Managing Diabetes in the Heat: Potential Issues and Concerns

Westphal, Sydney A.; Childs, Raymond D.; Seifert, Karen M.; Boyle, Mary E.; Fowke, Margaret; Iñiguez, Paul; Cook, Curtiss B.

doi:10.4158/ep09344.ra

Cited by 34 publications

(20 citation statements)

References 26 publications

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“…One study projects that the prevalence of diabetes in America could double by 2050, due in part to the aging of the U.S. population (Boyle et al 2010). Individuals with diabetes are at higher risk for heat-related morbidity and mortality than the general population (Federal Interagency Forum on Aging Related Statistics 2010; Westphal et al 2010). …”

Section: Resultsmentioning

confidence: 99%

Climate Change and Older Americans: State of the Science

Gamble

Hurley

Schultz

et al. 2013

Environ Health Perspect

166

114

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Background: Older adults make up 13% of the U.S. population, but are projected to account for 20% by 2040. Coinciding with this demographic shift, the rate of climate change is accelerating, bringing rising temperatures; increased risk of floods, droughts, and wildfires; stronger tropical storms and hurricanes; rising sea levels; and other climate-related hazards. Older Americans are expected to be located in places that may be relatively more affected by climate change, including coastal zones and large metropolitan areas.Objective: The objective of this review is to assess the vulnerability of older Americans to climate change and to identify opportunities for adaptation.Methods: We performed an extensive literature survey and summarized key findings related to demographics; climate stressors relevant to older adults; factors contributing to exposure, sensitivity, and adaptive capacity; and adaptation strategies.Discussion: A range of physiological and socioeconomic factors make older adults especially sensitive to and/or at risk for exposure to heat waves and other extreme weather events (e.g., hurricanes, floods, droughts), poor air quality, and infectious diseases. Climate change may increase the frequency or severity of these events.Conclusions: Older Americans are likely to be especially vulnerable to stressors associated with climate change. Although a growing body of evidence reports the adverse effects of heat on the health of older adults, research gaps remain for other climate-related risks. We need additional study of the vulnerability of older adults and the interplay of vulnerability, resilience, and adaptive responses to projected climate stressors.

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Section: Resultsmentioning

confidence: 99%

Climate Change and Older Americans: State of the Science

Gamble

Hurley

Schultz

et al. 2013

Environ Health Perspect

166

114

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“…86 If blood glucose levels exceed the renal threshold for glucose reabsorption, the resulting osmotic diuresis leads to substantial dehydration if adequate replacement fluids are not ingested, thereby impairing SkBF and sweating. It should also be noted that medications affecting renal function (i.e., diuretics and angiotensin-converting enzyme inhibitors) can adversely affect fluid balance.…”

Section: Hydrationmentioning

confidence: 99%

Do Heat Events Pose a Greater Health Risk for Individuals with Type 2 Diabetes?

Yardley

Stapleton

Sigal

et al. 2013

Diabetes Technology & Therapeutics

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Chronic medical conditions such as type 2 diabetes may alter the body's normal response to heat. Evidence suggests that the local heat loss response of skin blood flow (SkBF) is affected by diabetes-related impairments in both endothelium-dependent and non-endothelium-dependent mechanisms, resulting in lower elevations in SkBF in response to a heat or pharmacological stimulus. Thermoregulatory sweating may also be diminished by type 2 diabetes, impairing the body's ability to transfer heat from its core to the environment. Diabetes-associated co-morbidities and the medications (particularly those affecting fluid balance) required to treat these conditions may exacerbate the risk of heat-related illness by decreasing SkBF and sweating further. Unfortunately, the majority of studies measure local heat loss responses in the hands and feet and lack measures of core temperature. Therefore, the impact of these impairments on whole-body heat loss remains unknown. This review addresses heat-related vulnerability in individuals with type 2 diabetes by examining the literature related to heat loss responses in this population. Type 2 diabetes, its associated co-morbidities, and the medications required in their treatment may cause dehydration, lower SkBF, and reduced sweating, which could consequently impair thermoregulation. This effect is most evident in individuals with poor blood glucose control. Although type 2 diabetes can be associated with impairments in SkBF and sweating, more physically active individuals requiring fewer medications and having good blood glucose control may be able to tolerate heat as well as those of similar age and body composition.

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“…In recent years, temperature effects on diabetes patients have been observed with increased susceptibility to both cold and hot temperatures [7]. Heat impairs both the thermoregulative and orthostatic responses at high temperatures, while apparent loss of efferent vasomotor control during diabetic neuropathy have been noted in cold periods [15,16]. However, most studies that explored the effects of temperature on diabetes mortality were mainly undertaken in temperate and subtropical cities [17,18,19,20,21,22,23,24,25,26,27]; to the best of our knowledge, no study has been carried out in a tropical setting.…”

Section: Introductionmentioning

confidence: 99%

How Does Ambient Air Temperature Affect Diabetes Mortality in Tropical Cities?

Seposo

Đăng

Honda

2017

IJERPH

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Diabetes is well-known as one of the many chronic diseases that affect different age groups. Currently, most studies that evaluated the effects of temperature on diabetes mortality focused on temperate and subtropical settings, but no study has been conducted to assess the relationship in a tropical setting. We conducted the first multi-city study carried out in tropical cities, which evaluated the temperature–diabetes relationship. We collected daily diabetes mortality (ICD E10–E14) of four Philippine cities from 2006 to 2011. Same period meteorological data were obtained from the National Oceanic and Atmospheric Administration. We used a generalized additive model coupled with a distributed lag non-linear model (DLNM) in determining the relative risks. Results showed that both low and high temperatures pose greater risks among diabetics. Likewise, the study was able to observe the: (1) high risk brought about by low temperature, aside from the largely observed high risks by high temperature; and (2) protective effects in low temperature percentile. These results provide significant policy implications with strategies related to diabetes risk groups in relation to health service and care strategies.

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Managing Diabetes in the Heat: Potential Issues and Concerns

Cited by 34 publications

References 26 publications

Climate Change and Older Americans: State of the Science

Climate Change and Older Americans: State of the Science

Do Heat Events Pose a Greater Health Risk for Individuals with Type 2 Diabetes?

How Does Ambient Air Temperature Affect Diabetes Mortality in Tropical Cities?

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