SAN DIEGO (EGMN) – Many adults with diabetes who live in a hot climate don’t understand how hot weather impacts their disease self-management, results from a survey of 152 patients demonstrated.

For example, 29% of respondents did not initiate personal protective measures until temperatures reached 101°F, and 37% left their diabetes medications and supplies at home rather than risking them to heat exposure.

“This was quite concerning, because they wouldn’t have the means to check their blood sugars if they began to feel faint if they got behind the wheel to start driving; or if they needed to seek medical attention, they wouldn’t have the means to know if they should,” Dr. Adrienne Nassar said during a press briefing at the annual meeting of the Endocrine Society.

Previous studies have shown that people with diabetes have higher rates of emergency room visits, hospitalizations, and deaths caused by to heat illness during hot weather than during more temperate weather, but few published studies have assessed how patients manage their disease during extremely hot temperatures, said Dr. Nassar, a third-year resident in the department of internal medicine at Mayo Clinic, Scottsdale, Arizona.

“From a physiologic standpoint, the primary way in which we cool ourselves is through sweating, and diabetes patients may have an impaired ability to do so,” Dr. Nassar said.

In collaboration with the U.S. National Weather Service and the U.S. National Oceanic and Atmospheric Administration, Dr. Nassar and her associates surveyed 152 adults who attended the diabetes clinic at Mayo between Nov. 30, 2009, and Dec. 31, 2009 to assess the types of personal protective measures they take against the heat, as well as their knowledge of safe temperatures and exposure times.

The mean age of respondents was 64 years, 51% were female, 58% were non-Hispanic white, 83% had type 2 diabetes, and 77% used insulin.

More than half of the patients (60%) reported staying indoors to protect themselves against the heat, 56% drank fluids frequently, 45% applied sunscreen, and 45% wore protective clothing. However, 23% reported drinking only when they became thirsty, suggesting that they “were starting to get behind on their fluid status,” Dr. Nassar said.

Nearly three quarters of patients (71%) reported spending less than 1 hour in the heat, but 29% did not initiate personal protective measures until temperatures reached 101°F. “Heat-related illness can take place at 80°-90° when you factor in the heat index,” Dr. Nassar noted.

While 73% of patients said they had received information about the harmful effects of heat on insulin, fewer indicated that they had received information about extreme heat on glucose meters (41%), oral medications (39%), and glucose testing strips (38%), and 20% “did not know when to begin [taking precautions], although this information is included in the product information inserts [contained in packaging for] medications and glucose meters,” she said.

In addition, 37% of patients left their diabetes medications and supplies at home during hot days, rather than risk them to heat exposure.

Patients reported television as their primary source for weather information (89%), followed by radio, the Internet, and newspapers.

“Overall, we found that many patients expose themselves to high temperatures before initiating protective measures,” Dr. Nassar concluded. “We would like to repeat our survey in other populations, for example, outdoor laborers [who may employ unique protective strategies], adolescents, younger adults, and different socioeconomic groups.”

The study is expected to appear in the September 2010 issue of the Journal of Diabetes Science and Technology.

Dr. Nassar said that she had no relevant financial conflicts to disclose.

Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

圣地亚哥 (EGMN)——一项对居住于气候炎热地区的152例糖尿病成人患者的调查显示，许多患者并不知道高温是如何影响其对疾病的自我管理的。

 

例如，29%的调查对象在气温未达到38.3℃前并未采取任何自我防护措施，37%的调查对象表示宁可将糖尿病药物和用品放在家中，也不愿冒险将其暴露于高温中。

 

Adrienne Nassar博士在内分泌学会年会的新闻发布会上说：“这非常令人担忧，因为他们在感到眩晕时或准备开始开车时，身边都没有可测量血糖的仪器，另外在因缺乏测量仪而无法测量血糖的情况下，他们也不知道自身血糖水平如何以及是否需要就医。”

 

亚利桑那州斯科茨代尔梅奥诊所内科的第三年住院医师Nassar博士指出，既往研究表明，糖尿病患者在炎热天气期间因中暑所致的急诊就诊率、住院率和死亡率高于温和天气期间，但在已发表的研究中，较少有研究对患者在极高温天气期间管理自身疾病的方式进行评价。

 

Nassar博士说：“从生理观点来看，人体降温的主要方式是通过排汗，而糖尿病患者排汗功能可能有所受损。”

 

Nassar博士及其同事与美国国家气象局和美国国家海洋和大气管理局合作，对2009年11月30日至2009年12月31日期间梅奥糖尿病门诊收治的152例成人患者进行了调查，评价他们所采取的抵御高温的自我防护措施以及他们对安全气温和暴露时间的认识。

 

调查对象的平均年龄为64岁，51%为女性，58%为非西班牙裔白种人，83%患有2型糖尿病，77%使用胰岛素。

 

半数以上患者(60%)通过呆在室内来抵御高温，56%通过频繁喝水，45%通过擦防晒品，45%通过穿防护衣。Nassar博士说，然而，23%称仅在口渴时才喝水，这表明他们“未采取积极的补液措施。”

 

近3/4(71%)的患者称其在高温下呆的时间少于1 h，但29%的患者在气温达到38.3℃(101°F)前未采取任何自我防护措施。Nassar 博士指出：“将高温指数作为发病因素时，高温相关疾病可在26.6~32.2℃(80°-90°F)范围内发生。”

 

她表示，73%的患者称曾接收到有关高温对胰岛素不良影响的信息，较少的患者称曾接收到有关极度高温对血糖仪(41%)、口服药物(39%)和血糖测试纸(38%)的影响的信息，20%的患者表示“尽管这一信息已包含在药品和血糖仪包装内的产品说明书中，但仍不知道何时开始采取防护措施。”

 

此外，37%的患者在高温天期间宁可将自己的糖尿病药物和用品留在家中，也不愿冒险将它们暴露于高温下。

 

患者称电视是其获取天气信息的主要途径，其次为收音机、网络和报纸。

 

Nassar博士总结说：“总体而言，我们发现许多患者未采取任何防护措施就暴露于高温下。我们打算在户外工人(这些人可能采取独特的防护措施)、青少年、年轻成人和不同社会经济背景的群体等其他人群中重复我们的调查。”

 

该研究预计将发表于2010年9月出版的《糖尿病科学与技术杂志》(Journal of Diabetes Science and Technology)。

 

Nassar博士声明没有任何相关经济利益冲突。

 

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