September 18 — Heat and particulate air pollution may increase risk of diabetes-related hospitalizations, according to a recent paper published in BMJ Open Diabetes Research and Care. The study, co-authored by Barrak Alahmad, Research Fellow at the Department of Environmental Health at the Harvard T.H. Chan School of Public Health, is one of the first to look at the effects of multiple environmental exposures on the disease, and could have many implications for future research.
The findings indicate that high temperatures and dusty conditions are significant environmental factors that affect the health of patients. In Kuwait, where temperatures can reach up to 50°C (122°F) and dust storms are frequent, the research revealed that increased exposure to both heat and dust—either separately or together—heightens the risk of hospitalization for diabetes patients.
While the study did not pinpoint the mechanism of disease that may be causing the increase in hospitalizations, Professor Fahd Al-Mulla, Director of the Research Division at the Dasman Diabetes Institute, which partnered with Harvard Chan School on the research, noted that high temperatures lead to increased heat stress, which worsens glucose control and raises the risk of complications such as foot ulcers and fluctuations in blood sugar levels. Fine dust particles also cause vascular damage and increase inflammation, further complicating the condition of diabetes patients. Al-Mulla emphasized the need to integrate these environmental factors into health practices and policies to ensure healthcare systems are prepared to manage the growing effects of climate change on patients with diabetes.
As part of the study, researchers collected daily dust samples using specialized devices —custom-built on the Harvard Chan School’s campus in Boston — over a two-year period from 2017 to 2019. The devices were then sent back to The School and analyzed to determine pollution levels and the types of particulate matter. Additionally, temperature data was collected from meteorological stations.
Alahmad shared that this study could change the way we think about risk factors for chronic conditions like diabetes. “You would always think about the exercise, nutrition, diet, and the common traditional risk factors for diabetes [and] genetics,” he said. “But in a place like Kuwait, we’ve got extreme temperatures that are unprecedented, often exceeding 50 degrees Celsius during the summers, and because Kuwait is a desert country, it sees massive dust storms that blanket the entire country, increasing the levels of air pollution as well.”
Kuwait presented a unique opportunity to study the effects of heat, dust, and air pollution together. As extreme heat becomes an issue not only in desert climates like Kuwait, but also around the world, this study could be a precursor of things to come in other countries, like in the U.S., where diabetes also affects a large proportion of the population. Alahmad says of the study, “The direct relevance is for places that are hot and dusty, and there are other places in the world that are also hot and dusty. They might not be as extreme as we are seeing Kuwait, but Kuwait opens a window to a potential future, because we know that temperatures are increasing and the droughts are making dust storms more frequent.”
As wildfires continue to be an issue in the Western United States, Alahmad sees parallels between those hot and dusty desert conditions and the smoke pollution that affected many people in the U.S. this summer. This research substantiates how multiple environmental exposures occurring simultaneously, like wildfire smoke and hot days, could have an adverse impact on health.
Another unique aspect of this research was the data collection method. The air quality data was collected by devices custom-made to withstand the harsh conditions of Kuwait. Alahmad explains, “These devices were made here in [the Department of Environmental Health’s Landmark campus], Boston, and we shipped to Kuwait, where we operated them for 2 years. Every day the samples were collected and shipped to us in Boston. Then, here in our labs, we examined the composition of air pollution in Kuwait.”
The devices allowed Alahmad and his team to determine the type of pollution that was affecting air quality each day. “Many devices just give you a number (of airborne particulate matter concentration) for each day,” he said, which doesn’t allow researchers to know if the particles were from traffic, smoke, dust, or a combination.
“We cannot understand the total effect of the environment on individuals and populations unless we look at all aspects,” Alahmad said, “We can’t examine only one aspect of the environment at a time.”
Alahmad hopes to investigate this effect further, particularly how extreme heat and dusty conditions affect workers. Kuwait is home to many migrant workers, he says, and most people who are exposed to extreme temperatures and dust storms are people who work outdoors. While the conventional wisdom may be that workers are young and healthy, Alahmad says that workers are actually getting older and older. “People are working at later stages in their lives because of financial stress, and other factors. So, we see an aging population and we see a lot of diabetics in the workforce.”
The general public can mitigate their exposure to heat and dust by staying indoors, locking windows, or using air filters, but as Alahmad points out, “If someone is a construction worker, there’s no escape other than [maybe] a mask.” Even masks, he says, may not be adequate protection.
More research is needed to understand how these exposures affect outdoor workers, whether in Kuwait, or in the United States, where OSHA recently proposed new rules for construction and other outdoor workers to reduce the health impacts of exposure to extreme heat.
View this study in the News:
- DDI new study reveals severe health effects of dust and heat on diabetic patients, Arab Times Online
- New study shows the impact of dust storms, extreme heat on diabetics, Kuwait Times
This study was supported by a grant from the Kuwait Foundation for the Advancement of Science grant CN23- 13MM- 1795 awarded to BA. The sampling work was supported by the Veterans Affairs Cooperative Studies Program #595: Pulmonary Health and Deployment to Southwest Asia and Afghanistan, from the United States (US) Department of Veterans Affairs, Office of Research and Development, Clinical Science Research and Development, Cooperative Studies Program. This publication was also made possible by US Environmental Protection Agency grant RD- 835872, and the US National Aeronautics and Space Administration grant 80NSSC19K0225 awarded to PK.
