical activity are not diminished by pollution exposure, especially in vulnerable populations,” Su added.