Diabetes management amidst floods in Brazil
Authors: Lucas Strassburger Matzenbacher, Janine Alessi, Gabriela Heiden Telo
Journal: The Lancet (2024)

The day is May 8, 2024, and a helicopter flies over the city of Triunfo in the state of Rio Grande do Sul, Brazil, to ensure that a child aged 8 years with type 1 diabetes receives her insulin. This child had been without access to medication after her house was inundated by the massive floods that affected the southern region of the country. Unfortunately, this assistance was not the fate of many other people who found themselves without electricity or a telephone signal to even ask for help. Rio Grande do Sul, a Brazilian state with a population of nearly 11 million, similar to Sweden, is facing an unprecedented climatic disaster—the worst in its history.1Casemiro P Imagens de satélite mostram antes e depois de maior enchente da história no Rio Grande do Sul (in Portuguese).https://g1.globo.com/meio-ambiente/noticia/2024/05/06/imagens-de-satelite-mostram-antes-e-depois-de-maior-enchente-da-historia-no-rio-grande-do-sul.ghtmlDate: 2024Date accessed: May 15, 2024Google Scholar The National Meteorology Institute alerted on April 29, 2024, of severe rainfall, and by May 5, 2024, the state's condition was described as a war zone by the Governor of Rio Grande do Sul.2BBC BrasilThe chronology of the tragedy in Rio Grande do Sul (in Portuguese).https://www.bbc.com/portuguese/articles/cd1qwpg3z77oDate: May 11, 2024Date accessed: June 24, 2024Google Scholar The calamity has led to massive flooding, causing the evacuation of 538 000 residents, and affecting more than 2·3 million people, as 478 of 497 cities in the state of Rio Grande do Sul were severely affected.3Defesa Civil do Rio Grande do SulDefesa Civil atualiza balanço das enchentes no RS/15/5, 12h (in Portuguese).https://estado.rs.gov.br/defesa-civil-atualiza-balanco-das-enchentes-no-rs-15-5-12h#:~:text=Devido%20%C3%A0s%20fortes%20chuvas%20que,garantir%20a%20seguran%C3%A7a%20das%20pessoasDate: 2024Date accessed: May 15, 2024Google Scholar, 4Defesa Civil do Rio Grande do SulDefesa Civil atualiza balanço das enchentes no RS 18/06 (in Portuguese).https://defesacivil.rs.gov.br/defesa-civil-atualiza-balanco-das-enchentes-no-rs-10-6-9h-6671eb9e34066Date: 2024Date accessed: June 24, 2024Google Scholar The flood conditions are projected to persist for days and possibly weeks, aggravating damage to agriculture, infrastructure, and hampering relief distribution.5Instituto de Pesquisas HidráulicasPrevisões atualizadas de níveis de agua no guaíba, Segunda-feira, 13/05/24 12h (in Portuguese).https://www.ufrgs.br/iph/previsoes-atualizadas-de-niveis-dagua-no-guaiba-segunda-feira-13-05-24-12h/Date: 2024Date accessed: May 15, 2024Google Scholar As a result of this scenario, individuals living with chronic diseases, such as diabetes, which affects more than 10·5% of the Brazilian population, encounter heightened health-care access barriers amid current challenges.6International Diabetes FederationIDF diabetes atlas 10th edition.www.diabetesatlas.orgDate: 2021Date accessed: May 15, 2024Google Scholar Managing diabetes demands strict glycaemic control, diet, activity, and medication adherence, all increasingly hindered during this crisis. Civilians, non-governmental organisations, care entities, and Brazilian medical societies are making extensive efforts along with the Government to coordinate care, but the challenges that lie ahead seem to be even greater than initially anticipated. Flooded roads and warehouses impede medical access and refrigerated insulin distribution. In the case of type 1 diabetes, this shortage could rapidly lead to death.7Stougaard EB Amadid H Søndergaard E et al.Time trends in the incidence of diabetic ketoacidosis leading to hospital admission among adults with type 1 diabetes: a nationwide Danish register study.Diabetes Care. 2023; 46: 1897-1902Crossref PubMed Scopus (1) Google Scholar Challenges also include difficulty preserving fresh foods, restricted clean water access, dehydration, and increased infectious disease risks, affecting health and glycaemic control. Climate change is causing new humanitarian crises and accelerating existing ones in vulnerable communities globally. By raising awareness about the challenges faced, we can inspire action and support for those affected. People around the world are contributing donations, crucial for the initial management of the disaster. However, there is still a lot more work to be done. After all, our current reality is one of devastation, where much of what we once knew is now covered in layers of mud, and the path to reconstruction is lengthy. We declare no competing interests.