Tip 1 Diabetes Mellitus’lu Çocuk ve Adolesan Hastaların Retrospektif Olarak Değerlendirilmesi: Tek Merkez Deneyimi

Abstract

Amaç: Tip 1 diabetes mellitus(DM), çocukluk çağı ve adolesan dönemde en sık görülen kronik endokrin hastalıklardan birisidir. Diyabetli çocuğun izlemi sırasında amaç; ketoasidoz ve hipoglisemi ataklarının oluşumunu engellemek, hastaların normal büyüme-gelişmesini sağlamak ve kronik komplikasyonların gelişimini önlemektir. Tüm bunları yaparken de çocuğun ruh sağlığının korunması sağlanmalıdır. Bu çalışmada, kliniğimizde takip edilen Tip 1 DM’li çocuk ve adolesan hastaların hastane dosyalarını geriye dönük olarak olarak inceleyerek mevcut durumlarını değerlendirmeyi ve gelişen kronik komplikasyonları tespit etmeyi amaçladık.

Gereç ve Yöntemler: Bu çalışma, Sağlık Bakanlığı Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji Eğitim ve Araştırma Hastanesi, Pediyatrik Endokrinoloji pokliniğinde en az 1 yıllık takibi olan tip 1 DM tanılı olgular ile yapılmıştır. Olguların dosyaları geriye dönük olarak incelendi; fizik muayene bulguları, cinsiyet, yaş, diyabet tanısı konulan yaş , diyabet süresi, kullandıkları insülin miktarı (Ü/kg), kullandıkları insülin rejimi, kan lipid düzeyleri, son bir yıllık HbA1c değerleri, eşlik eden otoimmün hastalıklar ve son retinopati kontrolleri kaydedilmiştir. HbA1c % 6.5-7.5: İyi kontrollü diyabet, HbA1c % 7.6-9: Orta kontrollü diyabet, HbA1c > %9: Kötü kontrollü diyabet olarak kabul edilmiştir. Nefropati değerlendirmesi için mevcut olan olguların, 24 saatlik idrar ve 24 saatlik tansiyon monitorizasyonu sonuçları kaydedilmiştir.

Bulgular: Çalışmaya alınan 204 olgunun 112’si kız, 92’si erkekti. Hastaların yaş ortalaması 13.1 ± 3.82 yıl, diyabet tanısı aldıkları yaş ortalaması 7.66 ± 3.81 yıl, ortalama hastalık süreleri 5.52 ± 3.37 yıldı. Kullanılan insülin miktarının yaşla birlikte arttığı ancak yaş grupları arasında istatistiksel olarak anlamlı bir fark olmadığı bulundu. Çalışmaya dahil edilen hastaların HbA1c değerleri % 5.6-14.75 arasında, ortalama % 8.52 ± 1.49’dı. 10 yaşından küçük hastaların HbA1c düzeyi hem 10-15 yaş grubundan (p = 0.002) hem de 15 yaş üstü gruptan (p = 0.008) daha düşük bulundu. 5 yıldan az süren diyabetik olan hastalarda HbA1c düzeyi, hem 5-10 yıl süredir diyabetik gruptan (p = 0.004) hem de 10 yıldan uzun süredir diyabetik olan gruptan (p = 0.018) anlamlı olarak daha düşük bulundu. Tip 1 diyabetli olgulara en sık eşlik eden otoimmün hastalıklar otoimmün tiroid hastalığı (%13.7) ve çölyak hastalığı (% 4.9) olarak bulundu. Retinopati saptanan olgu yoktu. Yüz kırk altı olguda, 24 saatlik idrar toplandı ve glomeruler filtrasyon hızı(GFH) hesaplandı. Bu olguların % 29.5’inde GFH yüksek saptandı. Glomeruler filtrasyon hızı yüksekliği olan hastalar Evre 1 diyabetik nefropati olarak değerlendirildi. Yüz kırk altı olguda mikroalbumin düzeyleri incelendi ve %29.5’inde mikroalbuminüri saptandı. Diyabet süreleri ile GFH ve mikroalbuminüri arasında istatistiksel olarak anlamlı fark yoktu. Hastalık kontrolüne göre yaşam içinde kan basıncı izleme(YİKBİ) parametreleri değerlendirildiğinde iyi–orta kontrol grubu ile kötü kontrol grubu arasında hipertansiyon açısından istatiksel olarak anlamlı fark görülmedi.

Sonuç: 10 yaşın üzerindeki hastalarda HbA1c değerlerinin yüksek olması, diyabetik adolesan hastaların yönetiminin daha dikkatli yapılması gerektiğini düşündürmektedir. Glomeruler filtrasyon hızı hesaplanan grupta yüksek oranda evre 1 nefropati tespit edilmiş olması diyabetik nefropatinin erken tanınması ve tedavisinin planlanması için hastaların 24 saatlik idrar analizi ile taranmasının önemini göstermiştir. Hastalarımızın % 89.2’nin orta-kötü kontrol grubunda olması takiplerimizin daha titizlikle yapılması gerektiğini, bu hastaların kan lipid düzeylerindeki yüksekliğinin kardiyovasküler hastalıklar açısından önemli risk faktörü olduğu akılda tutulmalıdır. Diyabet izlemi titizlikle ve deneyimli bir ekiple yapılmalıdır. Gelişebilecek komplikasyonların büyük bir bölümü, iyi bir izlemle önlenebilen durumlardır. İyi bir izlem çocuğun fiziksel ve ruhsal olarak sağlıklı bir birey olmasını sağlayacaktır.

Keywords

• tip 1 diyabetes mellitus
• diyabetik komplikasyonlar
• Takip

Retrospective Evaluation of Type 1 Diabetes Mellitus Children and Adolescent Patients: A Single Center Experience

Abstract

Objective: Type 1 diabetes mellitus (DM) is one of the most common chronic endocrine diseases in childhood and adolescence. Preventing ketoacidosis and hypoglycemia attacks, ensuring normal growth and development, preventing chronic complication occurrence are the aims of diabetic child follow-up. While doing all these, the mental health of the child should be protected. In this study, we aimed to evaluate the status of pediatric and adolescent patients with Type 1 DM followed up in our clinic and to identify the chronic complications retrospectively by examining the hospital records.

Material and Methods: This study was carried out with cases with type 1 DM who had been followed up for at least 1 year in the pediatric endocrinology clinic of the Ministry of Health, Ankara Pediatric Health and Diseases Hematology Oncology Training and Research Hospital. The files of the cases were analysed retrospectively; physical examination findings, gender, age, diabetes diagnosis age, duration of diabetes, insulin regimen and the amount of insulin usage (U / kg), blood lipid levels, HbA1c values of the last year, accompanying autoimmune diseases and recent retinopathy controls were recorded. HbA1c percentages are classified as follows; 6.5-7.5%: Well controlled diabetes, 7.6-9%: Moderately controlled diabetes and HbA1c> 9%: Poorly controlled diabetes. For nephropathy evaluation, the 24-hour urine and 24-hour blood pressure monitoring results of the available cases were recorded.

Results: Of the 204 patients included in the study, 112 were female and 92 were male. The mean age of the patients was 13.1 ± 3.82 years, the mean age at which they were diagnosed with diabetes was 7.66 ± 3.81 years, and the mean duration of the disease was 5.52 ± 3.37 years. It was found that the amount of insulin used increased with age but it was not a statistically significant difference between the age groups. The HbA1c values of the patients included in the study were between 5.6-14.75%, and the average was 8.52 ± 1.49%. The HbA1c level in patients younger than 10 years old was lower than both 10-15 year-old group (p = 0.002), and patients older than 15 year-old group (p = 0.008). The HbA1c level in patients with diabetes lasting less than 5 years was found to be lower than both the group with diabetes lasting for 5-10 years (p = 0.004) and the group with diabetes lasting more than 10 years (p = 0.018 ). The most common autoimmune diseases accompanying patients with type 1 diabetes were autoimmune thyroid disease (13.7%) and celiac disease (4.9%). There were no cases with retinopathy. In 146 cases, 24-hour urine was collected and the glomerular filtration rate (GFR) was calculated. Glomerular filtration rate was found to be high in 29.5% of these cases. Patients with high glomerular filtration rate were evaluated as Stage 1 diabetic nephropathy. Microalbumin levels were examined in 146 cases, and microalbuminuria was detected in 29.5%. There was no statistically significant difference between diabetes duration both GFR and microalbuminuria.There was no statistically significant difference of ambulatory blood-pressure monitoring (ABPM) parameter between the good-moderate control group and the poor control group.

Conclusion: Because of high HbA1c levels in patients older than 10 years, the management of diabetic adolescent patients should be done more careful. The high percentage of stage 1 nephropathy detected in the group whose glomerular filtration rate was calculated showed the importance of screening patients with 24-hour urine analysis for early diagnosis and treatment of diabetic nephropathy. It should be kept in mind that 89.2% of our patients are in the middle-poor control group, and our follow-ups should be done more meticulously, and the high blood lipid levels of these patients is an important risk factor for cardiovascular diseases. Diabetes monitoring should be done meticulously and with an experienced team. Most of the complications that may develop are conditions that can be prevented with a good follow-up. A good follow-up will ensure that the child becomes a physically and mentally healthy individual.

Keywords

• Type 1 diabetes mellitus
• Diabetic complications
• Follow-up

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