December 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 disease is unknown, although
genetics and lifestyle factors, such as obesity and
lack of exercise, appear to be involved.
  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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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 inactive are
more likely to develop 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,
                                  amputations, and nerve damage.
                                  Exposure to environmental
                                  hazards, such as  air pollution and
                                  extreme heat can worsen  the
                                  health of persons living with
                                  diabetes.
   Percent of Population 65 Years and
         Older With Diabetes
             (By Ethnicity)'
 25%
 20%
                                         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.
 15%
 10%
  5%
  0%
14%
23%
24%
      Non-Hispanic  Non-Hispanic
        Whites      Blacks
                  Hispanics

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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
hospitalization 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
diabetes 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-
conditioning 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?
    LIMIT CONTACT WITH ENVIRONMENTAL FACTORS
Reduce exposure to traffic and
outdoor air pollution
Pay attention to Air Quality Index
(AQI) forecasts to learn when the
air is unhealthy for sensitive
groups. Check with your
healthcare provider about
lowering 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 and
there is cooking smoke or fumes
in the  building, put your air
conditioning 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 smoke-free
restaurants, bars and other public
places.  Properly vent wood-
burning 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.

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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.  Take a cool shower
or bath. Wear lightweight, light-
colored and loose-fitting clothing.
Ask your doctor or nurse if your
medications increase your
susceptibility to heat-related
illness.

Drink lots of fluids, but avoid
beverages containing caffeine or
alcohol. These 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.
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

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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.

     Ford  ES, Giles WH,  Dietz WH.
                                     5    Federal Interagency Forum on
                                     Aging-Related Statistics.  Older
                                     Americans 2004: Key Indicators of
                                     Weil-Being. Washington, DC. U.S.
                                     Governmental Printing Office.
                                     November 2004.

                                     6    Goldberg MS, Burnett RT, Bailar
                                     JC 3rd, Brook J, Bonvalot Y, Tamblyn
                                     R, Singh R, Valois MF, Vincent R. The
                                     association between daily mortality
                                     and ambient air particle pollution in
Prevalence of the metabolic syndrome  Montr*al' Quebec' 2: cause-specific
                                     mortality. Environ Res. 2001; 86(1):
                                     26-36.
among US adults: findings from the
Third National Health and Nutrition
Examination Survey. JAMA 2002;
287(3): 356-9.
3    Fox CS, Coady S, Sorlie PD,
D'Agostino RB Sr, Pencina MJ, Vasan
RS, Meigs JB, Levy D, Savage PJ.
Increasing cardiovascular disease
burden due to diabetes mellitus.
Circulation 2007; 115(12): 1544-50.

4    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.
7    Zanobetti A, Schwartz J.
Cardiovascular damage by airborne
particles: are diabetics more
susceptible? Epidemiology 2002;
13(5): 588-92.

8    Naumova EN, Egorov Al, Morris
RD, Griffiths JK. The elderly and
waterborne Cryptosporidium
infection: gastroenteritis
hospitalization before and during the
1993 Milwaukee outbreak. Emerging
Infectious Diseases 2004; 9(4): 418-
25.
                                                        Protecting the Health
                                                        of O Ider A tnerica tis

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