QUALITY OF LIFE OF PATIENTS WITH DIABETES MELLITUS IN ARMED CONFLICT

Abstract

The war in Ukraine has provoked the internal migration of millions of Ukrainians. Internally displaced persons (IDP) and residents of territorial communities (RTC) located in the war zone suffering from diabetes mellitus (DM) are at high risk of developing post-traumatic stress disorder (PTSD), anxiety and depression.

The purpose of the study was to assess the health-related quality of life of patients with type 1 and type 2 diabetes mellitus in the context of armed conflict.

Materials and methods. 26 patients with type 1 DM ((34.7±8.79) years) (group 1) and 65 with type 2 DM ((56.5±10.79) years) (group 2) (including 37 patients with type 2 DM who received insulin therapy ((59.0±8.1) years (group 3)) were examined. Among the study subjects, 43.9% (n=40) were IDPs and 56.1% (n=51) were RTCs located in the war zone. The level of fasting glycemia (FG) was determined by glucose oxidase method and glycosylated hemoglobin (HbA_1C) by colorimetric method. The Ukrainian version of the SF-36®Health Surveillance questionnaire was used; analyzed patients' subjective feelings using the HADS Hospital Anxiety and Depression Rating Scale.

Results. Patients in group 1 had significantly higher scores on the "General Health" scale than patients with type 2 DM. The physical health component was significantly higher in patients in group 1 compared to groups 2 and 3. Restrictions in daily activities due to the deterioration of the emotional state in patients of groups 2 and 3 compared to group 1 were established. In patients of groups 2 and 3, the average score on the "Mental Health" scale was significantly lower than in group 1, which indicated the possible development of PTSD. The physical activity of RTCs located in the war zone was significantly limited by the state of health compared to the IDPs group. A significant influence of the place of stay during the armed conflict on the mental health component of patients with DM has been established.

In 46.2% (n=42) of the examinees, the total score on the HADS-D subscale was within the normal range, in 24.2% (n=22) it corresponded to subclinical depression, and in 29.7% (n=27) it was clinically significant depression. Assessment of anxiety severity according to the HADS-A subscale showed that the total score in 49.5% (n=45) of patients was within the normal range, in 29.7% (n=27) it corresponded to subclinical anxiety, and in 20.9% (n=19) it was clinically significant anxiety. It was found that the total score on the HADS-D subscale in RTCs located in the war zone was significantly higher than in the IDP ((7.81±0.34) and (4.86±0.29); P<0.04). This also applies to the total score on the HADS-A subscale – ((8.56±0.36) and (5.57±0.45); P<0.05). The total score on the HADS-A subscale in the subjects is linearly associated with the level of HbA_1С (r=0.55; P<0.008) and non-linear with diastolic blood pressure (DBP) (r=0.32; P<0,05); the total score on the HADS-D subscale is linearly associated with HbA_1С (r=0,46; P<0,04), DBP (r=0,46; P<0,003) and nonlinearly with FG (r=-0,54; P<0,002).

Conclusions. In the context of armed conflict, patients with type 2 diabetes mellitus compared to patients with type 1 diabetes mellitus have a more significant deterioration in physical health component and mental health component. Patients with diabetes mellitus – residents of territorial communities located in the war zone, due to the deterioration of physical health component and mental health component, have more significant restrictions in daily activities, social contacts, and a decrease in the level of communication than internally displaced persons. In 53.9% of patients with diabetes mellitus in the conditions of armed conflict, clinical manifestations of depression of varying degrees of severity develop, in 50.6% – clinical manifestations of anxiety that negatively affect the physical condition, compensation of carbohydrate metabolism and blood pressure levels.