Diyabetimle Barıştım Projesi : Bir Çocuk Endokrinoloji Kliniğinde Yaşanan Başarı Öyküsü

Abstract

Amaç: Tip 1 diyabette (T1DM) uzun dönem komplikasyonların azaltılması ve/veya geciktirilmesi için iyi metabolik kontrol zorunludur. Tip 1 diyabetli çocuk ve ergenlerde motivasyon kaybı, bıkkınlık ve psikolojik sorunlar metabolik kontrolü güçleştirmektedir. Bu çalışmada, genellikle orta-alt gelir grubu ailelerin çocuklarının izlendiği bir çocuk endokrin kliniğinde diyabetli olgularda metabolik kontrolün iyileştirilmesi amaçlandı.Hastalar ve Yöntem: Proje kapsamında tüm diyabetli çocuklarda esnek ve yoğun insülin tedavisine geçildi, beslenme eğitimleri tekrarlandı, tüm çocuklara diyabet eğitim kitapları dağıtıldı. Kötü kontrollü diyabetlilere endokrin polikliniğinde daha çok zaman ayrıldı. Zorunlu durumlarda kan şekeri regülasyonu için hastaneye yatış yapıldı. Başlangıçtaki ve bir yılın sonundaki ortalama HbA1c değerleri karşılaştırıldı.Bulgular: Çalışmada ortalama diyabet süresi 6.0±3.2 yıl olan 91 (46’sı erkek) tip 1 diyabetli çocuk ve ergen yer aldı. Çalışma başlangıcında ortalama HbA1c % 8.2 iken bir yılın sonunda % 7.8’e geriledi (p<0.001). Başlangıçta HbA1c’si % 9.0 ve üzeri olan 25 kötü metabolik kontrollü olgu var iken çalışma sonunda bu sayı 15’e düştü (p<0,001). Çalışmada yer alan kızların daha yüksek başarı gösterdikleri ve başlangıçta % 8.3 olan HbA1c düzeyinin 1 yılın sonunda % 7.7’ye gerilediği görüldü (p=0,002). Kızlarda 12 olan kötü kontrollü diyabetli sayısı 4’e düşmüştü. Ancak erkek çocuklarda başlangıç ve bir yılın sonundaki ortalama HbA1c düzeyleri arasında anlamlı fark yoktu.Sonuç: Diyabetlilere yeterli zaman ayrılması, yoğun insülin ve beslenme tedavileri ile birlikte metabolik kontrolde düzelme sağlayabilmektedir. Erkek çocuklarda iyi metabolik kontrol sağlanması kızlara göre daha büyük güçlük göstermektedir. Erkek tip 1 diyabetlilerde daha iyi metabolik kontrol sağlanması için farklı stratejilerin geliştirilmesi gerekmektedir.

Keywords

• Tip 1, diyabet, ergen, HbA1c, metabolik kontrol

THE PROJECT OF MAKE PEACE WITH DIABETES: THE SUCCESS STORY IN ONE OF THE PEDIATRIC ENDOCRINOLOGY CLINIC

Abstract

Objective: In type 1 diabetes (T1DM), a good metabolic control is important to reduce and/or postpone complications. Achieving better metabolic control in children and adolescent with T1DM is difficult due to loss of motivation, psychological problems, getting bored and tired. The aim of this study was improvement of the metabolic control in patients with diabetes who come from middle and low income families. Patient and Methods: Within the project; all diabetic children were passed to flexible and intensive insulin treatment. Nutrition education was repeated by a dietitian and education books about diabetes were distributed to all children. Poorly controlled diabetics were allowed more times in their visits. If it was necessary for the glycemic regulation, patients were hospitalized. Mean HbA1c was compared at the beginning and at one year follow up examination.Results: Ninety-one children (46 boys) with mean diabetes duration of 6.0±3.2 years participated in this study. At the end of the year mean HbA1c was reduced from 8.2% to 7.8% and number of poorly controlled patients (HbA1c ı %9) decreased from 25 to 15 (p<0.001). The girls have shown higher success and their mean HbA1c level was reduced from 8.3% to 7.7%, and number of poorly controlled patients had fallen from 12 to 4 (p=0.002). However, there were no significant improvements in the mean HbA1c levels of the boys at the end of the year. Conclusions: To allow enough time to the diabetic children with intensive insulin and nutritional therapies can improve their metabolic controls. Achievement of good control in the diabetic boys shows a greater challenge. Different strategies must be developed to reach better metabolic control in boys with T1DM

Keywords

• Type 1, diabetes, adolescent, HbA1c, metabolic control

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