Geoenvironmental diabetology.

Many reports have documented the negative health consequences that environmental stressors can have on patients with diabetes. Studies examining the interaction between the environment and a patient with diabetes can be unified under a single discipline termed "geoenvironmental diabetology." Geoenvironmental diabetology is defined more specifically as the study of how geophysical phenomena impact a patient with diabetes, to include effects on metabolic control, ancillary equipment (e.g., glucometers and insulin pumps), medications, supplies, access to care, and influences on the adaptive strategies employed by patients to care for their diabetes under extreme circumstances. Geological events such as natural disasters (e.g., earthquakes) or extreme weather (e.g., heat waves) are examples of stressors that can affect patients with diabetes and that can be included under the heading of geoenvironmental diabetology. As proposed here, geoenvironmental diabetology refers to how events in the physical world affect those with diagnosed diabetes, rather than how environmental factors might trigger development of disease. As the global prevalence of diabetes continues to increase, including in parts of the world that are especially vulnerable to disasters and climate change, further discussion is warranted on how to best prepare for management of diabetes under conditions of extreme geological and weather events and a changing climate. An overview is presented of various studies that have detailed how geoenvironmental phenomena can adversely affect patients with diabetes and concludes with a discussion of requirements for developing strategies for geoenvironmental diabetes management.

Diabetes in the desert: what do patients know about the heat?

BACKGROUND: This study aims to identify self-management strategies used by patients with diabetes in hot weather, examine knowledge of safe temperatures and exposure times, and evaluate comprehension of weather data. METHODS: Patients attending an endocrinology clinic in southwestern United States were surveyed. RESULTS: One hundred fifty-two surveys completed from November 30 to December 31, 2009 were analyzed. Mean patient age was 64 years; diabetes duration e analyzed 15 years; 51% were women 83% had type 2 diabetes, 58% were non Hispanic white, and 77% were on insulin injections. Mean hemoglobin A1c was 7.9%; 38% had hemoglobin A1c values of 8.0% or higher. Patients used an array of personal protective measures during hot weather, and 71% limited heat exposure to less than one hour. Respondents typically took steps to protect their diabetes medication and supplies, but 37% chose to leave medications and supplies at home. Although 73% of respondents had received information regarding the effect of heat on insulin, only 39% had received information about the effect of heat on oral medications, 41% on glucose meters, and 38% on glucose test strips. The temperature at which patients took protective measures varied. Only 55% knew the definition of the heat index. CONCLUSION: Most survey participants took measures to protect themselves from the heat, although gaps in knowledge were evident. Many patients had suboptimal glycemic control, placing them potentially at risk for dehydration during the hottest months. Increased public awareness of this topic is needed, and diabetes education programs should include information about the heat where appropriate.

Managing diabetes in the heat: potential issues and concerns.

OBJECTIVE: To review issues surrounding management of diabetes mellitus during times of extreme high temperatures. METHODS: Materials used for this article were identified through a search of MEDLINE publications from 1966 to 2009. We chose English-language articles by using terms that cross-referenced diabetes mellitus, hot temperature, heat, desert, and insulin. RESULTS: Persons with diabetes may have greater susceptibility to adverse effects from heat (ie, increased number of emergency department visits and hospitalizations, increased occurrence of dehydration and electrolyte abnormalities, and higher death rate) than persons without diabetes. Alterations in glucose homeostasis may occur, and changes in insulin kinetics and stability are possible. The impact of heat exposure on equipment performance (eg, glucometers) must be considered. CONCLUSIONS: Having diabetes places a person at risk for heat-related health problems. Physicians must be aware of possible complications that diabetic patients may encounter in summer heat to prevent problems. Patient educational materials should be developed relating to self management skills in the heat, and the topic should be included in standard diabetes education programs when applicable.

A simple meal plan emphasizing healthy food choices is as effective as an exchange-based meal plan for urban African Americans with type 2 diabetes.

OBJECTIVE: To compare a simple meal plan emphasizing healthy food choices with a traditional exchange-based meal plan in reducing HbA(1c) levels in urban African Americans with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 648 patients with type 2 diabetes were randomized to receive instruction in either a healthy food choices meal plan (HFC) or an exchange-based meal plan (EXCH) to compare the impact on glycemic control, weight loss, serum lipids, and blood pressure at 6 months of follow-up. Dietary practices were assessed with food frequency questionnaires. RESULTS: At presentation, the HFC and EXCH groups were comparable in age (52 years), sex (65% women), weight (94 kg), BMI (33.5), duration of diabetes (4.8 years), fasting plasma glucose (10.5 mmol/l), and HbA(1c) (9.4%). Improvements in glycemic control over 6 months were significant (P < 0.0001) but similar in both groups: HbA(1c) decreased from 9.7 to 7.8% with the HFC and from 9.6 to 7.7% with the EXCH. Improvements in HDL cholesterol and triglycerides were comparable in both groups, whereas other lipids and blood pressure were not altered. The HFC and EXCH groups exhibited similar improvement in dietary practices with respect to intake of fats and sugar sweetened foods. Among obese patients, average weight change, the percentage of patients losing weight, and the distribution of weight lost were comparable with the two approaches. CONCLUSIONS: Medical nutrition therapy is effective in urban African Americans with type 2 diabetes. Either a meal plan emphasizing guidelines for healthy food choices or a low literacy exchange method is equally effective as a meal planning approach. Because the HFC meal plan may be easier to teach and easier for patients to understand, it may be preferable for low-literacy patient populations.