Online first
Review article
Published online: 2024-11-21

open access

Page views 157
Article views/downloads 47
Get Citation

Connect on Social Media

Connect on Social Media

The Impact of War and Conflict on People Living with Diabetes: A Scoping Review

Emma Ospelt1, Ann Mungmode1, Holly Hardison1, Anton Wirsch1, Nicole Rioles1, James Dawson1, McKing Amedari2, Halis K. Akturk3, Viral N. Shah4, Nuha El Sayed56, Osagie Ebekozien12

Abstract

Objective: There is substantial literature detailing the interaction between war and conflict on overall human health. However, there is limited understanding of the impact of war and conflict on people living with diabetes. This scoping review describes the impact of short- and long-term effects of exposure to war and conflict settings on people living with diabetes. Materials and methods: The scoping review was conducted between May and August of 2023, using articles published in the PubMed Central and Google Scholar databases. Articles published from 1950 to 2023 with the following key terms “diabetes”, “type 1 diabetes”, “type 2 diabetes”, “war”, “armed conflict”, “organized violence”, and “refugees” were reviewed. Results: A total of 151,347 articles were reviewed. After applying review criteria, 21 applicable articles were included in this scoping review. Three themes emerged from this review: 1) People living with diabetes in conflict zones are subject to elevated blood glucose and hemoglobin A1C (HbA1c) levels, which can lead to severe long-term complications. 2) The stress of war and conflict negatively impacts diabetes self-management and quality of life. 3) Healthcare access, including services and medication, is severely disrupted for people living with diabetes in these tumultuous environments. Conclusions: The findings underscore the profound and direct impacts of war and conflict on people living with diabetes, highlighting the disparities in care and the urgent need for further research to identify factors that exacerbate these challenges and strategies to mitigate them.

Article available in PDF format

View PDF Download PDF file

References

  1. Wisevoter. Countries Currenlty at War 2023. https://wisevoter.com/country-rankings/countries-currently-at-war/#tracker_introduction (7.05.2024).
  2. Global Appeal 2023 | Regional summary UNHCR 2022. https://reporting.unhcr.org/globalappeal/west-and-central-africa (7.05.2024).
  3. How High is the Cost of War Around the World in 2019? Vision of Humanity 2023. https://www.visionofhumanity.org/how-does-war-and-violence-affect-an-economy/#:~:text=The%202021%20Economic%20Value%20of,estimated%20to%20be%20%2414.4%20trillion (7.05.2024).
  4. Harada KH, Soleman SR, Ang JS, et al. Conflict-related environmental damages on health: lessons learned from the past wars and ongoing Russian invasion of Ukraine. Environ Health Prev Med. 2022; 27: 35.
  5. Cheraghi F, Shamsaei F, Mortazavi SZ, et al. The Effect of Family-centered Care on Management of Blood Glucose Levels in Adolescents with Diabetes. Int J Community Based Nurs Midwifery. 2015; 3(3): 177–186.
  6. Devakumar D, Birch M, Osrin D, et al. The intergenerational effects of war on the health of children. BMC Med. 2014; 12: 57.
  7. Mosley-Johnson E, Walker RJ, Thakkar M, et al. Relationship between housing insecurity, diabetes processes of care, and self-care behaviors. BMC Health Serv Res. 2022; 22(1): 61.
  8. Carpiniello B. The Mental Health Costs of Armed Conflicts-A Review of Systematic Reviews Conducted on Refugees, Asylum-Seekers and People Living in War Zones. Int J Environ Res Public Health. 2023; 20(4).
  9. Daudt HML, van Mossel C, Scott SJ. Enhancing the scoping study methodology: a large, inter-professional team's experience with Arksey and O'Malley's framework. BMC Med Res Methodol. 2013; 13: 48.
  10. Sharafi BAl, Tahami B. The Effect of War on the Control of Diabetes in Patients with Type 2 Diabetes Mellitus in Yemen: A Cross-Sectional Study. Endocrinol Metab Syndr. 2017; 6(4): 1–5.
  11. Kohrt BA, Carruth L. Syndemic effects in complex humanitarian emergencies: A framework for understanding political violence and improving multi-morbidity health outcomes. Soc Sci Med. 2022; 295: 113378.
  12. Roglic G, Metelko Z. Effect of war on glycemic control in type II diabetic patients. Diabetes Care. 1993; 16(5): 806–808.
  13. Yitshak-Sade M, Mendelson N, Novack V, et al. The association between an increase in glucose levels and armed conflict-related stress: A population-based study. Sci Rep. 2020; 10(1): 1710.
  14. Hammad AM, Al Qerem W, Alaqabani H, et al. Factors influencing hypertension and diabetes mellitus control among Syrian refugees in Zaatari refugee camp. Eur Rev Med Pharmacol Sci. 2022; 26(7): 2408–2414.
  15. Elliott JA, Das D, Cavailler P, et al. A cross-sectional assessment of diabetes self-management, education and support needs of Syrian refugee patients living with diabetes in Bekaa Valley Lebanon. Confl Health. 2018; 12: 40.
  16. Maar M, Manitowabi D, Gzik D, et al. Serious Complications for Patients, Care Providers and Policy Makers: Tackling the Structural Violence of First Nations People Living with Diabetes in Canada. International Indigenous Policy Journal. 2011; 2(1).
  17. Eljedi A, Mikolajczyk RT, Kraemer A, et al. Health-related quality of life in diabetic patients and controls without diabetes in refugee camps in the Gaza strip: a cross-sectional study. BMC Public Health. 2006; 6: 268.
  18. Saleh S, Abdouni L, Dimassi H, et al. Prevalence of non-communicable diseases and associated medication use among Syrian refugees in Lebanon: an analysis of country-wide data from the Sijilli electronic health records database. Confl Health. 2021; 15(1): 77.
  19. Ratnayake R, Rawashdeh F, AbuAlRub R, et al. Access to Care and Prevalence of Hypertension and Diabetes Among Syrian Refugees in Northern Jordan. JAMA Netw Open. 2020; 3(10): e2021678.
  20. Saleh S, Muhieddine D, Hamadeh RS, et al. Outpatient use patterns and experiences among diabetic and hypertensive patients in fragile settings: a cross-sectional study from Lebanon. BMJ Open. 2022; 12(5): e054564.
  21. Doocy S, Lyles E, Akhu-Zaheya L, et al. Health Service Utilization among Syrian Refugees with Chronic Health Conditions in Jordan. PLoS One. 2016; 11(4): e0150088.
  22. Malembaka EB, Karemere H, Bisimwa Balaluka G, et al. Are people most in need utilising health facilities in post-conflict settings? A cross-sectional study from South Kivu, eastern DR Congo. Glob Health Action. 2020; 13(1): 1740419.
  23. Khader A, Ballout G, Shahin Y, et al. Treatment outcomes in a cohort of Palestine refugees with diabetes mellitus followed through use of EHealth over 3 years in Jordan. Trop Med Int Health. 2014; 19(2): 219–223.
  24. Rimawi A, Shah A, Louis H, et al. Community Health Worker Program Outcomes for Diabetes and Hypertension Control in West Bank Refugee Camps: A Retrospective Matched Cohort Study. Glob Health Sci Pract. 2022; 10(5).
  25. Baxter LM, Eldin MS, Al Mohammed A, et al. Access to care for non-communicable diseases in Mosul, Iraq between 2014 and 2017: a rapid qualitative study. Confl Health. 2018; 12: 48.
  26. Mansour AA. Patients' opinion on the barriers to diabetes control in areas of conflicts: The Iraqi example. Confl Health. 2008; 2: 7.
  27. Jacklin KM, Henderson RI, Green ME, et al. Health care experiences of Indigenous people living with type 2 diabetes in Canada. CMAJ. 2017; 189(3): E106–E112.
  28. Lyles E, Burnham G, Chlela L, et al. Lebanon Health Access Survey (LHAS) Study Team. Health service utilization and adherence to medication for hypertension and diabetes among Syrian refugees and affected host communities in Lebanon. J Diabetes Metab Disord. 2020; 19(2): 1245–1259.
  29. Ofosu NN, Luig T, Chiu Y, et al. Understanding the bigger picture: syndemic interactions of the immigrant and refugee context with the lived experience of diabetes and obesity. BMC Public Health. 2022; 22(1): 345.
  30. Aziz AR, Alsabek MB. Diabetic foot and disaster; risk factors for amputation during the Syrian crisis. J Diabetes Complications. 2020; 34(2): 107493.
  31. Tung EL, Johnson TA, O'Neal Y, et al. Experiences of Community Violence Among Adults with Chronic Conditions: Qualitative Findings from Chicago. J Gen Intern Med. 2018; 33(11): 1913–1920.
  32. Smalls BL, Gregory CM, Zoller JS, et al. Effect of neighborhood factors on diabetes self-care behaviors in adults with type 2 diabetes. Diabetes Res Clin Pract. 2014; 106(3): 435–442.
  33. Stacey M, Gifford R, Pye A. Diabetes care in times of armed conflict. British Journal of Diabetes. 2022; 22(1): 1–4.
  34. Ahmed AM, Ahmed NH. Diabetes mellitus in Sudan: the size of the problem and the possibilities of efficient care. Practical Diabetes International. 2002; 18(9): 324–327.
  35. Alessi J, Yankiv M. War in Ukraine and barriers to diabetes care. Lancet. 2022; 399(10334): 1465–1466.
  36. Khan W, Jama M, Pesigan A, et al. Health can contribute to peace in the Eastern Mediterranean Region-what should be done to make it happen? Lancet. 2023; 402(10413): 1601–1603.
  37. American Diabetes Association Professional Practice Committee. 17. Diabetes Advocacy: Standards of Medical Care in Diabetes—2022. Diabetes Care. 2022; 45(Suppl 1): S254–S255.
  38. New MSF report shows unacceptable global double standard in diabetes care, even though better treatments cost little to produce and could be much more affordable [press release]. Access Campaign 2024. https://www.msfaccess.org/new-msf-report-shows-unacceptable-global-double-standard-diabetes-care-even-though-better (7.05.2024).
  39. Improving diabetes care in humanitarian settings International Alliance for Diabetes Action 2022. https://www.iadadiabetes.org/ (7.05.2024).
  40. Ocheretenko V. Diabetes and War: The Critical Role of Diabetes Organizations during Humanitarian Emergencies Direct Relief 2022. https://www.directrelief.org/2022/07/diabetes-and-war-the-critical-role-of-diabetes-organizations-during-humanitarian-emergencies/ (7.05.2024).
  41. Yoo JiW, Barmanray RD. The role of medical students in humanitarian responses to armed conflict. Lancet Diabetes Endocrinol. 2024; 12(2): 92–94.
  42. Virmani A, Brink SJ, Middlehurst A, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Management of the child, adolescent, and young adult with diabetes in limited resource settings. Pediatr Diabetes. 2022; 23(8): 1529–1551.