title: Glycemic control of diabetes patients under continuous rocket attacks.
abstract: BACKGROUND
  Evidence regarding the detrimental effects of exposure to stress on glycemic control among diabetes patients has mainly focused on personal life events or acute trauma. However, the effects of continuous exposure to extreme stress on type 2 diabetes patients have rarely been studied. The aim of the current study was to examine the association of continuous exposure to rocket attacks with glycemic control and with risk factors for diabetes complications among civilian type 2 diabetes patients. We focus on patients residing in the Western Negev in the south of Israel that has been subjected to rocket attacks fired from Gaza since the end of 2001.
  
  
  METHODS
  A two-arm retrospective cohort study of type 2 diabetes patients, aged 35-70 years, residing in a region with chronic exposure to rocket attacks (N = 1697) and in a non-exposed comparison region in Israel (N = 3000). Data were retrieved from the Health Maintenance Organization (HMO)'s database for four time periods representing exposure: chronic-2008; elevated-2009 (post'Cast Lead' operation); return to chronic-2010, 2011. Data included socio-demographic variables, HbA1c, BMI, LDL cholesterol, blood pressure. General Linear Models (GLM) were used for analysis.
  
  
  RESULTS
  For HbA1c, the model yielded a significant main effect for time, a borderline significance main effect for region, and a significant time by region interaction: no differences in HbA1clevels between the regions in 2008 and 2009, followed by significant differences between the regions in 2010 and 2011 when HbA1ccontinued to increase in the exposed region but decreased in the comparison region. Regarding risk factors, a significant main effect for time for LDL cholesterol only, and significant main effects for region were found in all factors: BMI and LDL cholesterol were higher in the exposed than in the comparison region, but blood pressure values were lower.
  
  
  CONCLUSIONS
  Continuous exposure to rocket attacks is associated with glycemic control and risk factors in a complex pattern. These preliminary findings require further studies of diverse types of civilian exposure to continuous extreme stress.
authors.affiliation: The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, 52900 Ramat Gan, Israel.
authors.forename: Varda
authors.initials: V
authors.lastname: Soskolne
authors.affiliation: The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, 52900 Ramat Gan, Israel.
authors.forename: Rachel
authors.initials: R
authors.lastname: Dekel
authors.affiliation: Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Shlomo
authors.initials: S
authors.lastname: Vinker
keywords: Glycemic control; Israel; Risk factors for complications; Rocket attacks; Trauma; Type 2 diabetes mellitus