Classification and Treatment Management in New Diagnosed Diabetes Mellitus Patients

Abstract

Objective: Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia. Type 1 diabetes is characterized by impaired insulin secretion, and type 2 diabetes is characterized by insulin resistance. In addition, other diabetes types related to single gene disorders, drug use, and genetic syndromes can be seen. In this study, it was aimed to investigate the symptoms and findings of the patients with new diagnosed diabetes and evaluate the classification.

Material and Method: Family history, clinical findings, diabetes antibodies (anti GAD, islet cell antibody and anti-insulin antibody), HbA1c levels were evaluated retrospectively in 113 patients who were admitted to our clinic between December 2016 and January 2019.

Results: The mean age of 113 patients included in the study was 10,4±4,3 (1,0-17,1) years. 72 (63,7%) had a family history. Obesity was present in 16 (14,1%). The average of HbA1c was %11,6 and C-peptit level was 0,74 ng/mL. Type 2 diabetes mellitus was present in 8 patients, Prader Willi Syndrome was present in 2 patients and monogenic diabetes in 2 patients. All of patients, 65 (57,5%) were presented with ketoacidosis, 11 (9,7%) with ketosis and 37 (32,7%) with hyperglycemia Antibodies were negative in 40 patients (35,3%). Of the 40 patients with negative diabetes antibodies, 21 (52,5%) had ketoacidosis, 3 (7,5%) had ketosis and 16 (40%) had only hyperglycemia.

Conclusion: In our study, it was noteworthy that 57.5% of the patients who were diagnosed with diabetes still presented with a severe clinical status such as ketoacidosis. In addition, it was observed that diabetes antibodies were negative in approximately half of the patients who were diagnosed with type 1 DM and presented with ketoacidosis. Making the correct classification in diabetes management is of great importance in the management of the patient and planning the right treatment. 

Keywords

• Autoantibody, diabetes, classification

Yeni Tanı Diyabetes Mellitus Hastalarında Sınıflandırma ve Tedavi Yönetimi

Abstract

Amaç: Diyabetus mellitus insulin salgılanması, aktivitesindeki bozulmaya bağlı olarak ortaya çıkan kronik hiperglisemi ile karakterize metabolik bozukluktur. Tip 1 diyabet insülin salınmasında bozukluk ile, tip 2 diyabet ise insülin direnci ile karakterizedir. Bunun dışında tek gen bozukluklarına, ilaç kullanımlarına, genetik sendromlara bağlı diyabet sınıfları da görülebilmektedir. Bu çalışmada yeni tanı diyabetli hastalarda başvuru semptom ve bulgularının araştırılması, sınıflamanın değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntem: Aralık 2016-Ocak 2019 döneminde kliniğimize başvurup diyabet tanısı almış 113 hastada aile öyküleri, geliş bulguları, diyabet antikorları (anti GAD, adacık hücre antikoru ve anti- insulin antikoru), HbA1c düzeyleri retrospektif olarak incelendi.

Bulgular: Çalışmaya alınan 113 hastanın yaş ortalaması 10,4 idi. 72’sinde (%63,7) aile öyküsü mevcuttu. 16’sında (%14,1) obezite mevcuttu. HbA1c ortalaması %11,6, C-peptit düzeyleri 0,74 ng/mL idi. 8 hastada tip 2 diyabetes mellitus, 2 hastada Prader Willi ve 2 hastada monogenik diyabet mevcuttu. Tüm hastaların 65’i (%57,5) ketoasidoz tablosu ile, 11’i (%9,7) ketoz ve 37’si (%32,7) hiperglisemi ile başvurmuştu. Hastaların 40’ında (%35,3) diyabet antikorları negatifti. Diyabet antikorları negatif olan 40 hastanın 21’inde (%52,5) ketoasidoz, 3’ünde (%7,5) ketoz ve 16’sında (%40) hiperglisemi mevcuttu.

Sonuç: Çalışmamızda, diyabet tanısı alan olguların %57,5 gibi önemli bir kısmının halen ketoasiadoz gibi ağır bir klinik tablo ile başvurduğu dikkati çekmekteydi. Ayrıca, tip 1 DM tanısı konulan ve ketoasidoz ile başvuran olguların yaklaşık yarısında diyabet antikorlarının negatif sonuçlandığı gözlendi. Diyabet yönetiminde doğru sınıflama yapmak, hastanın yönetiminde ve doğru tedavinin planlanmasında büyük önem taşımaktadır. Anahtar Sözcükler: Otoantikor, diyabet, sınıflama

Keywords

• Diyabetes mellitus
• ketoasidoz
• hiperglisemi

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