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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