Çocukluk çağı başlangıçlı tip 1 diyabette inflamatuar kan belirteçleri diyabetin prezantasyon şekli ve kümülatif glisemik kontrol durumunu yansıtabilir mi?

Abstract

Amaç: Tip 1 diyabetes mellitus (T1DM), çocukluk çağının en sık görülen diyabet formudur ve sistemik inflamasyonla ilişkili otoimmün β-hücre yıkımı ile karakterizedir. Bu çalışmanın amacı, inflamatuvar hematolojik indekslerin (SII, SIRI, NLR, PLR) çocukluk başlangıçlı T1DM’de başvuru tipi ve uzun dönem glisemik kontrolü yansıtma potansiyelini değerlendirmektir. Gereç ve Yöntemler: Nisan 2021 – Haziran 2024 tarihleri arasında, 2–18 yaş aralığında T1DM tanılı çocuklar ve yaş ile cinsiyet açısından eşleştirilmiş sağlıklı kontroller üzerinde kohort çalışması yürütüldü. Tanı anında hastalar klinik başvuru şekline göre diyabetik ketoasidoz (DKA), asidozsuz ketozis veya izole hiperglisemi olarak sınıflandırıldı. Hematolojik inflamasyon parametreleri (SII, SIRI, NLR, PIV, PDW, PCT, MPV) tanı anında ve bir yıllık takip sonunda ölçüldü. Tanı dönemi dışındaki ölçümler esas alınarak, bir yıllık ortalama HbA1c değerleri kümülatif glisemik kontrolü değerlendirmede kullanıldı. Buna göre hastalar iyi (<%7), orta (7–9%) ve kötü (>%9) metabolik kontrol gruplarına ayrıldı. Bulgular: Toplam 137 katılımcı (ortalama yaş 10,4±4,1 yıl; %51,1 kız (n: 67)] çalışmaya dahil edildi. T1DM’li hastaların %57,8’i DKA, %26,0’ı diyabetik ketozis ve %16,2’si izole hiperglisemi ile başvurdu. Tanı anında nötrofil ve lökosit sayıları ile birlikte SII, SIRI, NLR ve PLR düzeyleri DKA grubunda diğer alt gruplara ve kontrollere göre anlamlı derecede yüksekti (p<0,001). İnflamatuvar belirteçlerin takip döneminde metabolik kontrol düzeylerini ayırt etmede anlamlı bir değeri bulunmadı ve kümülatif HbA1c ile bu indeksler arasında korelasyon saptanmadı. ROC analizinde SII (AUC=0.793; %95 GA: 0.685–0.901) ve SIRI (AUC=0.780; %95 GA: 0.668–0.893) DKA’yı ayırt etmede en yüksek tanısal güce sahipti; optimal kesim değerleri sırasıyla 614.9 (sensitivite %76.9, spesifisite %75.9) ve 0.95 (sensitivite %85.4, spesifisite %65.5) olarak belirlendi. Sonuç: İnflamatuvar kan belirteçleri, özellikle SII ve SIRI, T1DM başlangıcında DKA varlığını belirlemede yararlı olabilir; ancak uzun dönem metabolik kontrolün öngörülmesinde değerli görünmemektedir.

Keywords

• Tip 1 diyabetes mellitus
• glisemik kontrol
• hematolojik inflamasyon indeksi
• nötrofil-lenfosit oranı
• sistemik immün inflamasyon indeksi

Can inflammatory blood markers reflect presentation type and cumulative glycemic control status in childhood-onset type 1 diabetes?

Abstract

Aim: Type 1 diabetes mellitus (T1DM) is the most common form of childhood diabetes and involves autoimmune β-cell destruction associated with systemic inflammation. This study aimed to evaluate the potential of inflammatory hematological indices (SII, SIRI, NLR, PLR) to indicate presentation type and long-term glycemic control in childhood- onset T1DM. Material and Methods: A longitudinal cohort study was conducted on children aged 2-18 years with T1DM and along with age- and sexmatched healthy controls, recruited between April 2021 and June 2024. At diagnosis, patients were categorized according to clinical presentation as diabetic ketoacidosis (DKA), ketosis without acidosis, or isolated hyperglycemia. Hematological inflammatory parameters (SII, SIRI, NLR, PIV, PDW, PCT, MPV) were measured at diagnosis and one-year follow- up. Mean HbA1c values obtained over the one-year follow-up period, excluding those from initial presentation, were used to assess cumulative glycemic control. Based on these values, patients were categorized into good (<7%), moderate (7–9%), and poor (>9%) metabolic control groups. Results: A total of 137 participants (mean age 10,4±4,1 years; %51,1 female (n: 67)] were included. Among T1DM patients, 57.8% presented with DKA. Seventy-seven children with T1DM and 60 healthy controls were included. Among the patients, 57.8% presented with DKA, 26.0% with diabetic ketosis, and 16.2% with isolated hyperglycemia. At diagnosis, neutrophil and leukocyte counts, as well as SII, SIRI, NLR, and PLR, were significantly higher in the DKA group than in the other subgroups and controls (p<0.001). Inflammatory markers were not useful in distinguishing metabolic control categories during follow-up, and no correlation was found between cumulative HbA1c and inflammatory indices at one year. In the ROC analysis, SII (AUC = 0.793; 95% CI: 0.685–0.901) and SIRI (AUC = 0.780; 95% CI: 0.668–0.893) demonstrated the highest diagnostic performance in distinguishing DKA; their optimal cut-off values were 614.9 (sensitivity 76.9%, specificity 75.9%) and 0.95 (sensitivity 85.4%, specificity 65.5%), respectively. Conclusion: Inflammatory blood markers, particularly SII and SIRI, appear to be valuable in identifying DKA at T1DM onset but not in predicting long-term metabolic control.

Keywords

• Type 1 diabetes mellitus
• glycemic control
• hematological inflammatory index
• neutrophil-lymphocyte ratio
• systemic immune inflammation index

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