How Increasing Temperatures, Pollution & Natural Disasters Affect People with Diabetes Across the Globe  - T1D Exchange

“Climate change is arguably one of the biggest health threats today and is estimated to cause approximately 250,000 additional deaths per year between 2030 and 2050,” explains the recent abstract published, The Impact of Climate Change on People with Diabetes: A Scoping Review, by the T1D Exchange Quality Improvement Collaborative (T1DX-QI) and diabetes population health colleagues.

The report lists factors including thermal stress, malnutrition, infectious diseases, extreme weather events, wildfires, and displacement.  

Regarding diabetes specifically, T1DX-QI reports that there’s a wealth of research on the relationship between climate change and its impact on the development and diagnosis rates of type 1 and type 2 diabetes. However, the impact of climate change on those already diagnosed with T1D and T2D has received far less attention. 

“The scoping review was conducted between November 2022 and February 2023, using articles published in PubMed Central and Google Scholar databases,” explains the study authors. “Articles published from 1970 to 2022 with the following key terms ‘diabetes’, ‘type 1 diabetes’, ‘type 2 diabetes’, ‘climate change’, ‘global warming’, and ‘natural disaster’ were reviewed.” 

The T1DX-QI team narrowed a list of nearly 14,000 articles down to only 42 closely related to climate change and people already living with diabetes —with 86% reporting significant results. Here’s a glance at their findings. 

Yes, factors related to climate change affect people with diabetes 

“People with diabetes (PWDs) are impacted directly by climate change-induced events including extreme temperatures, air pollution, and natural disasters,” explains the abstract.  

Their findings point to three specific features of climate change for PWDs across the globe: 

• Extreme temperatures: Every 1-degree increase in temperature increases a PWD’s risk of death by 14.7–29.2 percent. When temps are at their highest, vulnerable PWD’s risk of mortality is 78%. While that may sound extreme to those in moderate parts of the globe, temperatures in many areas can reach 110+ degrees. On the other hand, extreme cold demonstrated an increased risk of hospitalizations for PWDs. 
• Air pollution: “Air pollution impairs physiological function, including elevated blood glucose for adults with diabetes,” explains the abstract. Exposure to wildfires, for example, significantly increases a PWD’s risk of hospitalization for reasons related specifically to diabetes. 
• Natural disasters: Natural disasters likely lead to a person losing their home, at least temporarily if not indefinitely. This is associated with “increased difficulty in accessing and storing insulin, reduced access to healthy diets, and reduced glucose monitoring due to lack of supplies,” explains the abstract. 

The specific impact on PWDs includes: 

• Difficulty in storing insulin: In the hottest places on the planet, insulin is not safe outside of a refrigerator or cooler. Rising temps make it harder for PWDs in these countries to protect their insulin. 
• Lack of food or usual diet: Nutrition choices are a critical component of managing diabetes — and lack of food during hypoglycemia can be life-threatening.
• Accessing diabetes supplies: Being unable to get insulin, testing supplies, syringes, etc. can become quickly life-threatening.

The indirect consequences of the above-mentioned challenges mean people with diabetes face an increased risk of: 

• Being hospitalized for diabetes-related concerns, like DKA, severe hypoglycemia, etc. 
• Experiencing more diabetes-related complications and general suffering 
• Dying due to diabetes-related causes 

Extreme weather events highlight a critical impact on the safety and well-being of PWDs, including an increased risk of: 

• Displacement (the loss of your home and usual habitat) 
• Shortages in medical supplies 
• Shortages in food supplies 

For a person with diabetes, a lack of shelter, food, and medical supplies can become quickly life-threatening. In the long term, the lack of these things means the risk of developing complications, infections, and dangerous blood sugar fluctuations is extremely high. 

“Many of the events induced by climate change can have both direct and indirect effects on an individual’s blood glucose levels,” explains the abstract. “Individuals may experience hypoglycemia, hyperglycemia, and diabetes ketoacidosis (DKA) events. Worsened glycemic [management] in PWDs has been documented following earthquakes, hurricanes, and after exposure to colder temperatures.” 

The impact of climate change on PWDs calls for more support 

This scoping review makes a very clear conclusion: further research on climate change effects and the development of policies and support systems for PWDs is critical. 

“Exploring the impacts of climate change is so current and important, particularly for those living with diabetes,” explains Emma Ospelt, MPH, Data Analyst at T1D Exchange and one of the study’s leading authors. “This research illuminated the adverse effects individuals living with diabetes exposed to climate change may experience, and the need for future research and a call to action. It’s an honor to contribute to the growing body of literature on such a pressing topic.”