August 2007
If you've been
diagnosed
with diabetes
or metabolic
syndrome, a
precursor to
diabetes and
cardiovascular
disease, you
may be more
vulnerable to
environmental
hazards, such as
air pollution and
extreme heat.

                       Diabetes and
                       Environmental  Hazards
                       Information for Older Adults and
                       Their Caregivers
      Among persons age
      65 and older, 20% of
      U.S. men and 15%
      of women report
having diabetes.  More than
60 million people in the
United States (U.S.) suffer
from diabetes or metabolic
syndrome1-2, a precursor to
diabetes and cardiovascular
disease (heart disease and
stroke).
Diabetes is among the top
ten leading causes of death
in the U.S. for men and
women over 65 years of age3
and costs our nation more
than $132 billion annually1.

What is Diabetes?
Diabetes occurs when the
body fails to make insulin,
a hormone produced in the
pancreas. It also occurs
when the body does not
properly respond to insulin.
The exact cause of the dis-
ease is unknown, although
genetics and lifestyle factors,
such as obesity and lack
of exercise, appear to be
involved.
There are several types of
diabetes, but by far the most
common are Type  1 and
Type 2. Type 2, which affects
more than 90% of those with
diabetes, is more common
among older adults. People
who are overweight and inac-
tive are more likely to devel-
op Type 2 diabetes.
Diabetes carries an increased
risk for heart attack, stroke,
and complications  related to
poor circulation. It  can result
in long-term health problems
including blindness, heart
and blood vessel disease,
stroke, kidney failure, ampu-
tations, and nerve damage.
Exposure to environmental
hazards, such as air pollution
and extreme heat can worsen
the health of persons living
with diabetes.
  This fact sheet summarizes how environmental factors
 can affect the health of older adults who are living with
 diabetes and suggests how to minimize exposure to air
            pollution and extreme heat.

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 Diabetes is More Common
 Among Minorities

 In 2001, diabetes was the 5th leading
 cause of death for Native American and
 Hispanic women and the 6th leading cause
 of death for Native American and Hispanic
 men. Diabetes occurs more often in African
 Americans; Native Americans; some Asian
 Americans, Native Hawaiians and other
 Pacific Islander Americans; and Hispanics.
 Non-Hispanic blacks report significantly
 higher levels of diabetes, compared with
 non-Hispanic whites (23% compared to
 14%).  Hispanics also report higher levels
 of diabetes than  non-Hispanic whites (24%
 compared to 14%)4.
    Percent of Population 65 Years and
           Older With Diabetes
              (By Ethnicity)5
  25%


  20%


  15%


  10%


   5%


   0%
14%
23%
24%
        Non-Hispanic   Non-Hispanic
          Whites       Blacks
                  Hispanics
Environmental Factors Can
Affect the Health of Persons
with Diabetes

Air Quality
People living with diabetes are considered
at high risk for adverse health effects from
exposure to harmful particles, or air pollution
found both indoors and outdoors.  Breathing
in harmful particles from air pollutants (for
example, smoke, vehicle exhaust, industrial
emissions and  haze from burning fossil fuels)
may increase your risk of heart attack and
stroke.
A recent study  found that in adults living with
diabetes the ability of their blood vessels to
control blood flow was decreased on days
with high levels of particles from traffic and
coal-burning power plants. Decreased blood
flow has been  associated with an increased
risk of heart attack, stroke and other heart
problems. Other studies have shown that
when air pollution levels are high, people
with diabetes have higher rates of hospital-
ization and death related to cardiovascular
problems5-6.

Extreme Heat
Exposure to temperatures above 90 degrees
Fahrenheit can be very dangerous, especially
when humidity is also high.  Having diabe-
tes can make it more difficult for your body
to regulate its temperature7 during extreme
heat.  If you're living with diabetes, you
should take precautions during periods of
extreme heat. Avoiding exposure to extreme
temperatures is the best defense.  Air-con-
ditioning is one of the best ways to protect
against heat-related illness and death8.

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       What Can  You Do to Minimize  Exposure to

|                    Environmental Hazards?                     |


-


      Reduce exposure to traffic and outdoor air pollution
I       Pay attention to Air Quality Index (AQI) forecasts to learn when the air is          |
       unhealthy for sensitive groups. Check with your healthcare provider about low-
       ering your activity level when the AQI is high. If there is smoke outside of your
       home from forest or other types of fires, or if you live in a multi-family building
I       and there is cooking smoke or fumes in the building, put your air condition-       |
       ing on the re-circulate mode and keep  windows closed until the smoke has
       cleared.  Reduce your time in traffic.  Avoid physical activity. Limit exercise near
       busy roads.


      Keep smoke out of indoor spaces
       Avoid tobacco smoke. When you can, ask smokers to smoke outdoors. Choose
I       smoke-free restaurants, bars and other public places. Properly vent wood-burn-     
       ing stoves and fireplaces.


      Use caution when working around the house
       If you plan indoor painting activities, schedule it when  windows and doors can
       be left open and use fans to ventilate the area.  Take frequent fresh-air breaks;
       avoid painted rooms for several days.
I       Before renovating a home built before  1978, take precautions to avoid lead
       paint exposure.  Do not use a belt-sander, propane torch, heat gun, dry scraper
       or dry sandpaper to remove lead-based paint.  These generate unacceptable
       amounts of lead dust and fumes.


      Protect yourself  during  periods of extreme heat
       Use your air-conditioner or go to air-conditioned buildings in your community.
I       Take a cool shower or bath. Wear lightweight, light-colored and loose-fitting       |
       clothing. Ask your doctor or nurse if your medications  increase your susceptibil-
       ity to heat-related illness.
       Drink lots of fluids, but avoid beverages containing caffeine or alcohol. These
I       drinks can cause dehydration and increase your carbohydrate load.
       If a doctor limits your fluid  intake, be sure to ask how much you should be
       drinking during extreme heat events.

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   EPA's Aging Initiative is working to protect the health of older adults from environ-
   mental hazards through risk management and prevention strategies, education, and
   research. For more information about EPA's Aging Initiative, visit www.epa.gov/aging.
Additional Resources:

  U.S. EPA
   Indoor Air Quality: www.epa.gov/iaq/
   Air Quality Index: www.epa.gov/airnow

  Centers for Disease Control and Prevention
   http://www.cdc.gov/diabetes/

  National Institute of Diabetes and Digestive
   and Kidney Diseases:
   http://diabetes.niddk.nih.gov/

  American Diabetes Association
   www.diabetes.org


Endnotes
1  National Institute of Diabetes and Digestive
and Kidney Diseases. National Diabetes Statistics
fact sheet: general information and national esti-
mates on diabetes in the United States, 2005.
Bethesda, MD: U.S. Department of Health and
Human Services, National Institutes of Health,
2005.
2  Ford ES, Giles WH, Dietz WH. Prevalence of
the metabolic syndrome among US adults: find-
ings from the Third National  Health and Nutrition
Examination Survey. JAMA 2002; 287(3): 356-9.
3  Federal Interagency Forum on Aging-Related
Statistics. Older Americans Update 2006: Key
Indicators of Weil-Being. Washington, DC. U.S.
Governmental Printing Office. May 2006.
4  Federal Interagency Forum on Aging-
Related Statistics. Older Americans 2004: Key
Indicators of Weil-Being. Washington, DC. U.S.
Governmental Printing Office. November 2004.
5  Goldberg MS, Burnett RT, Bailar JC 3rd, Brook
J, Bonvalot Y, Tamblyn R, Singh R, Valois MF,
Vincent R. The association between daily mortal-
ity and ambient air particle pollution in Montreal,
Quebec, 2: cause-specific mortality. Environ Res.
2001; 86(1): 26-36.
6  Zanobetti A, Schwartz J. Cardiovascular dam-
age by airborne particles: are diabetics more sus-
ceptible? Epidemiology 2002; 13(5): 588-92.
7  USEPA. Excessive Heat Events Guidebook.
Office of Atmospheric Programs (6207J).
Washington, DC. EPA 430-B-06-006. June 2006.
8  Naughton MP, Henderson A, Mirabelli MC,
Kaiser R, Wilhelm JL, Kieszak SM, Rubin CH,
McGeehin MA.  Heat-related mortality during
a 1999 heat wave in Chicago. Am J Prev Med.
2002; 22(4): 328-9.
                                               Publication Number EPA 100-F-07-020

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