Climate Change and Multisystem Disruption of Diabetes Care: A Climate-Health System

Climate change increases the need for health systems to prepare for extreme weather events that threaten continuity of chronic disease care. This narrative review examines the clinical and health system implications of flooding for diabetes care in Southeast Asia, using the November 2025 Hat Yai floods in southern Thailand as a case study. We synthesized evidence from disaster medicine literature, regional epidemiological studies, and current diabetes guidance. Floods interrupt safe water, food, electricity, transport, and health services, while dehydration, infection, and preexisting cardiovascular and kidney disease increase susceptibility to acute multisystem decompensation. Modern cardiometabolic therapies add context-dependent hazards, including euglycemic diabetic ketoacidosis with sodium-glucose cotransporter-2 inhibitors and metformin-associated lactic acidosis during acute kidney injury, and loss of insulin refrigeration and medicine supplies threatens glycemic stability. We propose a climate-health system framework that links these hazards, with practical sick-day rules, insulin-storage measures, and roles for patients, health-care teams, and health systems across the disaster cycle. Integrating these measures into routine diabetes care and national health adaptation strategies may reduce preventable complications, although flood-specific intervention evidence remains limited.