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Continuous Glycemic Monitoring Metrics of Children and Adolescents with Type 1 Diabetes During the Iron Swords War

Yossi Steier, Eyal Cohen-Sela, Shay Averbauch

    The Israel Medical Association Journal : IMAJ
    |July 23, 2025
    PubMed

    Insights

    The Iron Swords war impacted glycemic control in pediatric type 1 diabetes (T1D) patients. Insulin pump users maintained stable glucose levels, while socioeconomic position and therapy type influenced outcomes.

    Area of Science:

    • Endocrinology
    • Pediatric Diabetes Management
    • Public Health Crises Impact on Chronic Disease

    Background:

    • The Iron Swords war imposed significant stress, potentially disrupting glycemic control in individuals with type 1 diabetes (T1D).
    • Understanding the impact of acute conflict on chronic disease management is crucial for public health preparedness.

    Purpose of the Study:

    • To assess changes in continuous glucose monitoring (CGM) metrics among pediatric T1D patients during the Iron Swords war.
    • To identify factors influencing glycemic control stability during a period of conflict.

    Main Methods:

    • A retrospective analysis of CGM data from 99 pediatric T1D patients was conducted.
    • Glycemic metrics including time-in-range, time-in-tight-range, hypoglycemia, and severe hyperglycemia were compared across three periods: pre-war, immediate post-outbreak, and four months later.
    • Patients were stratified by insulin therapy (multiple daily insulin vs. insulin pump, with or without open-source automated insulin delivery systems) and socioeconomic position (SEP).

    Main Results:

    • No overall significant changes in CGM metrics were observed for the entire cohort during the war.
    • Patients using insulin pumps, particularly with open-source automated insulin delivery (OS-AID), demonstrated superior pre-war glycemic control and maintained stability.
    • Higher SEP was associated with better baseline CGM metrics, but the lower SEP group showed improved time-in-tight-range, while the higher SEP group experienced increased severe hyperglycemia post-outbreak. Multiple daily insulin (MDI) users showed increased severe hyperglycemia post-outbreak.

    Conclusions:

    • Pediatric patients with T1D using insulin pumps maintained glycemic control during the Iron Swords war.
    • Socioeconomic position and insulin delivery method significantly influenced individual susceptibility to glycemic dysregulation during the conflict.
    • These findings highlight the importance of tailored diabetes management strategies during stressful events.
    Abstract

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