Dynamics of cortisol levels and the state of vitamin D supply during the full-scale war in Ukraine in patients with type 2 diabetes mellitus

Background. Assessment of the role of stress hormones and vitamin D levels under the influence of a long-term psychotraumatic factor provides information necessary for the prevention of type 2 dia­betes mellitus (T2DM) complications. The aim of the study was to evaluate the dynamics of the stress hormone cortisol and the state of vitamin D supply in patients with T2DM during the full-scale war in Ukraine compared to the pre-war state. Materials and methods. In 2021–2024, a prospective study was conducted, which inclu­ded patients with T2DM and a glycated hemoglobin (HbA1c) level ≥ 7 %, individuals with insulin resistance without DM and people without DM aged 19–75 years. Exclusion criteria were as follows: T2DM with severe chronic complications, HbA1c level < 7 %, acute inflammatory processes, oncological diseases, body mass index ≥ 40 kg/m2, intake of antidepressants, vitamin D drugs less than 2 months before the study. The average level of 25(OH)D, serum and salivary cortisol were studied every year from 2021 to 2024. Laboratory studies were performed using the methods of chemiluminescence and enzyme-linked immunoassay. Results. Patients with T2DM have a lower mean level of vitamin D and it decreases during the war, being significantly lower in 2023 and 2024 compared to 2021. In people without diabetes, the average level of vitamin D also decreases during the war years, but in general it is higher, within the limits of vitamin D insufficiency. In 2024, the average level of vitamin D in these patients increased, which indicates a more active medical intervention. When determi­ning the dynamics of serum cortisol in patients without DM in 2024, the following is observed. It was significantly higher than before the war, and in patients with DM2, it was highest in 2022 with a gradual downward trend in 2023 and a return to an increase of the average level in 2024. In this group of patients, the difference between indicators is not reliable. When determining the dynamics of salivary cortisol, we observe an increase in the average level during the war in patients without DM, and an increase in the average level during the war with a peak in 2023 in patients with insulin resistance without DM. In patients with T2DM, there is an increase in cortisol during the war, which was also present before it began. The lowest level was observed in this group of patients in 2022. Conclusions. Patients with T2DM during the war compared to the pre-war period had a stably increased level of salivary cortisol. In people without T2DM, there is a significant increase in the average level of cortisol in saliva during the war compared to the pre-war period. It is recommended to reduce the level of insulin resistance through lifestyle modification, maintaining an adequate level of vitamin D.