Sulaieva Oksana, Yerokhovych Viktoriia, Zemskov Sergii, Komisarenko Iuliia, Gurianov Vitalii, Pankiv Volodymyr, Tovkai Oleksandr, Yuzvenko Tetyana, Yuzvenko Violetta, Tovkai Andrii, Shaienko Zlatoslava, Falalyeyeva Tetyana, Skrypnyk Nadiya, Romaniv Taras, Pasyechko Nadiya, Krytskyy Taras, Danyliuk Solomiia, Klantsa Andrii, Krasnienkov Dmytro, Gurbych Oleksandr, Kobyliak Nazarii
Medical Laboratory CSD, Kyiv 02000, Ukraine.
Kyiv Medical University, Kyiv 02099, Ukraine.
EClinicalMedicine. 2024 Dec 15;79:103008. doi: 10.1016/j.eclinm.2024.103008. eCollection 2025 Jan.
Although the number of studies reporting war-induced effects on the health of the Ukrainian population has been growing, there are still little data on assessing patients with type 2 diabetes (T2D) during the war. This study aimed to evaluate the impact of war on T2D patients' health to define key risk factors promoting disease progression.
A survey covering various aspects of T2D patients' experience and glycemic control data was conducted from June 2022 to February 2024. Overall, 1193 patients from all regions of Ukraine were enrolled in the study. According to the difference between the initial and current levels of HbA1c, all the respondents were subdivided into two categories: progressors (with HbA1c levels greater than 5% of the initial value) and stable (patients with stable HbA1c levels). Next, the impact of intrinsic and war-related factors on T2D progression was assessed via logistic regression analysis and machine learning tools.
Two years of war experience was associated with significant increase in the median HbA1c from 7.8% (7.0-8.93) to 8.4% (7.4-9.9; p < 0.001), with the highest value occurring in eastern and northern Ukraine. HbA1c levels demonstrated a time-dependent pattern of growth, reflecting the cumulative effect of war-related factors on T2D patients' health. Witnesses of armed attacks and occupation aggravated the T2D course. Experience with military actions (p = 0.002), occupation (p = 0.001), internal displacement (p = 0.018) and family member injury or death (p = 0.031) increased HbA1c. In addition, lack of regular glucose monitoring (p < 0.001), consultation by endocrinologists (p < 0.001), diet inconsistency (p = 0.017) and scarcity of physical activity (p = 0.047) affected the HbA1c parameters.
This study demonstrated a dramatic cumulative effect of the war on T2D patients' health. Uncovered direct and indirect war-related risk factors can guide further adjustment of diabetic care in Ukraine to improve T2D patient support.
National Research Foundation of Ukraine (grant number 2022.01/0089).
尽管报告战争对乌克兰民众健康影响的研究数量一直在增加，但关于战争期间2型糖尿病（T2D）患者评估的数据仍然很少。本研究旨在评估战争对T2D患者健康的影响，以确定促进疾病进展的关键风险因素。
于2022年6月至2024年2月开展了一项涵盖T2D患者经历各个方面和血糖控制数据的调查。总体而言，来自乌克兰所有地区的1193名患者参与了该研究。根据糖化血红蛋白（HbA1c）初始水平与当前水平的差异，所有受访者被分为两类：病情进展者（HbA1c水平高于初始值的5%）和病情稳定者（HbA1c水平稳定的患者）。接下来，通过逻辑回归分析和机器学习工具评估内在因素和与战争相关的因素对T2D进展的影响。
两年的战争经历与HbA1c中位数从7.8%（7.0 - 8.93）显著增加到8.4%（7.4 - 9.9；p < 0.001）相关，最高值出现在乌克兰东部和北部。HbA1c水平呈现出时间依赖性增长模式，反映了与战争相关的因素对T2D患者健康的累积影响。武装袭击和占领的目击者使T2D病情加重。军事行动经历（p = 0.002）、被占领（p = 0.001）、国内流离失所（p = 0.018）以及家庭成员受伤或死亡（p = 0.031）会使HbA1c升高。此外，缺乏定期血糖监测（p < 0.001）、内分泌科医生会诊（p < 0.001）、饮食不规律（p = 0.017）以及身体活动不足（p = 0.047）会影响HbA1c参数。
本研究表明战争对T2D患者健康具有显著的累积影响。所发现的与战争相关的直接和间接风险因素可为乌克兰糖尿病护理的进一步调整提供指导，以改善对T2D患者的支持。
乌克兰国家研究基金会（资助编号2022.01/0089）。
