Endocrine Abstracts

JOINT3329

Background: War is one of the strongest stressors that affects the physical and psychological heath. In Ukraine, full-scale military operations have led to significant deterioration in access to medical care, chronic stress, a shortage of vital medicines, changes in diet and the lifestyle. These can provoke metabolic disorders predisposing to insulin resistance and diabetes mellitus development. One of the important indicators for diabetes diagnosis and control is the level of glycated hemoglobin (HbA1c). In this study we assessed the impact of war on distirbution of HbA1c values at populational level with respect to gender of people tested at pre-war and 3-year war period.

Methods: This population-based study involved 106,883 participants who underwent HbA1c testing from over Ukraine at the period from 2021 to 2024. This sample included 68,696 males and 38,187 females, of different age.

Results: According to the data analysis, the start of full-scale aggression in 2022 significantly affected HbA1c levels, which differed substantially from 2021, 2023, and 2024 (P<0,001). The prewar level of HbA1c in the Ukrainian population comprised 5.82%. The beginning of the war in Ukraine was associated with a sharp increase of HbA1c in males from 6.01% (5.47-8.54%) in 2021 to 6.88% (5.54-10.26%) in 2022 when the full-scale invasion began. In 2023 and 2024, HbA1c levels returned to prewar values reaching 5.98% (5.44-8.14) and 6.02% (5.58-7.43), respectively. In women, the highest levels of HbA1c were also noted in 2022, when the full-scale invasion began (6.24; 5.43-9.14%), compared with the pre-war period in 2021 (5.77; 5.33-7.15%). However, the following decline of HbA1c in 2023 and 2024 was insignificant, so HbA1c levels in 2023 (5.89%; 5.40-7.50%) and 2024 (5.98%; 5.54-7.10%) kept higher than in prewar period. Thus, females demonstrated long-term glycemic shifts induced by war-related factors. This data reflects gender differences in scale and length of HbA1c level changes in response to war.

Conclusions: The war significantly affects the health of Ukrainians, provoking acute and chronic shifts in carbohydrate metabolism and glycemic profile indicators. The start of the war was associated with a rise in HbA1c levels. While men demonstrated a sharp increase with further normalization of HbA1c, females showed prolongation of changes in HbA1c.