Impact of a Major Earthquake on Glycemic Control in Adults with Type 2 Diabetes: A Retrospective Cohort Study from...

Objectives: This study aimed to evaluate the impact of the 6 February 2023 Kahramanmaraş-centered earthquakes on glycemic control in adults with type 2 diabetes mellitus (T2DM) by analyzing pre-post changes in HbA1c and fasting glucose. In addition, it sought to identify key clinical and biochemical predictors of glycemic worsening in the post-disaster period using routinely available laboratory data. Materials and Methods: This retrospective pre-post observational cohort study included 550 adult patients with established T2DM who received care at two centers in Gaziantep, Türkiye. Laboratory data-including HbA1c, fasting glucose, triglycerides, HDL, and albumin-were compared between two periods: three months before and three to five months after the earthquake. Paired samples t-tests, Spearman's correlation, multiple linear regression, and ROC analysis were used to evaluate changes in glycemic control and its predictors. Results: The mean age of the participants was 56.2 ± 11.0 years; 43.3% were male and 56.7% female. Post-earthquake, HbA1c (p = 0.012) and fasting glucose (p < 0.001) increased significantly, indicating deterioration in metabolic control. White blood cell (p = 0.003) and platelet counts (p < 0.001) rose, while HDL (p < 0.001), ALT (p = 0.002), and triglycerides (p = 0.010) decreased. ΔHbA1c correlated positively with ΔGlucose (r = 0.362, p < 0.001), ΔTriglyceride (r = 0.323, p < 0.001), LDL (r = 0.173, p < 0.001), and total cholesterol (r = 0.107, p = 0.032), and negatively with ΔAlbumin (r = -0.332, p = 0.029), ΔHDL (r = -0.175, p < 0.001), and WBC (r = -0.112, p = 0.009). In the fully adjusted multivariable model (age, sex, BMI, diabetes duration, insulin use), independent predictors of ΔHbA1c included ΔGlucose (β = 0.007, p < 0.001), ΔTriglyceride (β = 0.004, p = 0.001), ΔHDL (β = -0.010, p = 0.011), ΔAlbumin (β = -0.016, p = 0.007), and ΔWBC (β = -0.009, p = 0.022). Clinical predictors were BMI (β = 0.006, p = 0.045), diabetes duration >10 years (β = 0.094, p = 0.009), and insulin use (β = 0.121, p = 0.003) (Adjusted R² = 0.319). ROC analysis confirmed ΔGlucose as the strongest predictor of worsening glycemic control (AUC = 0.81; sensitivity 82.1%, specificity 73.4%). Additional predictors included insulin use (AUC = 0.66, p < 0.001), ΔTriglyceride (AUC = 0.65, p < 0.001), BMI (AUC = 0.63, p = 0.002), diabetes duration >10 years (AUC = 0.62, p = 0.004), and ΔHDL (AUC = 0.61, p = 0.016), each providing more modest predictive value. Conclusions: Glycemic control became significantly worse in adults with T2DM after the February 2023 earthquake, as reflected by increases in HbA1c and fasting glucose. Both biochemical parameters (Glucose, Triglyceride, HDL, Albumin, WBC) and clinical characteristics (BMI, diabetes duration >10 years, insulin use) were independently associated with glycemic deterioration. Among these, glucose remained the strongest predictor (AUC = 0.81), while BMI, insulin therapy, and longer diabetes duration provided additional predictive value. These findings suggest that routinely available clinical and laboratory data can be used to identify patients at highest risk of metabolic decompensation in disaster settings.