Glycemic Controls of Patients with Type 1 Diabetes, Affecting Factors and Relationship Between Type 1 Diabetes and Infection Frequency

Abstract

Objective: Type 1 diabetes mellitus (Type 1 DM) is the most common endocrine-metabolic disorder at childhood and adolescence. In this study, it was aimed to determine the risk factors for poor metabolic control in Type 1 DM, the frequency of infection in the cases, the frequency of accompanying autoimmune diseases, the effect of Type 1 DM on the final height and body mass index (BMI) and to review the treatment and follow-up.

Material and Methods: The present study included 184 children and adolescent with Type 1 DM. The patient charts were retrospectively reviewed and a questionnaire was applied including sociodemographic characteristics of the patients, and history of infection.

Results: Of the cases included, 53.5% were girl whereas 46.7% were boy with a mean age of 12.71±0.31 years. Mean age at diagnosis was 7.71±0.29 years while mean Hb1ac value was 8.45±1.78. No correlation was found between mean HbA1c value and family history for diabetes mellitus, household size, residency and monthly income. Since type 1 DM is a chronic disease, the final dye effect in patients was made by comparing the target height with the final height. It was observed that 29 patients who reached to final height passed over their target height. It was determined that as the mean HbA1c value, which is an indicator of metabolic control, increased, microalbuminuria and neuropathy increased. There was no severe infection requiring hospitalization. The mean number of infection per year was 2.3 and there was no increase in the frequency of infection.

Conclusion: In conclusion, duration of disease and increased age, puberty, socioeconomic status, incompliance to dietary recommendation and failure in attending control visits were identified as risk factor for poor metabolic control in patients with Type 1 DM. It was found that patients reached to target height by improved metabolic control. No increase in infection rate or severe infection requiring hospitalization was observed in our patients. The frequency of autoimmune diseases was similar to the literature.

Keywords

• Hemoglobin A1C
• Infection
• Metabolic
• Type 1 Diabetes Mellitus

Tip 1 Diyabet Hastalarının Glisemik Kontrolleri, Etkileyen Faktörler ve Tip 1 Diyabet ile Enfeksiyon Sıklığı İlişkisi

Abstract

Amaç: Tip 1 diabetes mellitus (Tip 1 DM), çocukluk ve ergenlikte en sık görülen endokrin-metabolik bozukluktur. Bu çalışmada, Tip 1 DM’de kötü metabolik kontrol için risk faktörleri, olgularda enfeksiyon sıklığı, eşlik eden otoimmün hastalık sıklığı, Tip 1 DM’un final boyuna ve vücut kitle indeksine (VKİ) etkisinin saptanması planlanarak tedavi ve izlemlerinin tekrar gözden geçirilmesi amaçlanmıştır.

Gereç ve Yöntemler: Bu çalışmaya Tip 1 DM’li 184 çocuk ve ergen dahil edilmiştir. Hasta dosyaları retrospektif olarak incelenmiştir ve hastaların sosyodemografik özelliklerini ve enfeksiyon öyküsünü içeren bir anket uygulanmıştır.

Bulgular: Dahil edilen vakaların% 53.5’i kız,% 46.7’si erkek olup yaş ortalaması 12.71±0.31 yıldı. Ortalama tanı yaşı 7.71±0.29 yıl iken ortalama Hb1ac değeri 8.45±1.78’di. Ortalama HbA1c değeri ile tip 1 DM için aile öyküsü, ev halkı büyüklüğü, ikametgah ve aylık gelir arasında bir korelasyon bulunmadı. Tip 1 DM kronik bir hastalık olması nedeni ile hastalarda nihai boya etkisi, hedef boy ile nihai boy karşılaştırılarak yapıldı. Nihai boya ulaşan 29 hastanın hedef boylarını geçtiği görüldü. Metabolik kontrolün bir göstergesi olan ortalama HbA1c değeri arttıkça mikroalbüminüri ve nöropatinin arttığı saptandı. Olgularda hastanede yatış gerektirecek ciddi enfeksiyon olmadığı ve yıllık ortalama enfeksiyon sayısı 2,3 olduğu görüldü. Enfeksiyon sıklığında artış saptanmadı.

Sonuç: Sonuç olarak, Tip 1 DM’li hastalarda kötü metabolik kontrol için risk faktörü olarak hastalık süresi ve artmış yaş, ergenlik, sosyoekonomik durum, diyet önerilerine uyumsuzluk ve kontrol ziyaretlerine gelememe tespit edilmiştir. Geliştirilmiş metabolik kontrol ile hastaların hedef boya ulaştığı görülmüştür. Hastalarımızda enfeksiyon oranında artış veya hastanede yatmayı gerektirecek ciddi enfeksiyon görülmemiştir. Literatür ile benzer otoimmün hastalık sıklığı izlenmiştir.

Keywords

• Tip 1 diyabetes mellitus
• metabolik kontrol
• demografik özellikler
• enfeksiyon sıklığı

References

1. Mayer-Davis EJ, Kahkoska AR, Jefferies C, Dabelea D, Balde N, Gong CX, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes 2018;27:7-19.
2. Rewers M, Pihoker C, Donaghue K, Hanas R, Swift P, Klingensmith GJ. Assessment and monitoring of glycemic control in children and adolescents with diabetes. Pediatr Diabetes 2007;8:408-18.
3. Helgeson VS, Honcharuk E, Becker D, Escobar O, Siminerio L. A focus on blood glucose monitoring: Relation to glycemic control and determinants of frequency. Pediatr Diabetes 2011;12:25-30.
4. Abu-Ashour W, Twells LK, Valcour JE, Gamble JM. Diabetes and the occurrence of infection in primary care: A matched cohort study. BMC Infect Dis 2018;18:67.
5. Carey IM, Critchley JA, Dewilde S, Harris T, Hosking FJ, Cook DG. Risk of infection in type 1 and type 2 diabetes compared with the general population: A matched cohort study. Diabetes Care 2018; 41:513-21.
6. Bartelink ML, Hoek L, Freriks JP, Rutten GEHM. Infections in patients with type 2 diabetes in general practice. Diabetes Res Clin Pract 1998;40:15-9.
7. Wolfsdorf JI, Glaser N, Agus M, Fritsch M, Hanas R, Rewers A, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes 2018;27:155–77.
8. Neyzi O, Günöz H, Furman A, Bundak R, Gökçay G, Darendeliler F, et al. Türk Çocuklarında Vücut Ağırlığı, Boy Uzunluğu, Baş Çevresi ve Vücut Kitle İndeksi Referans Değerleri. Çocuk Sağlığı ve Hastalıkları Dergisi 2008;51:1-14.

9. Modell V, Gee B, Lewis DB, Orange JS, Roifman CM, Routes JM, et al. Global study of primary immunodeficiency diseases (PI)--diagnosis, treatment, and economic impact: an updated report from the Jeffrey Modell Foundation. Immunol Res 2011;51:61–70.
10. Hanas R, Donaghue K, Klingensmith G, Swift PGF. ISPAD Clinical Practice Consensus Guidelines 2006-2007. Pediatr Diabetes 2006;7:352-60.
11. Alexander V, Blair A, Blair M, Campbell I, Collier A, Croll J, et al. Factors influencing glycemic control young people with type 1 diabetes in Scotland: A population-based study (DIABAUD2). Diabetes Care 2001;24;239-44. Çakir S, Saǧlam H, Özgür T, Eren E, Tarim Ö. Tip 1 diyabetli çocuklarda glisemik kontrolü etkileyen faktörler. Guncel Pediatr 2010;8:7-19.
12. Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. Diabetes Control and Complications Trial Research Group. N Engl J Med 1993;329;977-86.
13. Rosilio M, Cotton JB, Wieliczko MC, Gendrault B, Carel JC, Couvaras O, et al. Factors associated with glycemic control: A cross-sectional nationwide study in 2,579 french children with type 1 diabetes. Diabetes Care 1998;21:1146-53.
14. Drash AL. The Etiology of Diabetes Mellitus. N Engl J Med 1979; 24;300:1211–3.
15. Kandemir N, Açikgöz E, Yordam N. The epidemiology of juvenile-onset insulin-dependent diabetes mellitus in Turkish children. A retrospective analysis of 477 cases. Turk J Pediatr 1994;36:191-5.
16. Haller MJ, Atkinson MA, Schatz D. Type 1 diabetes mellitus: Etiology, presentation, and management. Pediatr Clin North Am 2005;52:1553-78.
17. Patterson CC, Dahlquist G, Soltész G, Green A. Variation and trends in incidence of childhood diabetes in Europe. Lancet 2000;355:873-6.
18. Taşkın E, Yılmaz E, Kılıç M, Ertuğrul S. The epidemiological features of the type I diabetes mellitus. FÜ Sağ Bil Derg 2007;21:75-9.
19. Dunger DB, Sperling MA, Acerini CL, Bohn DJ, Daneman D, Danne TPA, et al. European Society for Paediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society consensus statement on diabetic ketoacidosis in children and adolescents. Pediatrics 2004;113:e133-40.
20. Bismuth E, Laffel L. Can we prevent diabetic ketoacidosis in children? Pediatr Diabetes 2007;8:24-33.
21. Bideci A, Demirel F, Çamurdan O, Cinaz P. Tip 1 Diyabetli Çocuklarda İlk Başvuru Bulgularinin Deǧerlendirilmesi. Cocuk Sağlığıve Hast Derg 2006;49:112–6.
22. Kocabas A, Aldemir Kocabas B, Karaguzel G, Akcurin S. Assessment of Anthropometric and Metabolic Follow-Up Characteristics of Patients with Type 1 Diabetes Mellitus. Turkish J Pediatr Dis 2013;7:113–8.
23. Gallegos-Macias AR, Macias SR, Kaufman E, Skipper B, Kalishman N. Relationship Between Glycemic Control, Ethnicity And Socioeconomic Status İn Hispanic And White Non-Hispanic Youths With Type 1 Diabetes Mellitus. Pediatr Diabetes 2003;4:19-23.
24. Hassan K, Loar R, Anderson BJ, Heptulla RA. The Role Of Socioeconomic Status, Depression, Quality Of Life, And Glycemic Control İn Type 1 Diabetes Mellitus. J Pediatr 2006;149:526-31.
25. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2009;32 Supp 1:S62-7.
26. Cotellessa M, Barbieri P, Mazzella M, Bonassi S, Minicucci L, Lorini R. High incidence of childhood type 1 diabetes in Liguria, Italy, from 1989 to 1998. Diabetes Care 2003;26:1789-9.
27. Güven A, Aydin M. Beş Yaşından Önce Tip 1 Diyabetes Mellitus Tanısı Alan Çocuklarda Etiyopatogenezde Rol Alan Faktörler. Çocuk Sağlığı ve Hast Derg 2005;48:295-300.
28. Bala KA, Didin M, Kaba S, Aslan O, Karaman S. Tip 1 Diyabet Mellitus Olgularının Değerlendirilmesi. Van Tıp Derg 2017;24:85–90.
29. Elamin A, Hussein O, Tuvemo T. Growth, puberty, and final height in children with Type 1 diabetes. J Diabetes Complications 2006;20;252-6.
30. Dorchy H, Roggemans MP, Willems D. Glycated hemoglobin and related factors in diabetic children and adolescents under 18 years of age: A Belgian experience. Diabetes Care 1997;20:2-6.
31. Karjalainen J, Knip M, Mustonen A, Åkerblom HK. Insulin autoantibodies at the clinical manifestation of Type 1 (insulin-dependent) diabetes - a poor predictor of clinical course and antibody response to exogenous insulin. Diabetologia 1988;31:129-33.
32. Donaghue KC, Marcovecchio ML, Wadwa RP, Chew EY, Wong TY, Calliari LE, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Microvascular and macrovascular complications in children and adolescents. Pediatr Diabetes 2018;19 Suppl 27:262-74.
33. Şimsek DG, Aycan Z, Özen S, Çetinkaya S, Kara C, Abali S, et al. Diabetes care, glycemic control, complications, and concomitant autoimmune diseases in children with type 1 diabetes in Turkey: A multicenter study. JCRPE J Clin Res Pediatr Endocrinol 2013;5:20-6.
34. Bognetti E, Brunelli A, Meschi F, Viscardi M, Bonfanti R, Chiumello G. Frequency and correlates of severe hypoglycaemia in children and adolescents with diabetes mellitus. Eur J Pediatr 1997;156:589–91.
35. Kakleas K, Soldatou A, Karachaliou F, Karavanaki K. Associated autoimmune diseases in children and adolescents with type 1 diabetes mellitus (T1DM). Autoimmunity Reviews 2015;14:781-97.
36. Karagüzel G, Şimşek S, Deǧer O, Ökten A. Screening of diabetes, thyroid, and celiac diseases-related autoantibodies in a sample of Turkish children with type 1 diabetes and their siblings. Diabetes Res Clin Pract 2008;80:238-43.
37. Pham-Short A, Donaghue KC, Ambler G, Phelan H, Twigg S, Craig ME. Screening for celiac disease in type 1 diabetes: A systematic review. Pediatrics 2015;136:e170-6.
38. Peleg AY, Weerarathna T, McCarthy JS, Davis TME. Common infections in diabetes: Pathogenesis, management and relationship to glycaemic control. Diabetes Metab Res Rev 2007;23:3-13.