Diabetes and Disasters: Not if, but when, and what we can do

ABSTRACT

Background: Every country has many people living with diabetes, and disasters of various types will inevitably happen, impacting them and others. During and after any disaster the related challenges to individuals with diabetes increase, amplified by such factors as loss of shelter, power and communications, reduced access to healthy food, clean water, medications, and to healthcare providers. Injury, infection and unstable diabetes, including increased risk of vascular events may also occur. Morbidity and mortality is increased often for years after the disaster is over. Forward planning can mitigate adverse outcomes and ideally includes multiple stakeholders beyond patients and the healthcare system. Aim: To overview disaster response preparation, including elements related to diabetes care. Method: Available national and international guidelines for disaster responses, in particular those related to diabetes and to the COVID-19 have been reviewed. Results: The ‘’PARR’’ framework Preparedness, Action, Response and Recovery elements for disaster planning is a useful approach. Multi-level planning, at individual, healthcare professional, the local and national community, and international levels are desirable. Local councils, local and national governments, government, healthcare organisations, the military, communications, power and transport providers, the media, NGOs and international organisations and responders should be considered. Existent and emerging resources, such as from the International Diabetes Federation (IDF), some of the IDF Regions and from various national diabetes associations to assist diabetes care during disasters are or will soon be available. Some existent resources are compiled at ww.ajenkinsdiabetes.org. Checklists, templates, contacts and pre-prepared response kits can be helpful. Some guidance from recent COVID-19 experiences is available. Particularly vulnerable people with diabetes to consider include those with diabetes complications, such as vision loss, renal failure, amputations, frailty, cognitive impairment, children and youth with diabetes, pregnant women with diabetes and dying people with diabetes. Human Rights-related and Palliative Care aspects of disasters should be considered. Conclusions: Disasters will continue to happen. Careful preparation, particularly with consideration of local circumstances and international resources and contacts can mitigate adverse outcomes for people with diabetes. Discussion: Disasters will continue to happen. Careful preparation, particularly with consideration of local circumstances and international resources and contacts, and collaboration, can mitigate adverse outcomes for people with diabetes.