Abstract
BackgroundGiven the double jeopardy of global increases in rates of obesity and climate change, it is increasingly important to recognise the dangers posed to diabetic patients during periods of extreme weather. We aimed to characterise the associations between ambient temperature and general medical practitioner consultations made by a cohort of type-2 diabetic patients. Evidence on the effects of temperature variation in the primary care setting is currently limited.MethodsCase-crossover analysis of 4,474,943 consultations in England during 2012–2014, linked to localised temperature at place of residence for each patient. Conditional logistic regression was used to assess associations between each temperature-related consultation and control days matched on day-of-week.ResultsThere was an increased odds of seeking medical consultation associated with high temperatures: Odds ratio (OR) = 1.097 (95% confidence interval = 1.041, 1.156) per 1 °C increase above 22 °C. Odds during low temperatures below 0 °C were also significantly raised: OR = 1.024 (1.019, 1.030). Heat-related consultations were particularly high among diabetics with cardiovascular comorbidities: OR = 1.171 (1.031, 1.331), but there was no heightened risk with renal failure or neuropathy comorbidities. Surprisingly, lower odds of heat-related consultation were associated with the use of diuretics, anticholinergics, antipsychotics or antidepressants compared to non-use, especially among those with cardiovascular comorbidities, although differences were not statistically significant.ConclusionsType-2 diabetic patients are at increased odds of medical consultation during days of temperature extremes, especially during hot weather. The common assumption that certain medication use heightens the risk of heat illness was not borne-out by our study on diabetics in a primary care setting and such advice may need to be reconsidered in heat protection plans.
Highlights
Given the double jeopardy of global increases in rates of obesity and climate change, it is increasingly important to recognise the dangers posed to diabetic patients during periods of extreme weather
Our results show that diabetic patients are at increased odds of consulting a general medical practitioner (GP) during days of temperature extremes, especially during hot weather
There was limited statistical power to detect interactions, diabetics with cardiovascular or respiratory comorbidities had an elevated risk of heat-related GP consultation, but there was no evidence for a heightened risk among those with renal failure or neuropathy
Summary
Given the double jeopardy of global increases in rates of obesity and climate change, it is increasingly important to recognise the dangers posed to diabetic patients during periods of extreme weather. In the US diabetics were reported to have a 17% higher risk of dying on hot days compared to other subjects, which was greater than for any other disease considered [1]. This is probably due to compromised heat dissipation among diabetics which. Given the double jeopardy of global increases in obesity rates and global climate change, it is increasingly important to recognise the dangers posed to diabetic. Mechanisms have been postulated by which medications may heighten heat risk, there is little epidemiological evidence to support singling-out specific drug-types, nor the extent to which any increased risk is attributable to the drug or to the underlying disease it is being used to treat [8]
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