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Fall 2023

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Tolerating the Ever Increasing Heat: Challenges and Potential Solutions for People with Type 2 Diabetes

Maricarmen Vizcaino, PhD1, and Mario Ismael Hernandez, BS2, and the Climate Change SIG

We can no longer be indifferent to climate change. This past July 2023, the global mean air temperature reached a record several days in a row [1]. This was even taxing for people who live in one of the hottest places on Earth and the United States, Arizona. However, even in this state where people are used to temperatures in the 100F (40C) this has been unprecedented, resulting in a continuous increase in emergency department visits and hospitalizations [2].

Climate change is a public health emergency. There is an urgent need to protect vulnerable populations that because of their age, health status, and/or living conditions have greater difficulty to adapt to extreme heat. Let’s focus on the case of people with Type 2 diabetes (T2D). As most people have experienced in the past, our skin becoming warmer and sweaty are some of the physiological adaptations that take place in our body to dissipate heat. For people with T2D these adaptations are impaired due to cardiovascular and neurological dysfunction leading to reduced heat tolerance [3,4]. Responses to heat stress can be further compromised if comorbidities are present and certain medications are taken (e.g., diuretics prescribed to manage hypertension may lead to dehydration) [3,4]. Thus, it is imperative that people diagnosed with T2D understand the challenges that their body faces during extreme heat and adopt mitigation strategies.

Challenges for diabetes management

Exercise is central for the adequate management of T2D as it improves insulin sensitivity, enhances cardiovascular health, helps to manage body weight, among many other benefits [5]. The American Diabetes Association recommends light walking as a great way to incorporate physical activity into daily life [6]. However, how can we ask our patients and members of our community to take up or maintain the habit of walking (or any other form of outdoor exercise) when the temperature is greater than 95 degrees F during the whole Summer in many parts of the country? As we finish this article, it is 100 degrees F at 7:00 pm in the month of August in Phoenix, AZ.

Maintaining an active lifestyle is just one barrier for disease management that people with diabetes face amid extreme temperatures. Other forms of self-care such as keeping doctor’s appointments or picking up prescription medicine may be difficult if people rely on public transportation and must wait for transit in extreme weather. Another challenge is excessive heat exposure during work shifts for those working in the construction and agriculture industries - a large proportion of US Hispanics work in these sectors [7], and they also happen to have higher prevalence and incidence of T2D compared to non-Hispanic Whites [8].

Potential solutions

To address these challenges, behavioral scientists and public health professionals must develop innovative solutions to address the climate change emergency while designing and testing new interventions and community programs to prevent and manage T2D. Some of these potential solutions are the following:

  • Home exercise - Prior research has shown that home-based exercise may be effective in improving glycemic control, lipid profile, and body composition [9], and may reduce the risk for CVD [10] for people with T2D. However, further research is needed to explore the potential of this exercise modality to improve diabetes outcomes, especially when it comes to individualized exercise sessions.
  • Heat therapy - It may sound counterintuitive, but using passive heating (e.g., hot tub bathing, hot water spa) may be beneficial for diabetes management. A recent meta-analysis looked at the effects of heat therapy and found a trend towards better glycemic control among adults with T2D [11], and thus represents a potential approach to heat acclimatization for people with T2D within a controlled environment. Additional studies are needed to determine its efficacy and safety.
  • Telehealth - There is an opportunity for local organizations and community programs to offer the option of diabetes education classes delivered entirely remotely to improve diabetes outcomes. Previous studies have found that telehealth interventions (e.g, online platform, app) are effective in supporting diabetes self-care and improving glycemic control [12,13]. Nonetheless, there is a lot of room for exploration such as the use of ‘promotoras’ to lead telehealth interventions or the use of social media to deliver T2D prevention education. 
  • Comprehensive diabetes education - National, international, and local organizations should start providing comprehensive education on the detrimental effects of heat exposure for people with T2D. Currently, neither the American Diabetes Association nor the International Diabetes Federation include any information on the risks of heat exposure on the health of people with T2D, or any strategies for diabetes management during extreme temperatures [14,15]. 

Conclusion

While our society continues to address climate change and ambient temperatures continue to rise, we need to take proactive steps to protect ourselves and members of vulnerable populations who are most likely to be affected by the ever-increasing heat. As behavioral scientists and public health professionals, we must make a collective effort to explore and generate innovative interventions that promote and sustain human health in the context of global warming and extreme temperatures.

Affiliations

  1. Research Assistant Professor, College of Health Solutions, Arizona State University
  2. M.S. student in Clinical Exercise Physiology, College of Health Solutions, Arizona State University 

References

  1. Center for Climate and Energy Solutions. Heat waves and climate change. Extreme weather. https://www.c2es.org/content/heat-waves-and-climate-change/
  2. Centers for Disease Control and Prevention. National Environmental Public Health Tracking Network. https://ephtracking.cdc.gov/DataExplorer/?c=35&i=173&m=-1
  3. Kenny, G. P., Yardley, J., Brown, C., Sigal, R. J., & Jay, O. (2010). Heat stress in older individuals and patients with common chronic diseases. Cmaj, 182(10), 1053-1060.
  4. Ratter-Rieck, J.M., Roden, M. & Herder, C. Diabetes and climate change: current evidence and implications for people with diabetes, clinicians and policy stakeholders. Diabetologia66, 1003–1015 (2023). https://doi.org/10.1007/s00125-023-05901-y
  5. Colberg, S. R., Sigal, R. J., Yardley, J. E., Riddell, M. C., Dunstan, D. W., Dempsey, P. C., ... & Tate, D. F. (2016). Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes care, 39(11), 2065.
  6. American Diabetes Association. It’s a great time to get moving. Healthy Living. https://diabetes.org/healthy-living/fitness
  7. U.S. Bureau of Labor Statistics. (2021). Hispanics in the Labor Force: 5 Facts. https://blog.dol.gov/2021/09/15/hispanics-in-the-labor-force-5-facts
  8. Center for Disease Control and Prevention. (2022). National and State Diabetes Trends. https://www.cdc.gov/diabetes/library/reports/reportcard/national-state-diabetes-trends.html
  9. Dadgostar, H., Firouzinezhad, S., Ansari, M., Younespour, S., Mahmoudpour, A., & Khamseh, M. E. (2016). Supervised group-exercise therapy versus home-based exercise therapy: Their effects on Quality of Life and cardiovascular risk factors in women with type 2 diabetes. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 10(2), S30-S36.
  10. Shinji, S., Shigeru, M., Ryusei, U., Mitsuru, M., & Shigehiro, K. (2007). Adherence to a home-based exercise program and incidence of cardiovascular disease in type 2 diabetes patients. International journal of sports medicine, 877-879.
  11. Sebők, Édel, Z., Váncsa, S., Farkas, N., Kiss, S., Erőss, B., Török, Z., Balogh, G., Balogi, Z., Nagy, R., Hooper, P. L., Geiger, P. C., Wittmann, I., Vigh, L., Dembrovszky, F., & Hegyi, P. (2021). Heat therapy shows benefit in patients with type 2 diabetes mellitus: a systematic review and meta-analysis. International Journal of Hyperthermia, 38(1), 1650–1659. https://doi.org/10.1080/02656736.2021.2003445 
  12. Agastiya, I. M. C., Kurianto, E., Akalili, H., & Wicaksana, A. L. (2022). The impact of telehealth on self-management of patients with type 2 diabetes: a systematic review on interventional studies. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 16(5), 102485.
  13. Anderson, A., O’Connell, S. S., Thomas, C., & Chimmanamada, R. (2022). Telehealth interventions to improve diabetes management among Black and Hispanic patients: a systematic review and meta-analysis. Journal of Racial and Ethnic Health Disparities, 1-12.
  14. American Diabetes Association. Healthy Living. https://diabetes.org/healthy-living
  15. International Diabetes Federation. Type 2 diabetes. https://idf.org/about-diabetes/type-2-diabetes/