The Hidden Link Between Where You Live and Type 2 Diabetes

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Investigators discovered that diabetes rates were nearly twice as high in the most climate-vulnerable areas compared with the least vulnerable.

Type 2 diabetes is often discussed in terms of personal risk factors like weight, diet, physical activity and family history. But growing evidence suggests that where you live — including environmental conditions and community resources — may also play an important role.

This study looked at whether living in communities that are more vulnerable to climate-related stressors is linked to a higher risk of developing Type 2 diabetes.

“Integrating climate vulnerability into clinical data gives us a clearer view of the totality of environmental and social exposures shaping health,” said co-lead investigator Sadeer Al-Kindi, M.D., Houston Methodist medical director of environmental health and prevention. “This work reveals risks that traditional factors overlook and helps us identify vulnerable communities earlier, so we can deliver truly targeted, preventive care.”

What Is the Climate Vulnerability Index (CVI)?

The Climate Vulnerability Index (CVI) is a place-based measure that reflects how vulnerable a community is to climate-related risks. It includes factors such as exposure to extreme heat, flooding and pollution, as well as social and economic stressors like poverty, housing instability and limited access to health care. Communities with a higher CVI are considered less able to prepare for, respond to and recover from climate-related events.

How the Study Was Conducted

Researchers analyzed health records from more than 1 million adults who received care through a large health system in the Greater Houston area between 2016 and 2023. All participants were adults without diabetes at the start of the study and had ongoing contact with the health care system. Each person’s residential census tract was linked to a CVI score, which was divided into four groups — from lowest vulnerability (Q1) to highest vulnerability (Q4).

What the Investigators Measured

The main outcome was whether participants developed Type 2 diabetes over time. Diabetes diagnoses were identified using medical codes, prescriptions for diabetes medications or laboratory results showing elevated blood sugar. The investigators adjusted their analyses for age, sex, race and ethnicity, insurance status, cardiometabolic risk factors and baseline blood sugar levels.

Key Findings

Over the study period, more than 40,000 people developed Type 2 diabetes. The risk was significantly higher among those living in the most climate-vulnerable communities. People in the highest CVI group developed diabetes at a rate of 2.66 cases per 100 person-years, compared with 1.48 cases per 100 person-years in the lowest CVI group. After seven years, 14.1% of people in high-CVI areas had developed diabetes, compared with 8.6% in low-CVI areas.

Over a seven-year period, those living living in the highest-vulnerability communities had a 23% higher risk of developing Type 2 diabetes.

What This Means for Patients

These findings suggest that diabetes risk is shaped not only by individual choices and biology, but also by environmental and social conditions. Living in areas affected by climate stress, limited resources or long-term socioeconomic challenges may increase chronic stress, disrupt healthy routines and limit access to preventive care — all of which can contribute to diabetes risk.

“Where you live matters for your diabetes risk,” said co-lead investigator Jad Ardakani, M.D., a clinical research fellow in the Houston Methodist Research Institute. “Climate stressors and socioeconomic conditions can shape health in powerful ways. Recognizing this helps us better target prevention for the communities that need it most.”