The superior doctor prevents sickness. The mediocre doctor attends to impending sickness. The inferior doctor treats actual sickness.”
– Chinese Proverb

The management of diabetes today requires an understanding of the concept of the circular economy in eliminating waste and pollution, circulating products and materials at their highest level, and regenerating nature.

Today, we saw a 64-year-old woman for her follow-up visit to the diabetes clinic. She is our typical Oklahoma patient with type 2 diabetes mellitus (DM) with multiple comorbidities, including morbid obesity, heart disease requiring stent placement, high blood pressure, and dyslipidemia.

She has multiple complications due to her chronic medical conditions, including blindness in one eye and severe neuropathy with a lack of feeling in her feet. Our patient weighs 261 lbs. Her body mass index (BMI) is 44.9.

As a reminder, the healthy adult BMI range is 18-25. She was having a hard time getting on the exam table and had to be examined sitting in a chair. Her physical activity was limited due to deconditioning and vision problems. She is currently taking 27 different medications, including oral metformin and dapagliflozin, injectable semaglutide, degludec insulin once daily, and aspart insulin injections three times per day just for the treatment of her DM.

She is giving herself about four injections per day with “one-time use” pen needles. This treatment regimen constitutes 124 used needles per month for the environment for a single patient. Semaglutide comes in a once-weekly dose of a one-time-use disposable plastic pen. We will evaluate this case to determine the climate cost of the diabesity pandemic and also about how much plastic trash is being produced with attempts to manage this chronic condition.

Approximately 537 million adults are living with DM as per the 2021 international diabetes federation estimate, and the number is predicted to rise to 643 million by 2030. One of the major risk factors for diabetes is obesity and a sedentary lifestyle. The food industry has been a major contributor to the rise in global obesity. During the last few decades, the food industry expanded tremendously, adversely affecting the environment. With the expansion of the fast-food industry, meat consumption has increased all over the world — the negative impact of increased meat consumption on the environment cannot be denied.

Livestock farming causes greenhouse gas emissions, overconsumption of water, overuse of land resources, waste production, and water and air quality degradation. Industrial meat is the single biggest cause of deforestation globally. Meat consumption poses several health risks, such as DM, cardiovascular diseases, and colorectal cancers, and it negatively impacts the environment.

There is a vast amount of research on the environment’s impact on diabetes. Still, today we would like to draw your attention to the flip side and talk about how diabetes might be impacting the environment. For a moment, we would like you to think about the 37.3 million Americans suffering from DM and the innumerable number of needles, syringes, lancets, blood glucose monitoring strips, blood glucose monitors, continuous glucose sensors, insulin bottles, pens, infusion tubing, disposable pumps, device batteries, and packaging they would use in a year.

The lack of a circular economy of these items poses a serious risk with regard to infection control and other such biohazards.

The necessity of this evil does not leave much to be said about the solution to this problem other than recognizing its existence, trying to appropriately dispose of the waste that has already been generated, and moving towards more biodegradable or environment-friendly options.

The eventual burden of this problem will lie on the backs of pharmaceutical companies, and we can only hope that it will not significantly impact our health care costs.

Global warming has been a major factor in the actual climate change scenario. Twenty-three percent of the total greenhouse gasses emitted are from agriculture, forestry and other land uses. The consumption of meat and meat products provides nutrients such as proteins, iron, and vitamins. But this source of protein has a great environmental impact. Livestock production has a negative impact on greenhouse gas emissions as well as water footprint, water pollution, and water scarcity. Due to this, it is evident that there is an important need to change current lifestyle and consumption habits for human health and also the planet’s health. Among the variety of meats available, poultry and pig meat have been shown to be the highest consumption.

In 2014-2016, the total meat consumption per capita worldwide is 34.1 kg per year, of which 60 percent is red meat (pork, sheep, beef). And red meat production, especially beef, produces more carbon dioxide due to ruminant enteric fermentation.

The circular economy concept includes eliminating waste and pollution, circulating products and materials at their highest level, and regenerating nature. It was conceived to be a wheel that would propel us towards greater sustainability, but it seems the wheel has been halted, and we have found ourselves arrested in a loop where man-made risk factors create the disease, and then our attempts at the disease management further exacerbate environmental risk factors, propelling a vicious cycle onward and downward.

Syeda Fatima Murtaza, Ali R. Chaitou, and Jobby John are physicians.

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