Features of glycemical control in modern adolescents with diabetes type 1 and influence of the war in ukraine on their condition

Objective — to determine the state of glycemic control in adolescents with type 1 diabetes (T1D) in modern conditions and the impact of the war in Ukraine on its indicators. Materials and methods. A comprehensive examination of adolescents with type 1 diabetes aged 11—18 years, who were examined and treated in the endocrinological department of the SI «Institute for Children and Adolescents Health Care of the National Academy of Medical Sciences of Ukraine» during 2020—2024, was conducted. Clinical and anamnestic and laboratory­instrumental examination of patients was carried out in accordance with the standards of medical care «Diabetes in children» (Order of the Ministry of Health of Ukraine No. 413 dated 28.02.2023). The patients were divided into groups taking into account the time of the examination and the level of sexual development. According to the design of the study, the indicators of glycemic control of patients who were examined before and after the start of the war in Ukraine (groups 1 and 2, respectively) were compared. Database creation and statistical processing of results were carried out using Microsoft Excel and SPSS 17.0 application packages. The level of significance was set at p < 0.05. Results and discussion. The relationship between indicators of glycemic control (GC) and the level of sexual development (SD) in modern teenagers with T1D was determined. It was established that not only the HbA1c level, but also the variability of glycemia and the time spent in the target range of glycemia during the day (TIR) changed during the period of puberty. The maximum percentage of patients with high CV indicators falls on the period of puberty itself and late puberty (62.5 and 67.7 %, respectively). This affects the TIR indicators, the optimal values of which are recorded only in 11.6 and 17.9 % of those examined in the period of actual and late puberty, respectively. It has been proven that optimal GC can be achieved only under conditions of low variability of glycemia and being in the target range for more than 70 % of the time during the day. The study of GC indicators in teenagers who were negatively affected by the war on the territory of Ukraine did not determine a probable increase in the percentage of patients with HbA1c indicators that exceeded 9.0 %. However, the number of adolescents with TIR targets probably decreased (6.2 and 16.1 % before the war, p < 0.05) due to the high variability of glycemia during the day with a level of coefficient of variability (CV) > 36.0 % (72.3 and 59.2 % before the war, p < 0.05). Conclusions. Despite the introduction of the latest technologies for the treatment of T1D, the dependence between GC indicators and the level of SD has been determined in today’s teenagers. The unfavorable conditions of the war in Ukraine contributed to an increase in the percentage of patients with a decrease in the time spent in the target range due to the high variability of glycemia during the day.