Impact of short-term exposure to extreme temperatures on diabetes mellitus morbidity and mortality? A systematic review and meta-analysis.

Xuping Song,Xiayang Li,Liangzhen Jiang,Yan Zhang,Yue Hu,Wenqiang Huang,Xinyi Wang,Yuan Meng,Anchen Shi,Jing Tang,Yan Feng,Yan Ma,Dongdong Zhang

doi:10.1007/s11356-021-14568-0

Abstract

The relationship between diabetes mellitus and short-term exposure to extreme temperatures remains controversial. A systematic review and meta-analysis were performed to assess the association between extreme temperatures and diabetes mellitus morbidity and mortality. PubMed, Embase, the Cochrane Library, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched since inception to January 1, 2019, and updated on November 17, 2020. The results were combined using random effects model and reported as relative risk (RR) with 95% confidence interval (CI). In total, 32 studies met the inclusion criteria. (1) Both heat and cold exposures have impact on diabetes. (2) For heat exposure, the subgroup analysis revealed that the effect on diabetes mortality (RR=1.139, 95% CI: 1.089-1.192) was higher than morbidity (RR=1.012, 95% CI: 1.004-1.019). (3) With the increase of definition threshold, the impact of heat exposure on diabetes rose. (4) A stronger association between heat exposure and diabetes was observed in the elderly (≥ 60 years old) (RR=1.040, 95% CI: 1.017-1.064). In conclusion, short-term exposure to both heat and cold temperatures has impact on diabetes. The elderly is the vulnerable population of diabetes exposure to heat temperature. Developing definitions of heatwaves at the regional level are suggested.

Highlights

The Intergovernmental Panel on Climate Change indicated that the impact of climate change on public health attracted extensive attention in 21st century (Allen et al 2014)
The elderly is the vulnerable population of diabetes exposure to heat temperature
The criteria for eligibility were used: (i) studies that evaluated the effect of extreme temperatures on diabetes morbidity or mortality (ICD-9:250 or ICD10:E10-E14), and (ii) studies design were time series or case crossover; (iii) Extreme temperatures accord with at least one of the following four temperature exposures: cold, heat, cold spells and heat waves; (iv) studies provided at least one of the following estimates: percentage change, relative risk (RR) or odds ratio (OR) with 95% confidence interval (CI) or enough information for calculation; and (v) the publication language was restricted to English

Summary

Introduction

The Intergovernmental Panel on Climate Change indicated that the impact of climate change on public health attracted extensive attention in 21st century (Allen et al 2014). There is a great threat that global climate change will increase in the future (Hansen et al 2012). Extreme temperatures, such as heat effect and cold effect, is an important respect of climate change and a significant risk factor for human health throughout the world, associations of temperatures with morbidity and mortality have been supported in numerous scientific literatures (Bayram 2017 and Gronlund et al 2018). The burden of diabetes is related to the matter of therapy aimed at glycemic control, and significantly influences the patient’s survival, quality of life, and development of organ system degeneration

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