Wildfire smoke is one example of air pollution, and it’s associated with an increase in the risk of health complications in people with diabetes, according to a study published in June 2020 in Environmental Health Perspectives. In other research, such as a review published in September 2020 in Gut Microbes, scientists have uncovered the surprising role that air pollution in cities can play in altering gut bacteria and increasing diabetes risk. “In diabetes care, we focus on the whole person. What is their environment? How do they live? Where do they live?” says Melissa Young, PharmD, BC-ADM, CDCES, a clinical pharmacist and spokesperson for the Association of Diabetes Care and Education Specialists (ADCES). Dr. Young provides telehealth primary care for the Department of Veterans Affairs across several states, including Colorado and Idaho. RELATED: 8 Surprising Risk Factors for Type 2 Diabetes
Can Exposure to Air Pollution Affect a Person’s Risk of Diabetes?
The global toll of air pollution on diabetes is significant, according to a study published in July 2018 in the Lancet Planetary Health. An estimated 3.2 million cases of diabetes globally could be attributed to elevated air pollution in 2016, with increasing burden falling on people living in low- and lower- to middle-income countries. “It’s only recently that air pollution has been considered as a factor contributing to greater risk for type 2 diabetes,” says Tanya Alderete, PhD, an assistant professor at the University of Colorado in Boulder who studies the causes and consequences of type 2 diabetes. Dr. Alderete uncovered health disparities for Latino children living in urban Los Angeles from 2001 to 2012. She found that increased air pollution increased risk factors for type 2 diabetes such as decreased insulin sensitivity and reduced production of insulin in overweight and obese children. Her findings were published in July 2017 in Diabetes. Why is pollution so bad? Pollution carries fine particles, including metals and other toxins, that inflame the lungs and other parts of the body. Some experts hypothesize that inflammation from fine particles in air pollution increases the risk of type 2 diabetes. Alderete suspects air pollution changes the gut in unhealthy ways, potentially contributing to type 2 diabetes. Young adults in Southern California with greater exposure to air pollution had less-diverse gut microbiomes, according to one of her studies, which was published in May 2020 in Environmental International. The gut microbiome is the group of microorganisms, including bacteria, that help your body break down food and may protect against infection. Air pollution alone does not cause diabetes, cautions Alderete. “It’s a constellation of risk factors that include poor diet, poor physical activity, and greater exposure to environmental toxicants,” she says. Nevertheless, people should try to limit exposure to air pollution from traffic and industry as much as possible. “Try to exercise away from busy roadways. It’s never a bad idea to check air quality levels before going outside to exercise.” Air quality is now included in many weather apps, or you can download air-quality specific apps like AirVisual. She hopes her research helps policy makers improve air quality standards and promote changes in public health policy. “That could mean building schools or developing affordable housing further away from busy roadways,” says Alderete. RELATED: Loneliness May Be a Risk Factor for Type 2 Diabetes, Study Finds
Air Pollution Can Increase Health Risks for People With Diabetes
“People with diabetes need to be aware of their surroundings and the air quality,” says Young. Smoke from wildfires is an increasing source of air pollution, according to a report published in November 2020 in the New England Journal of Medicine. Researchers have found people with diabetes may be negatively affected by smoke. In the previously mentioned study, researchers examined ambulance dispatch calls of roughly 500,000 people over five fire seasons in British Columbia. These included severe fire seasons in 2010, 2014, and 2015, when more than 740,000 acres burned. Exposure to elevated levels of fine particulate matter in smoke was associated with increased ambulance dispatches, within 24 to 48 hours, for episodes of high and low blood sugar, says Jiayun Yao, PhD, who led the research while at the University of British Columbia School of Population and Public Health. She now works for the British Columbia Centre for Disease Control in Vancouver. “Just the stress of having a fire nearby could increase blood glucose,” says Young, a certified diabetes care and education specialist, adding that continued high blood glucose can produce extremely high levels of ketones leading to diabetic ketoacidosis (DKA), a serious and life-threatening complication that is more common in people with type 1 diabetes than those with type 2. People with diabetes may be more sensitive to fine particles in smoke, especially in light of their high prevalence of heart disease, says Young. Indeed, air pollution has been shown to double the risk for hospital admissions for heart disease in people with diabetes, according to a study in Epidemiology. RELATED: How Wildfire Smoke Affects Your Health
Be Prepared for Emergencies Like Wildfires That Can Lower Air Quality
“People with diabetes need to be aware of the potential impact from poor air quality events such as wildfire smoke, and to have an action plan to reduce exposures,” Dr. Yao says. Young recommends that individuals managing diabetes keep track of changes to blood sugar and call their diabetes care team with any questions. She recommends keeping a list of your providers’ phone numbers handy for when questions arise. She says that paper or surgical masks, scarves, and bandanas will not protect your lungs from the fine particles in wildfire smoke. An N95 respirator may help reduce the risk, but it must fit properly, so ask your physician if you’re considering purchasing one (N95 masks are also in short supply during the pandemic). A sick day kit is also essential for emergencies because it has enough medication, food and supplies to get you through several days. You can learn how to make a sick day kit at the ADCES website. “We need to be careful and be prepared,” says Young, adding that the COVID-19 pandemic has recently forced patients and providers to prepare for all kinds of disasters including wildfires. The Centers for Disease Control and Prevention (CDC) also has information on dealing with wildfires. RELATED: How to Prepare for a Hurricane if You Have Diabetes
Practical Tips for Dealing With Air Pollution if You Have Diabetes
Reducing exposure to air pollution is important for people with diabetes, says Young. Monitor air quality by visiting AirNow.gov, the U.S. Air Quality Index, to find the latest information in your area, she says. Use apps on your phone or tablet or watch the local news to keep tabs on air quality. “Try to stay inside if it’s a high-pollution day and it’s recommended to stay indoors if you have a chronic condition. Don’t go outside for your walk,” says Young. Being inside more means paying attention to indoor air quality, too. “Make sure the filters on your HVAC system are clean,” says Young. You can use an air purifier or portable air cleaner designed for single areas of the home. Air cleaners won’t remove all pollutants from the air, but they can help, says Young, who recommends checking out the U.S. Environmental Protection Agency’s Guide to Air Cleaners in the Home. If the air quality is bad, don’t do anything to stir up the air, like vacuuming. “Always be prepared, watchful, and aware of your surroundings,” says Young. “Be as healthful as possible. Keep up with blood glucose testing, and if you have questions, check with your diabetes care team.” RELATED: How Exercise Helps Prevent and Manage Type 2 Diabetes
