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• W2433779909 abstract "Letters to the EditorDiabetes Mellitus in the Arabian Peninsula Subhash C. AryaMBBS, PhD Subhash C. Arya Research Physician, Centre for Logistical Research and Innovation, M-122, Greater Kailash II, New Delhi 110048, India Email: Search for more papers by this author Email the corresponding author at [email protected] Published Online:1 May 2002https://doi.org/10.5144/0256-4947.2002.258SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor. In a recent issue of Annals, Al-Mahroos1 outlined the recent emergence of diabetes mellitus in the Arabian Peninsula. Surely, a well-planned public health program against diabetes mellitus coordinated by the Health Ministries would address insulin-resistance among the Arabs as well as the preventive strategies. Nevertheless, impending global climate change would adversely affect innumerable patients of diabetes mellitus in the Arabian Peninsula.The climate change would interfere with diagnostic techniques and therapeutic interventions. Insulin, the sheet of anchor of therapeutic intervention, has to be stored in powdered form of –20°C, and in injection form at 2-8°C. To maintain biological activity, injections never have to be frozen during storage.2 Furthermore, oral hypoglycemic, suplhonylureas and biguanids are to be stored in controlled temperature of 15-25 or 30°C. Any inadvertent exposure to higher temperatures or accidental freezing could be disastrous for insulin potency.A new record for global temperature was established during July 1998 when the average global temperature reached was 15.5°C, and was declared the hottest month in the past 120 years.3 High temperatures, if accompanied by high humidity, would involve enormous heat transmission to insulin and oral antidiabetic preparations prescribed for patients with diabetes mellitus. During the 1995 heat wave in Chicago, the maximum temperature reached was 40°C, but the heat-index, an estimate of radiative and evaporative transfer of heat was 48.3°C.4 Moreover, in developing countries, poor electricity supplies that disrupt the working of appliances designed to maintain temperatures at appropriate level5 accompany heat waves. Furthermore, wars, civil unrest, and national distress disrupt power generation facilities in large metropolitan towns for long periods.6 Insulin injections which are not meant to be frozen might get frozen accidentally, just as happens to vials of hepatitis B vaccine. In the Northern Territory of Australia, continuous monitoring of 144 vaccine vials showed that during transport to various immunization centers, 47.5% of vials had been exposed to temperature of –3°C or lower.7 Similar problems of handling could be possible in the case of insulin too.During the assay of field samples of chloroquine, amoxycillin, tetracycline, cotrimoxazole and ampiclox in Nigeria and Thailand, 36.5% of samples were found to be substandard. Moreover, in six samples of chloroquine, there was no active ingredient left.8 The scourge of poor quality antidiabetic therapeutics needs attention by quantification of field samples for active ingredients and their stabilization against adverse environment.Addition of trehalose, pirodavir or deuterium oxide to labile vaccines stabilized the formulation against high temperatures.9 An identical strategy would be useful for insulin and oral antidiabetics. Distinctive symbols have been mandatory for inflammables, poisons and radioactive substances. It would be desirable to insist on distinctive marks on vials or tablets to indicate storage requirements about temperature and humidity. Furthermore, simple tests that do not require costly equipment or trained personnel would be needed to quantify active ingredient of insulin, suphlonylurea or biguanid in physicians' premises itself.High and low-ambient temperatures modify the assay data on blood glucose. A glucose load in a tolerance test is associated with different mean adjusted glucose concentration at a high or low ambient temperature. A 75-g load of glucose in 1030 pregnant women led to 0.20 mmol/L (3.6 mgm%) higher concentration at 25-31°C than at 25-31°C.10 Temperature, humidity, light and altitude11 also affect the performance of blood glucose monitors frequently used to quantify glucose in the home rather than hospitals.12Future effects of global climate warming and the El Niño effect on blood glucose assay would be minimized after a comprehensive evaluation of the inimical effects of temperature, humidity, sunlight and altitude on different parameters. The conventional assays performed in laboratories and at home with portable glucose meters11 should be meticulously evaluated to ensure the data on glucose estimates samples are accurate and precise. A well-integrated approach to ensure availability of potent therapeutic agents, as well as sensitive and specific test for glucose level would indeed ensure that the harmful effects of climate change is countered effectively. The large number diabetics all over the world need not suffer due to cryptic effects of environment on potency of anti-diabetic therapeutics or efficacy of glucose quantification technology available.ARTICLE REFERENCES:1. Al-Mahroos F. Diabetes mellitus in the Arabian Peninsula . Ann Saudi Med. 2000; 20:111–2. Google Scholar2. Physicians' Desk Reference, 53rd edition. Montvale: Medical Economics Company, 1999. Google Scholar3. United States Environmental Protection Agency. Global warming. Vice President Gore announces new data showing that July 1998 was the hottest month on record . August10, 1998. Google Scholar4. Heat-related mortality – Chicago, July 1998 . MMWR. 1995; 44:577–9. Google Scholar5. Kumar S. India's heat wave and rains result in massive death toll . Lancet. 1998; 351:1869. Google Scholar6. Horton R. Croatia and Bosnia: the imprints of War-II: consequences . Lancet. 1999; 353:771. Google Scholar7. Miller NC, Harris MF. Are childhood immunization programmes in Australia at risk? Bull Wld Hlth Org. 1994; 72:401–8. Google Scholar8. Shakoor O, Taylor RB, Behrens RH. Assessment of the incidence of substandard drugs in developing countries . Trop Med Int Hlth. 1997; 2:839–45. Google Scholar9. New approaches to stabilisation of vaccine potency. In: Brown F, editor. Basel: Karger, 1996. Google Scholar10. Schmidt MI, Matos Branchtein L, et al.. Variation in glucose tolerance with ambient temperature . Lancet. 1994; 344:1054–5. Google Scholar11. Urdang M, Ansede-Luna G, Muller B, et al.. An independent pilot study into the accuracy and reliability of home glucose monitors . Lancet. 1999; 353:165–6. Google Scholar12. Nichols JH. Laboratory and bedside evaluation of portable glucose meters (author's reply) . Am J Clin Path. 1995; 104:483. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 22, Issue 3-4May-July 2002 Metrics History Published online1 May 2002 InformationCopyright © 2002, Annals of Saudi MedicinePDF download" @default.
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