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Doctors and patients can make good progress in controlling a chronic disease, and then life may intervene, sometimes in a violent, chaotic way.
The civil war now being fought in Syria presents a question for physicians around the world that was raised in a poster presentation by Syrian physicians presented at the Endocrine Society’s annual meeting: How best to manage metabolic control, blood pressure, lipids, and gonadal and sexual function in a crisis setting? All of these may be affected by the stress of conflict, lack of access to health resources, and other factors.
Mainstream news coverage of the Syrian conflict tends to emphasize death tolls and ground gained or lost by the warring parties. Dr. Saad Sakkal and associates at the Aleppo (Syria) Care Center took a more personalized look at 200 patients with diabetes who were being seen quarterly at the center’s endocrine/diabetes clinic before and during the war.
In the 6 months of July-December 2010, before the civil unrest started, patients showed an average 8–mm Hg drop in systolic blood pressure, a 7–mm Hg decline in diastolic blood pressure, a decrease of 37 mg/dL in fasting blood sugar results, and a 62 mg/dL decrease in 2-hour postprandial glucose results. Their hemoglobin A1c levels improved on average by 2.5% and insulin doses decreased by 22%. Triglyceride levels decreased by 59 mg/dL and the triglyceride:HDL ratio improved by an average of 1.31.
Measures of gonadal and sexual dysfunction (such as libido, erectile dysfunction, and gonadal hormone deficiencies) improved in 17 of 37 patients with one of these dysfunctions at baseline.
The civil unrest wiped out those gains, and then some.
After the civil unrest started, in the 6 months of July-December 2011, the average blood pressure rose by 26/8–mm Hg on average, fasting blood sugar results increased by 47 mg/dL, 2-hour postprandial glucose levels increased by 128 mg/dL, average HbA1c levels increased by 2%, and insulin doses increased by 25%. Cholesterol and triglyceride levels increased, and the triglyceride:HDL ratio worsened by an average of 1.72.
Measures of gonadal and sexual dysfunction worsened in 16 patients. Although previous studies have shown that stress affects metabolic control in general, there are few or no prior data on the influence of civil unrest on gonadal and sexual dysfunction in patients with diabetes, Dr. Sakkal reported.
Although the stress producer in the study was "civil unrest," which now has progressed to all-out civil war, it’s reasonable to think that the same health problems might occur in other disasters with long-term effects, such as tsunamis, hurricanes, earthquakes, and perhaps even poverty.
Avoiding death is the primary goal in these situations, of course, but the Syrian physicians also are hard at work helping the living live. How can physicians best help survivors with a chronic illness deal with the effects of a stressful situation?
The study excluded patients with new-onset diabetes or other new illnesses. Dr. Sakkal reported having no financial disclosures.
–Sherry Boschert (on Twitter @sherryboschert)
Doctors and patients can make good progress in controlling a chronic disease, and then life may intervene, sometimes in a violent, chaotic way.
The civil war now being fought in Syria presents a question for physicians around the world that was raised in a poster presentation by Syrian physicians presented at the Endocrine Society’s annual meeting: How best to manage metabolic control, blood pressure, lipids, and gonadal and sexual function in a crisis setting? All of these may be affected by the stress of conflict, lack of access to health resources, and other factors.
Mainstream news coverage of the Syrian conflict tends to emphasize death tolls and ground gained or lost by the warring parties. Dr. Saad Sakkal and associates at the Aleppo (Syria) Care Center took a more personalized look at 200 patients with diabetes who were being seen quarterly at the center’s endocrine/diabetes clinic before and during the war.
In the 6 months of July-December 2010, before the civil unrest started, patients showed an average 8–mm Hg drop in systolic blood pressure, a 7–mm Hg decline in diastolic blood pressure, a decrease of 37 mg/dL in fasting blood sugar results, and a 62 mg/dL decrease in 2-hour postprandial glucose results. Their hemoglobin A1c levels improved on average by 2.5% and insulin doses decreased by 22%. Triglyceride levels decreased by 59 mg/dL and the triglyceride:HDL ratio improved by an average of 1.31.
Measures of gonadal and sexual dysfunction (such as libido, erectile dysfunction, and gonadal hormone deficiencies) improved in 17 of 37 patients with one of these dysfunctions at baseline.
The civil unrest wiped out those gains, and then some.
After the civil unrest started, in the 6 months of July-December 2011, the average blood pressure rose by 26/8–mm Hg on average, fasting blood sugar results increased by 47 mg/dL, 2-hour postprandial glucose levels increased by 128 mg/dL, average HbA1c levels increased by 2%, and insulin doses increased by 25%. Cholesterol and triglyceride levels increased, and the triglyceride:HDL ratio worsened by an average of 1.72.
Measures of gonadal and sexual dysfunction worsened in 16 patients. Although previous studies have shown that stress affects metabolic control in general, there are few or no prior data on the influence of civil unrest on gonadal and sexual dysfunction in patients with diabetes, Dr. Sakkal reported.
Although the stress producer in the study was "civil unrest," which now has progressed to all-out civil war, it’s reasonable to think that the same health problems might occur in other disasters with long-term effects, such as tsunamis, hurricanes, earthquakes, and perhaps even poverty.
Avoiding death is the primary goal in these situations, of course, but the Syrian physicians also are hard at work helping the living live. How can physicians best help survivors with a chronic illness deal with the effects of a stressful situation?
The study excluded patients with new-onset diabetes or other new illnesses. Dr. Sakkal reported having no financial disclosures.
–Sherry Boschert (on Twitter @sherryboschert)
Doctors and patients can make good progress in controlling a chronic disease, and then life may intervene, sometimes in a violent, chaotic way.
The civil war now being fought in Syria presents a question for physicians around the world that was raised in a poster presentation by Syrian physicians presented at the Endocrine Society’s annual meeting: How best to manage metabolic control, blood pressure, lipids, and gonadal and sexual function in a crisis setting? All of these may be affected by the stress of conflict, lack of access to health resources, and other factors.
Mainstream news coverage of the Syrian conflict tends to emphasize death tolls and ground gained or lost by the warring parties. Dr. Saad Sakkal and associates at the Aleppo (Syria) Care Center took a more personalized look at 200 patients with diabetes who were being seen quarterly at the center’s endocrine/diabetes clinic before and during the war.
In the 6 months of July-December 2010, before the civil unrest started, patients showed an average 8–mm Hg drop in systolic blood pressure, a 7–mm Hg decline in diastolic blood pressure, a decrease of 37 mg/dL in fasting blood sugar results, and a 62 mg/dL decrease in 2-hour postprandial glucose results. Their hemoglobin A1c levels improved on average by 2.5% and insulin doses decreased by 22%. Triglyceride levels decreased by 59 mg/dL and the triglyceride:HDL ratio improved by an average of 1.31.
Measures of gonadal and sexual dysfunction (such as libido, erectile dysfunction, and gonadal hormone deficiencies) improved in 17 of 37 patients with one of these dysfunctions at baseline.
The civil unrest wiped out those gains, and then some.
After the civil unrest started, in the 6 months of July-December 2011, the average blood pressure rose by 26/8–mm Hg on average, fasting blood sugar results increased by 47 mg/dL, 2-hour postprandial glucose levels increased by 128 mg/dL, average HbA1c levels increased by 2%, and insulin doses increased by 25%. Cholesterol and triglyceride levels increased, and the triglyceride:HDL ratio worsened by an average of 1.72.
Measures of gonadal and sexual dysfunction worsened in 16 patients. Although previous studies have shown that stress affects metabolic control in general, there are few or no prior data on the influence of civil unrest on gonadal and sexual dysfunction in patients with diabetes, Dr. Sakkal reported.
Although the stress producer in the study was "civil unrest," which now has progressed to all-out civil war, it’s reasonable to think that the same health problems might occur in other disasters with long-term effects, such as tsunamis, hurricanes, earthquakes, and perhaps even poverty.
Avoiding death is the primary goal in these situations, of course, but the Syrian physicians also are hard at work helping the living live. How can physicians best help survivors with a chronic illness deal with the effects of a stressful situation?
The study excluded patients with new-onset diabetes or other new illnesses. Dr. Sakkal reported having no financial disclosures.
–Sherry Boschert (on Twitter @sherryboschert)
