STRESS HYPERGLYCEMIA AS A MARKER OF METABOLIC RESPONSE AND A FACTOR OF DIABETES MANIFESTATION IN PATIENTS WITH SEVERE COMBINED TRAUMA AND BURNT INJURIES (literature review and own research)

Abstract

Topicality. In the context of ongoing full-scale aggression, the problem of combat trauma is becoming critical for the national healthcare system. Severe combined injuries are accompanied by profound metabolic disorders, among which stress hyperglycemia occupies a leading place. Understanding the mechanisms of transformation of an acute stress response into a chronic pathology, such as diabetes mellitus, is vital for reducing mortality and successful rehabilitation of military personnel.

Purpose and methodology. This work aimed to analyze the features of the manifestation of diabetes mellitus and the course of stress hyperglycemia in patients with gunshot wounds. The study was based on a retrospective clinical and statistical analysis of medical histories of 596 patients (average age – 43.6 years), who were in the intensive care unit of the Emergency Medical Care Clinic, Military Medical Clinical Center of the Northern District of the Medical Forces Command during 2023-2025. Additionally, statistical data on 318 diabetic servicemen treated at the SI «V. Danilevsky Institute for Endocrine Pathology Problems of the NAMS of Ukraine» for the period from 2014 to 2026 were processed. A systematic review of scientific literature was also conducted in the archives of specialized publications available on the Internet, as well as using the databases Web of Science, Scopus, The Cochrane Library, MedLine, EMBASE, Global Health, etc.

Results. The analysis demonstrated a rapid increase in the number of cases of diabetes among the military, starting from 2022, with a predominance of type 2 disease (62%). It was found that in 93% of cases, stress hyperglycemia developed against the background of critical conditions, such as acute respiratory distress syndrome and pneumonia. At the same time, in 72.4% of the victims, the glycemia level fluctuated within 10.1–14.0 mmol/L. Glucocorticoid therapy, which was received by 70% of the examined, turned out to be an important factor in the destabilization of metabolism. It was proven that combat stress and injuries were the direct cause of the manifestation of diabetes in 2.5% of people who previously had no signs of diabetes.

Conclusions. Stress hyperglycemia is an objective marker of injury severity and a predictor of adverse clinical prognosis. The combination of traumatic shock, combat psycho-emotional stress and iatrogenic effects of glucocorticoids forms persistent insulin resistance. The results obtained justify the need to introduce mandatory endocrinological screening and long-term monitoring of carbohydrate metabolism in the system of medical rehabilitation of veterans to prevent disability due to diabetes.