Department of Internal Medicine, Diabetes Outpatient Clinics, General Hospital of Mytilene "Vostanio", 83100 Mytilene, Lesvos, Greece.
Department of Emergency Medicine (Research), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
Int J Environ Res Public Health. 2024 Jun 25;21(7):828. doi: 10.3390/ijerph21070828.
Diabetes mellitus is a non-communicable disease which poses a great burden on refugee populations, who are confronted with limited access to healthcare services and disruption of pre-existing pharmacological treatment.
We sought to evaluate the degree of hyperglycaemia in refugees with known or recently diagnosed diabetes, to assess cardiovascular comorbidities and diabetes complications, to review and provide available therapeutic options, and to compare, if possible, the situation in Lesvos with other locations hosting refugee populations, thus raising our awareness towards barriers to accessing healthcare and managing diabetes in these vulnerable populations and to propose follow-up strategies.
We retrospectively studied 69 refugee patients (68% of Afghan origin, 64% female) with diabetes mellitus (81% with type 2 diabetes), who were referred to the diabetes outpatient clinics of the General Hospital of Mytilene, Lesvos, Greece, between June 2019 and December 2020. Age, Body Mass Index, diabetes duration, glycaemic control (HbA1c and random glucose), blood pressure, estimated renal function, lipid profile, diabetes complications and current medication were documented at presentation and during subsequent visits.
For all patients with type 1 diabetes and type 2 diabetes, age at presentation was 17.7 and 48.1 years, BMI 19.6 kg/m and 28.9 kg/m and HbA1c 9.6% and 8.7%, respectively (all medians). One-third (29%) of patients with type 2 diabetes presented either with interrupted or with no previous pharmacological treatment. Insulin was administered to only 21% of refugees with poorly controlled type 2 diabetes. Only half of the patients (48%) with hypertension were taking antihypertensive medication and one-sixth (17%) were taking lipid-lowering medication. Forty-two per cent (42%) of patients were lost to follow-up.
Our results showed that a significant portion of refugees with diabetes have either no treatment at all or have had their treatment discontinued, that insulin is still underutilised and that a significant portion of patients are lost to follow-up. It is essential to enhance our ability to identify refugees who may be at risk of developing diabetes or experiencing complications related to the disease. Additionally, it is important to expand access to crucial treatment and monitoring services. By improving our policies for managing non-communicable diseases, we can better support the health and well-being of these vulnerable populations. Furthermore, it is vital to recognize that Greece cannot bear the burden of the refugee crisis alone; international support and collaboration are necessary to address these challenges effectively.
糖尿病是一种非传染性疾病，给难民群体带来了巨大负担，他们面临着医疗服务获取途径有限和先前存在的药物治疗中断的问题。
我们旨在评估已知或近期诊断为糖尿病的难民的高血糖程度，评估心血管合并症和糖尿病并发症，回顾并提供可用的治疗选择，并在可能的情况下将莱斯沃斯的情况与其他收容难民的地点进行比较，从而提高我们对这些弱势群体获取医疗保健和管理糖尿病的障碍的认识，并提出后续策略。
我们回顾性研究了 2019 年 6 月至 2020 年 12 月期间在希腊米蒂利尼总医院糖尿病门诊就诊的 69 名糖尿病患者（68%来自阿富汗，64%为女性）。记录患者的年龄、体重指数、糖尿病病程、血糖控制（HbA1c 和随机血糖）、血压、估计的肾功能、血脂谱、糖尿病并发症和当前用药情况。
所有 1 型和 2 型糖尿病患者的就诊年龄分别为 17.7 岁和 48.1 岁，BMI 分别为 19.6kg/m 和 28.9kg/m，HbA1c 分别为 9.6%和 8.7%（均为中位数）。三分之一（29%）的 2 型糖尿病患者要么中断了药物治疗，要么没有进行过药物治疗。只有 21%的血糖控制不佳的 2 型糖尿病患者使用胰岛素。仅有一半（48%）的高血压患者服用抗高血压药物，六分之一（17%）的患者服用降脂药物。42%（42%）的患者失访。
我们的研究结果表明，相当一部分糖尿病难民要么完全没有治疗，要么治疗中断，胰岛素的使用率仍然较低，而且相当一部分患者失访。因此，我们需要提高识别可能患有糖尿病或出现与疾病相关并发症风险的难民的能力。此外，扩大获取关键治疗和监测服务的途径至关重要。通过改进我们管理非传染性疾病的政策，我们可以更好地支持这些弱势群体的健康和福祉。此外，我们必须认识到，希腊不能独自承担难民危机的负担，国际支持和合作对于有效应对这些挑战是必要的。
