Lack of green space may be linked to high BP in people with type 1 diabetes
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Key takeaways:
- People with type 1 diabetes who lived in an area in the U.S. with low vegetation had higher odds for high blood pressure.
- Living in an area with air pollution was associated with lower odds for high BP.
HOUSTON — People with type 1 diabetes who lived in areas with little green space were more likely to have high blood pressure, but odds were lower for those exposed to more air pollution, according to study data.
In an analysis of data from the T1D Exchange clinic registry, presented at the Association of Diabetes Care and Education Specialists annual meeting, researchers analyzed associations between environmental risk factors and high BP among adults and adolescents with type 1 diabetes. Jorden Rieke, BSN, RN, CCRN, a nursing PhD student and predoctoral fellow at the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland, said the findings were mixed: People living in areas with little vegetation had higher odds of high BP, but those living in areas with more air pollution had lower odds for elevated BP in this sample.
“[Providers should] assess environmental risk in conjunction with assessing cardiometabolic profiles in diabetes care and diabetes education,” Rieke said during a presentation. “If someone’s goals are to lose weight and to get more physical activity, how does their environment impact that? Is there something we can look at and assess that we may not be thinking of?”
Rieke and colleagues conducted a retrospective cross-sectional secondary analysis of data from 5,597 adolescents and adults with type 1 diabetes who had survey and electronic health record data available in the T1D Exchange clinic registry from 2007 to 2017 (mean age, 36.7 years; 87.7% non-Hispanic white). Researchers obtained light pollution, air pollution and vegetation density data and linked these to each participant’s residential zip code to determine environmental risk factors. High exposure to air pollution was defined as living in an area with particulate matter2.5 of greater than 10 µg/m3, high exposure to light pollution was defined as an approximate total sky brightness of more than 0.188 mcd/m2, and low to sparse vegetation or green space was categorized as a normalized difference vegetation index score of less than 0.5. Participants had high BP if they had a systolic BP of more than 130 mm Hg or a diastolic BP of more than 80 mm Hg.
Rieke was supported in this work by her mentors, Stephanie Griggs, PhD, RN, FAAN, assistant professor at the Frances Payne Bolton School of Nursing at Case Western Reserve University; and Julia Blanchette, PhD, RN, BC-ADM, CDCES, nurse scientist in the division of endocrinology and a diabetes care and education specialist at University Hospitals Center for Diabetes and Metabolic Care and a clinical assistant professor of medicine at Case Western Reserve University.
Of the study group, 30.9% had high BP. Participants had a mean HbA1c of 8%.
In a model adjusting for age, sex, race and ethnicity, social deprivation index, education, income, BMI, LDL cholesterol, HbA1c and type 1 diabetes duration, participants were more likely to have high BP if they lived in an area with low to sparse healthy vegetation (adjusted OR = 1.203; 95% CI, 1.048-1.382; P = .009) compared with those living in an area with more vegetation. There was no association between light pollution and odds for high BP. People exposed to high levels of air pollution were less likely to have high BP compared with those living in areas with less pollution (aOR = 0.679; 95% CI, 0.512-0.894; P = .006), a finding that Rieke said was surprising.
“We expected there to be odds for higher BP with high air pollution, so our finding was inconsistent with the literature,” Rieke said. “When we ran some additional analyses and dug into this a little bit deeper, those suggested that this relationship might be pretty weak, and it’s only related to diastolic BP and not systolic BP in our sample.”
Rieke said there were several limitations, including a lack of access to all covariates and that the area-level data may not perfectly reflect individual risk. Additionally, the use of normalized difference vegetation index was originally developed for agricultural use and the current study had an overrepresentation of non-Hispanic white people. She said future studies should incorporate more comprehensive environmental risk and social determinants of health measures, more diverse samples and more covariates.
Rieke remarked on the need for additional studies with robust designs to answer questions about environmental risk factors and cardiometabolic health among people living with type 1 diabetes in the United States.
“This study is a first step for showing us some relationships, but we need to do more, and we need to look at different types of [study] designs to get the answers we’re looking for,” Rieke said.
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Rieke J, et al. F20A. Presented at: ADCES23; Aug. 4-7, 2023; Houston.
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