FACTORS INFLUENCING THE CLINICAL EVOLUTION OF DIABETES MELLITUS AND THE QUALITY OF SPECIALIZED MEDICAL CARE FOR PATIENTS WITH THIS ENDOCRINOPATHY IN ARMED CONFLICT
DOI:
https://doi.org/10.21856/j-PEP.2023.3.13Keywords:
diabetes mellitus, armed conflict, humanitarian crisisAbstract
Management of diabetes mellitus (DM) is particularly challenging during humanitarian crises caused by armed conflict. The review aims to identify determinants that can improve the management of DM in a humanitarian context.
The following problems of management of patients with DM in conditions of armed conflict are highlighted: food security; decreased physical activity due to limited space and safety issues; limited access to medical facilities and medicines; lack of human resources who have training and experience working with patients with DM; inaccessibility or inadequate provision of individual means of self-control and consumables for them; economic difficulties; household problems (loss or damage to housing); socio-psychological maladjustment and emotional effect inherent in the war itself.
170 patients with type 1 DM (n=67) and type 2 (n=103) were examined. Among the subjects, 28.2% (n=48) were internally displaced persons, and 15.2%, were those who had been directly in the combat zone for some time. A comparative analysis of the main clinical and biochemical parameters of the study in the pre-war period (according to medical histories for 2021) with those during the war was carried out.
It was determined that the lack of proper control of the disease during the war led to the emergence of chronic complications of DM: 4.1% were diagnosed with distal polyneuropathy de novo, metabolic cardiomyopathy in 3.5%, coronary heart disease in 12.9%, arterial hypertension in 7.6%, metabolic-associated fatty liver disease, and diabetic foot syndrome in 1.17%.
In the survey, 8.3% of respondents indicated problems with the provision of hypoglycemic drugs and 66.7% of problems with the availability of self-control means of the disease (glucometers, test strips). 80.5% of respondents indicated the lack of conditions for compliance with dietary recommendations. More than 60% of respondents noted short-term (several days) or long-term (weeks) episodes of lack of self-control of the disease due to the unavailability of self-control or unfavorable conditions (stay in shelters, evacuation, etc.).
Staying in the zone of humanitarian crisis negatively affects the clinical course of DM, and contributes to the development or progression of existing chronic complications. Because of this, further research is needed to clarify the epidemiology of DM in a humanitarian crisis and to develop simplified, cost-effective models of medical care for patients with this endocrinopathy.
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