Risk factors of diabetes mellitus in ATO/JFO participants, clinical course, diagnosis and their impact on duration of treatment

Abstract

Purpose. To analyze the risk factors for diabetes mellitus (DM) in participants of anti-terrorist operation/ joint forces operation (ATO/JFO), features of the clinical course, diagnosis and dependence of them duration of treatment.

Materials and methods. 106 servicemen (active, reserve, pensioners of the Ministry of Defence Ukraine) of the Armed Forces of Ukraine aged 30 to 70, who were treated in general therapy and nephrology clinics of the National Military Medical Clinical Center "Main Military Clinical Hospital" (Kyiv). The main group consisted of 61 patients with DM, who are participants in hostilities during the anti-terrorist operation in Eastern Ukraine. The control group consisted of 45 patients with DM, who did not take part in hostilities in Eastern Ukraine.  The experience of the disease in the control group was (25.6 ± 2.28) years and in patients of the main group - (5.2 ± 1.4) years. 75.47% of patients from the general group received hypoglycemic drugs, 16.98% of patients received insulin group drugs, 7.54% of patients were on combination therapy (sugar-lowering drugs + insulin group drugs).  The complex of examination included traditional general clinical studies, biochemical (plasma glucose, glycosylated hemoglobin, cholesterol and triacylglycerides (TAG). If necessary, instrumental research methods and specialist consultations were used.  Statistical processing of data and research results was performed by methods of variation and descriptive statistics on a personal computer using standard data analysis packages Microsoft Excel 2016 and STATISTICA 6.0.

Results. It was found that 59.02% of servicemen fell ill with diabetes after participating in hostilities and 40.98% of patients developed the disease before being in the ATO zone. Post-traumatic stress disorder (PTSD) was observed in the main group in 42.6% of patients, asthenoneurotic syndrome - 34.2%, encephalopathy of mixed genesis (dyscirculatory, dysmetabolic, hypertensive) - 32.79%, and in the control group encephalopathy was observed in encephalopathy 42.22% of patients had no PTSD.  Assessment of the treatment of patients with diabetes showed that at the time of hospitalization military patients of the ATO/JFO zone regularly received antidiabetic therapy/insulin therapy in only 74.2% of cases, while patients who were not participants in the ATO/JFO received hypoglycemic therapy/insulin therapy more often - 93.5%, p˂0.05. Among the probable causes of irregular maintenance therapy were 42.62% of patients with PTSD, 32.78% - encephalopathy, 18.03% had alcohol abuse, 4.9% - traumatic brain injury. The mean plasma glucose level in patients of the main group was (12.1 ± 0.61) mmol/l, while in patients of the control group the plasma glucose level was significantly lower and was (7.63 ± 0.37) mmol / l, p˂0.05. The average level of glycosylated serum hemoglobin in the main group was higher (9.15 ± 0.38) % than in the control group - (7.69 ± 0.48) %, p˂0.05. The mean serum cholesterol content in the main and control groups did not differ significantly, and the level of TAG was significantly higher in patients of the main group (5.02 ± 0.18) mmol/l than in the control - (2.02 ± 0.35) mmol/l. Diabetic polyneuropathy with predominant lesions of the lower extremities (82.6%) and diabetic nephropathy (33.3%) were significantly more common in patients of the control group than in the main group. Significantly more often in the control group than in the main coronary heart disease (91.11%), heart failure (86.66%), diffuse cardiosclerosis (91.11%). Hypertensive heart disease and mixed encephalopathy were observed in both groups with equal frequency. In the main group there were no patients with myocardial infarction and acute cerebral circulatory damage. This is due to the fact that the control group included patients with a longer history of the disease than the main one.

Conclusions. The participation of servicemen in the ATO/JFO increases the risks and provokes the emergence of diabetes - 59.02%. Prolonged stay in the state of chronic stress (PTSD - 42.62%) during service in the combat zone leads to rapid and sudden development of diabetes, accompanied by high average values of plasma glucose (12.1 ± 0.18) mmol/l and glycosylated serum hemoglobin (9.15 ± 0.38) %. In participants of ATO/JFO diabetes occurs earlier (46 ± 0.98 years), compared with non-combatants (50 ± 0.27 years), and the main complications are: microangiopathy of the lower extremities (47.5%), diabetic retinal lesions (45.9%) and diabetic polyneuropathy with predominant lesions of the lower extremities (44.3%). Complex service tasks that arise in the military during hostilities, PTSD (42.62%), encephalopathy of mixed genesis (32.79%), alcohol abuse (18.03%), traumatic brain injury (4,91%) lead to irregular intake of hypoglycemic and antihypertensive drugs. This causes rapid progression of the underlying and comorbidities, their exacerbation, the formation of numerous complications and prolongs the length of their stay in hospital (14 ± 2.2 bed-days) compared with the control group (10 ± 0.45 bed-days), p˂ 0.05.