If you’ve been 

diagnosed 

with diabetes 

or metabolic 

syndrome, a 

precursor to 

diabetes and 

cardiovascular 

disease, you 

may be more 

vulnerable to 

environmental 

hazards, such as 

air pollution and 

extreme heat. 

F

a

c

t

S

h

e

et 

August 2007 

Diabetes and 

Environmental Hazards 

Information for Older Adults and 

Their Caregivers 

Among persons age	 

65 and older, 20% of	 

U.S. men and 15%	 

of women report	 

having diabetes. More than	 

60 million people in the	 

United States (U.S.) suffer	 

from diabetes or metabolic	 

syndrome1,2, a precursor to	 

diabetes and cardiovascular	 

disease (heart disease and	 

stroke). 

Diabetes is among the top	 

ten leading causes of death	 

in the U.S. for men and	 

women over 65 years of age3	 

and costs our nation more	 

than $132 billion annually1.	 

What is Diabetes? 

Diabetes occurs when the	 

body fails to make insulin,	 

a hormone produced in the	 

pancreas. It also occurs	 

when the body does not	 

properly respond to insulin. 	 

The exact cause of the disease is unknown, although	 

genetics and lifestyle factors,	 

such as obesity and lack	 

of exercise, appear to be	 

involved. 	 

There are several types of	 

diabetes, but by far the most	 

common are Type 1 and	 

Type 2. Type 2, which affects	 

more than 90% of those with	 

diabetes, is more common	 

among older adults. People	 

who are overweight and inactive are more likely to develop Type 2 diabetes. 

Diabetes carries an increased	 

risk for heart attack, stroke,	 

and complications related to	 

poor circulation. It can result	 

in long-term health problems	 

including blindness, heart	 

and blood vessel disease,	 

stroke, kidney failure, amputations, and nerve damage.	 

Exposure to environmental	 

hazards, such as air pollution	 

and extreme heat can worsen	 

the health of persons living	 

with diabetes. 

This fact sheet summarizes how environmental factors 

can affect the health of older adults who are living with 

diabetes and suggests how to minimize exposure to air 

pollution and extreme heat. 
Diabetes is More Common 

Among Minorities 

In 2001, diabetes was the 5th leading	 

cause of death for Native American and	 

Hispanic women and the 6th leading cause	 

of death for Native American and Hispanic	 

men. Diabetes occurs more often in African	 

Americans; Native Americans; some Asian	 

Americans, Native Hawaiians and other	 

Pacific Islander Americans; and Hispanics. 	 

Non-Hispanic blacks report significantly	 

higher levels of diabetes, compared with	 

non-Hispanic whites (23% compared to	 

14%). Hispanics also report higher levels	 

of diabetes than non-Hispanic whites (24%	 

compared to 14%)4. 	 

Percent of Population 65 Years and 


Older With Diabetes 


(By Ethnicity)5


25% 

20% 

15% 

10% 

5% 

0% 14%	 23% 24% 

Non-Hispanic	 

Whites 

Non-Hispanic	 Hispanics

Blacks 

Environmental Factors Can 

Affect the Health of Persons 

with Diabetes 

Air Quality 

People living with diabetes are considered	 

at high risk for adverse health effects from	 

exposure to harmful particles, or air pollution	 

found both indoors and outdoors. Breathing	 

in harmful particles from air pollutants (for	 

example, smoke, vehicle exhaust, industrial	 

emissions and haze from burning fossil fuels)	 

may increase your risk of heart attack and	 

stroke. 

A recent study found that in adults living with	 

diabetes the ability of their blood vessels to	 	 

control blood flow was decreased on days	 

with high levels of particles from traffic and	 

problems. Other studies have shown that	 

when air pollution levels are high, people	 

with diabetes have higher rates of hospitalization and death related to cardiovascular	 

problems5,6. 

Extreme Heat 

Exposure to temperatures above 90 degrees	 

Fahrenheit can be very dangerous, especially	 

when humidity is also high. Having diabetes can make it more difficult for your body	 

to regulate its temperature7 during extreme	 

heat. If you’re living with diabetes, you	 

should take precautions during periods of	 

extreme heat. Avoiding exposure to extreme	 

temperatures is the best defense. Air-conditioning is one of the best ways to protect	 

against heat-related illness and death8. 

coal-burning power plants. Decreased blood	 

flow has been associated with an increased	 

risk of heart attack, stroke and other heart	 
What Can You Do to Minimize Exposure to 


Environmental Hazards?


LIMIT CONTACT WITH ENVIRONMENTAL FACTORS


n Reduce exposure to traffic and outdoor air pollution 

	 Pay attention to Air Quality Index (AQI) forecasts to learn when the air is	 

unhealthy for sensitive groups. Check with your healthcare provider about lowering your activity level when the AQI is high. If there is smoke outside of your	 

home from forest or other types of fires, or if you live in a multi-family building	 

and there is cooking smoke or fumes in the building, put your air conditioning on the re-circulate mode and keep windows closed until the smoke has	 

cleared. Reduce your time in traffic. Avoid physical activity. Limit exercise near	 

busy roads. 	 

	 

n Keep smoke out of indoor spaces 

	 Avoid tobacco smoke. When you can, ask smokers to smoke outdoors. Choose	 

smoke-free restaurants, bars and other public places. Properly vent wood-burning stoves and fireplaces. 	 

n Use caution when working around the house 	 

	 If you plan indoor painting activities, schedule it when windows and doors can	 

be left open and use fans to ventilate the area. Take frequent fresh-air breaks;	 

avoid painted rooms for several days. 	 

	 Before renovating a home built before 1978, take precautions to avoid lead	 

paint exposure. Do not use a belt-sander, propane torch, heat gun, dry scraper	 

or dry sandpaper to remove lead-based paint. These generate unacceptable	 

amounts of lead dust and fumes. 

n Protect yourself during periods of extreme heat 

	 Use your air-conditioner or go to air-conditioned buildings in your community. 	 

Take a cool shower or bath. Wear lightweight, light-colored and loose-fitting	 

clothing. Ask your doctor or nurse if your medications increase your susceptibility to heat-related illness.	 

	 Drink lots of fluids, but avoid beverages containing caffeine or alcohol. These	 

drinks can cause dehydration and increase your carbohydrate load.	 

	 If a doctor limits your fluid intake, be sure to ask how much you should be	 

drinking during extreme heat events. 
EPA’s Aging Initiative is working to protect the health of older adults from environmental hazards through risk management and prevention strategies, education, and	 

research. For more information about EPA’s Aging Initiative, visit www.epa.gov/aging.	 

Additional Resources: 

n	 U.S. EPA	 	 	 	 	 	 

2 	 Ford ES, Giles WH, Dietz WH. Prevalence of	 

the metabolic syndrome among US adults: findings from the Third National Health and Nutrition	 

Examination Survey. JAMA 2002; 287(3): 356-9. 

3 	 Federal Interagency Forum on Aging-Related	 

Statistics. Older Americans Update 2006: Key	 

Indicators of Well-Being. Washington, DC. U.S.	 

Governmental Printing Office. May 2006. 	 

4 	 Federal Interagency Forum on AgingRelated Statistics. Older Americans 2004: Key	 

Indicators of Well-Being. Washington, DC. U.S.	 

Governmental Printing Office. November 2004. 

5 	 Goldberg MS, Burnett RT, Bailar JC 3rd, Brook	 

J, Bonvalot Y, Tamblyn R, Singh R, Valois MF,	 

Vincent R. The association between daily mortal­

	 Indoor Air Quality: www.epa.gov/iaq/	 	 ity and ambient air particle pollution in Montreal,	 

	 Air Quality Index: www.epa.gov/airnow	 Quebec, 2: cause-specific mortality. Environ Res.	 

2001; 86(1): 26–36. 

n	 Centers for Disease Control and Prevention	 6 	 Zanobetti A, Schwartz J. Cardiovascular dam­ http://www.cdc.gov/diabetes/ 	 age by airborne particles: are diabetics more susceptible? Epidemiology 2002; 13(5): 588–92. 

n	 National Institute of Diabetes and Digestive	 

and Kidney Diseases:	 	 7	 USEPA. Excessive Heat Events Guidebook.	 

http://diabetes.niddk.nih.gov/ Office of Atmospheric Programs (6207J).	 

Washington, DC. EPA 430-B-06-006. June 2006. 	 

n	 American Diabetes Association	 	 8	 Naughton MP, Henderson A, Mirabelli MC,	 

www.diabetes.org Kaiser R, Wilhelm JL, Kieszak SM, Rubin CH,	 

McGeehin MA. Heat-related mortality during	 	 a 1999 heat wave in Chicago. Am J Prev Med.	 Endnotes 2002; 22(4): 328-9. 

1 	 National Institute of Diabetes and Digestive	 

and Kidney Diseases. National Diabetes Statistics	 

fact sheet: general information and national estimates on diabetes in the United States, 2005.	 

Bethesda, MD: U.S. Department of Health and	 

Human Services, National Institutes of Health,	 

2005. 

Publication Number EPA 100-F-07-020