Summer 2023
The Environmental Toll of Diabetes: The Cost of Managing a Chronic Condition
Cassandra Gonzalez, MA1; Allyson S. Hughes, PhD2 & the Diabetes SIG
Diabetes in the US
Diabetes, a serious chronic health condition, affects approximately 37.3 million Americans, or 11.3% of the total population today. All types of diabetes are steadily on the rise with more than 1.5 million American being diagnosed yearly and estimates projecting 1 in 3 adults could have type 2 diabetes by the year 2050 (Centers for Disease Control, 2010). As the 7th leading cause of death in the U.S., diabetes prevention and management is critical. In the U.S., diabetes has significant annual costs with estimates of 327 billion USD being spent yearly for the continuous care and management of diabetes. With less than five thousand endocrinologists to treat diabetes, an individual can expect to wait on average 3 to 4 months to see a specialist in the U.S.
Diabetes Technology
Diabetes technology including continuous glucose monitors (CGMs), blood glucose monitors, insulin pens, and insulin pumps, are essential in the management of diabetes. Millions of American use these diabetes management tools to improve their blood glucose levels, quality of life, and preventing or delaying long-term complications associated with diabetes. The medical devices and tools needed to manage diabetes including syringes, insulin bottles, pens, monitoring strips, lancets, pumps, and batteries are typically created with single use plastic and result in an exponential amount of waste.
Climate Change
It is well known that plastic waste and pollution are a major human and environmental health threat. Plastic is not a biodegradable product, meaning that all manufactured plastic that has ever been made still exists on earth. Only 16% of global plastic is recycled while the remaining waste ends up in landfills, incinerated, or ultimately dumped. The breakdown of plastic overtime releases greenhouse gases that pose a significant concern for climate change. As a result, humans have significantly contributed to the growing rates of greenhouse gases released, leading to a global increase in temperatures and long-term shifts to the climate (Al-Shihabi, Moore, & Chowdhury, 2022). In addition to the detrimental consequences for the planet, climate change can negatively affect overall health in a multitude of ways, especially for those with diabetes. Individuals with diabetes have an alerted response to heat and are especially vulnerable to climate change and rising temperatures (Ratter-Rieck, Roden, & Herder, 2023). Thus, considerable attention to diabetes-related waste is vital for overall environmental and human health.
Diabetes and Climate Change
The prevalence of diabetes and concern for climate change are rising in tandem. The introduction of CGMs, insulin pumps, and related insulin delivery systems contribute greatly to the improvement in daily management of diabetes. Rapid evolution of diabetes technology has revolutionized the way that people with diabetes and caregivers manage diabetes. Diabetes technologies are evolving for more targeted treatments including access to glucose information, increased safety, self-efficacy, and ease of accessibility for the self-management of diabetes. For example, insulin pens offer a portable alternative to traditional syringes, while CGMs offer virtually effortless glucose information on demand with fewer finger pricks overall. However, a substantial environmental concern is the use of diabetes management technology designed for single use. Exponential growth in single use disposable technologies in diabetes self-management and its associated shipping materials (i.e., cardboard boxes) result in a substantial amount of waste. More so, as one of the greatest generators of plastic pollution, plastic packaging significantly threatens the earth’s ecosystems due to the rapidly growing use of single-use plastics for packaging and consumer use.
Although diabetes technology and packaging are innovative in the management of diabetes, it is not innovative in the way that it is disposed of. With the sharp rise in cases of diabetes comes the growing demand for diabetes management technology. With the U.S. being a leading producer and consumer of plastic waste globally, single-use plastic that cannot be eliminated demands the ability to be reduced, reused, and recycled (Law et al., 2020). While the environmental impact from diabetes management waste has been recognized, the majority of manufacturers and pharma companies do not offer recyclable or sustainable technologies. Solutions aimed to mitigate climate change may serve in the overall reduction and prevention of morbidity and complications associated with diabetes.
Recommendations
Here are some action-oriented solutions for people with diabetes to reduce the environmental impact of diabetes related waste:
- Buy in bulk when possible (i.e., low blood sugar treats in bulk)
- Recycle packaging and shipping materials
- To learn more about which diabetes management supplies can be recycled visit https://beyondtype1.org/diabetes-supplies-disposal/
- Donate unused or unwanted supplies
- Use insulin pens instead of syringes
- Use mail back system when available
- Abbot Freestyle Libre mail back system https://www.freestyle.abbott/us-en/home/sensor-kit-take-back-pilot.html
Here are some action-oriented solutions for pharma and diabetes device companies to reduce the environmental impact of diabetes related waste:
- Reduce shipping box sizes, switch to paper packing materials, only include printed receipts in packing materials if people with diabetes opt in (otherwise only email)
- Donate unused or unwanted supplies
- Financially support innovative technologies that seek to reduce waste
- Develop mail back systems for recycling
- Create online resources to show people how and where to recycle any recyclable items
Additional Resources on Diabetes Technology and Climate Change
For more information on initiatives to reduce waste management and promote environmental sustainability visit the Diabetes Technology Society (DTS), Green Diabetes Initiative 2021 Summit Report at: https://www.diabetestechnology.org/gdi/
References
Al-Shihabi, F., Moore, A., & Chowdhury, T. (2022). Diabetes and climate change. Diabetic Medicine, 40(3), e14971.
Centers for Disease Control. (2010). Number of Americans with Diabetes Projected to Double or triple by 2050. Retrieved from : https://www.cdc.gov/media/pressrel/2010/r101022.html
Heinemann, L., & Krisiunas, E. (2019). Diabetes Technology and Waste: A Complex Problem Piling Up!. Journal of Diabetes Science and Technology, 13(5), 815–816. https://doi.org/10.1177/1932296819836395
Law, K., Starr, N., Siegler, T., Jambeck, J., Mallos, N., & Leonard, G. (2020). The United States contribution of plastic waste to land and ocean. Science Advances, 6(44), 1-7.
Ratter-Rieck, J. M., Roden, M., & Herder, C. (2023). Diabetes and climate change: current evidence and implications for people with diabetes, clinicians and policy stakeholders. Diabetologia, 1–13. Advance online publication. https://doi.org/10.1007/s00125-023-05901-y
Affiliations
- University of Louisville, Department of Psychological and Brain Sciences
- Ohio Heritage College of Osteopathic Medicine; Department of Primary Care