Glycaemic biomarker trends across pre-war and wartime periods in Ukraine, 2021–2024: a repeated cross-sectional study

Background The ongoing war in Ukraine have exposed the population to unprecedented stressors the long-term metabolic consequences of which remain insufficiently characterised. This study evaluated changes in glycaemic control and related biomarkers in the Ukrainian population during ongoing war between 2021 and 2024. Methods This large-scale, single centre repeated cross-sectional study analysed routine laboratory data across Ukraine from January 2021 to December 2024. We included a convenience sample of adults aged 18–90 years with complete demographic data who underwent on fasting plasma glucose (FPG) (108,346 individuals), of whom 86,077 also had glycated haemoglobin (HbA1c) results. Additional data was available for 2502 insulin and 9000 cortisol measurements. Biomarker trends were assessed annually and quarterly, stratified by sex, age, and geographic region, and categorised as corresponding to normoglycemia, prediabetes, and diabetes. Findings In 2021, median HbA1c was 5.71% (interquartile range; IQR 5.34–6.34), with 28.7% of individuals in the prediabetic and 22.3% in the diabetic range. By 2024, median HbA1c rose to 5.91%, with prediabetes increasing from 28.7% to 37.7%, and diabetic levels rate growing from 22.3% to 26.4%. As a result, 64% of all individuals tested in 2024 had HbA1c above the normoglycaemic threshold. Women and working-age adults showed the greatest glycaemic deterioration, despite men having higher absolute levels. Interpretation The Ukrainian population experienced significant metabolic deterioration during the war. Rising HbA1c and the growing prevalence of prediabetes and diabetes, particularly among women and younger adults, indicate escalating cardiometabolic risks. Future prospective longitudinal studies are needed to evaluate the long-term effectiveness of integrated metabolic and psychosocial interventions in conflict-affected populations. Funding National Research Foundation of Ukraine.