Hajat S, Haines A, Sarran C, Sharma A, Bates C, Fleming L E
London School of Hygiene & Tropical Medicine, London, UK.
Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
Environ Health. 2017 Jul 12;16(1):73. doi: 10.1186/s12940-017-0284-7.
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. 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.
Case-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.
There 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.
Type-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.
鉴于全球肥胖率上升和气候变化的双重危机，认识极端天气期间糖尿病患者面临的危险变得愈发重要。我们旨在描述环境温度与一组2型糖尿病患者向全科医生咨询之间的关联。目前，关于基层医疗环境中温度变化影响的证据有限。
对2012年至2014年英格兰的4474943次咨询进行病例交叉分析，并将其与每位患者居住地的局部温度相关联。采用条件逻辑回归评估每次与温度相关的咨询与按星期几匹配的对照日之间的关联。
高温与寻求医疗咨询的几率增加有关：高于22℃时，每升高1℃，比值比（OR）=1.097（95%置信区间=1.041，1.156）。低于0℃的低温期间几率也显著升高：OR =1.024（1.019，1.030）。在患有心血管合并症的糖尿病患者中，与热相关的咨询尤为高发：OR =1.171（1.031，1.331），但肾衰竭或神经病变合并症患者并无更高风险。令人惊讶的是，与未使用利尿剂、抗胆碱能药、抗精神病药或抗抑郁药相比，使用这些药物与热相关咨询的几率较低，尤其是在患有心血管合并症的患者中，尽管差异无统计学意义。
2型糖尿病患者在极端温度的日子里寻求医疗咨询的几率增加，尤其是在炎热天气期间。我们对基层医疗环境中的糖尿病患者进行的研究并未证实某些药物使用会增加中暑风险这一普遍假设，在热防护计划中可能需要重新考虑此类建议。
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