Objective The war in Sudan, which began in April 2023, has displaced millions and severely disrupted the healthcare system. This study assessed the association between armed conflict, displacement, and glycemic control in people living with diabetes (PWD), as well as the prevalence of diabetes-related complications in this context. Research Design and Methods This is a cross-sectional study. Using systematic random sampling, 385 displaced adults living with diabetes, aged 19 years or older, were recruited. The study was conducted at the diabetes center in Port Sudan from October 2024 to May 2025. Data on sociodemographic characteristics, clinical history, and barriers to care were collected through structured questionnaires. Bivariate analyses and binary logistic regression were used to identify factors associated with uncontrolled diabetes. Results Participants had a mean age of 53 ± 12 years; 51.4% were female. All were displaced because of the armed conflict. The mean HbA1c was 9.38% (± 2.42); only 16.6% of participants achieved glycemic control (HbA1c < 7.0%). Poor adherence to diabetes management was reported by 15.8% of patients, with an average HbA1c of 12.09% in this group. A high prevalence of complications was observed, with 26.5% and 20.8% of patients having diabetic foot and diabetic retinopathy, respectively. In regression analysis, poor adherence was the sole factor significantly associated with uncontrolled diabetes (OR 41.96, 95% CI [11.04, 159.52], p < 0.001). Female gender and higher education were associated with higher mean HbA1c in bivariate analysis (9.63% vs. 9.11%, p = 0.015; p = 0.007, respectively) but were not independent predictors in the multivariate model. Stress exposure was nearly universal (99.2%) but not significantly associated with glycemic control in this sample. Conclusions In this cross-sectional study of displaced PWD, the context of armed conflict in Sudan was associated with a high prevalence of poor glycemic control; diabetic foot syndrome was present in 26.5% and retinopathy in 20.8% of participants; as these were self-reported and patient overlap was not assessed, these figures represent individual prevalences rather than cumulative burden. Adherence to management was the key modifiable factor correlated with glycemic outcomes. These findings highlight an urgent need for conflict-sensitive diabetes management strategies. Humanitarian responses should consider ensuring reliable, affordable access to care and support programs as a potential means to address the cascade of diabetes-related complications in conflict settings.

Tragic impact of armed conflict on glycemic control among displaced people living with diabetes in Sudan

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发表日期：

2026年7月17日

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Nihad Babiker,
Sufian Noor,
Elamin Abdelgadir

摘要

Objective

The war in Sudan, which began in April 2023, has displaced millions and severely disrupted the healthcare system. This study assessed the association between armed conflict, displacement, and glycemic control in people living with diabetes (PWD), as well as the prevalence of diabetes-related complications in this context.

Research Design and Methods

This is a cross-sectional study. Using systematic random sampling, 385 displaced adults living with diabetes, aged 19 years or older, were recruited. The study was conducted at the diabetes center in Port Sudan from October 2024 to May 2025. Data on sociodemographic characteristics, clinical history, and barriers to care were collected through structured questionnaires. Bivariate analyses and binary logistic regression were used to identify factors associated with uncontrolled diabetes.

Results

Participants had a mean age of 53 ± 12 years; 51.4% were female. All were displaced because of the armed conflict. The mean HbA1c was 9.38% (± 2.42); only 16.6% of participants achieved glycemic control (HbA1c < 7.0%). Poor adherence to diabetes management was reported by 15.8% of patients, with an average HbA1c of 12.09% in this group. A high prevalence of complications was observed, with 26.5% and 20.8% of patients having diabetic foot and diabetic retinopathy, respectively. In regression analysis, poor adherence was the sole factor significantly associated with uncontrolled diabetes (OR 41.96, 95% CI [11.04, 159.52], p < 0.001). Female gender and higher education were associated with higher mean HbA1c in bivariate analysis (9.63% vs. 9.11%, p = 0.015; p = 0.007, respectively) but were not independent predictors in the multivariate model. Stress exposure was nearly universal (99.2%) but not significantly associated with glycemic control in this sample.

Conclusions

In this cross-sectional study of displaced PWD, the context of armed conflict in Sudan was associated with a high prevalence of poor glycemic control; diabetic foot syndrome was present in 26.5% and retinopathy in 20.8% of participants; as these were self-reported and patient overlap was not assessed, these figures represent individual prevalences rather than cumulative burden. Adherence to management was the key modifiable factor correlated with glycemic outcomes. These findings highlight an urgent need for conflict-sensitive diabetes management strategies. Humanitarian responses should consider ensuring reliable, affordable access to care and support programs as a potential means to address the cascade of diabetes-related complications in conflict settings.