Tip 1 Diyabetes Mellituslu Hastaların Tanı Anındaki Klinik ve Laboratuvar Özelliklerinin Metabolik Kontrole Etkisi

Yıl 2019, Cilt: 19 Sayı: 4, 753 - 760, 28.11.2019

Özlem Kara

https://doi.org/10.17098/amj.651991

Öz

Amaç: Tip 1 diabetes mellitus (T1DM) çocukluk yaş grubunda sık görülen kronik metabolik bir hastalıktır. İyi metabolik kontrol ile diyabetle ilişkili mikrovasküler komplikasyonların ilerlemesi yavaşlar hatta gelişimi önlenebilmektedir. Bu nedenle metabolik kontrolü etkileyen faktörlerin belirlenmesi önemlidir. Bu çalışmada ile tanı anındaki T1DM’li çocuk ve ergenlerin demografik, klinik ve laboratuvar özelliklerinin metabolik kontrol üzerindeki etkisini değerlendirilmesi amaçlandı.
Materyal ve Metot: Hastalar son 1 yıllık ortalama hemoglobinA1c (HBA1c) düzeylerine göre metabolik kontrol düzeyleri belirlendi. Ortalama HBA1c düzeyi <%7,5 iyi kontrol, %7,6-9 orta kontrol ve >%9 kötü kontrol olarak tanımlandı. Hasta verileri ile ortalama HBA1c düzeyleri karşılaştırıldı.
Bulgular: Toplam 144 hasta çalışmaya alındı. Pik tanı yaşı 4-6 yaş (%21,51) ve 12-14 yaş (%20,83) olarak saptandı. Hastaların %10’unda birinci derece akrabalarında T1DM mevcuttu. Ortalama HBA1c düzeyleri kızlarda %7,7 (7,2-8,8), erkeklerde %7,8 (7,0-8,6) idi. Hastaların %38,19’i iyi, %41,68’si orta ve %20,13’si kötü kontrollüydü. İyi kontrollü hastaların tanı yaşı 9,13±4,30 yıl iken kötü kontrollülerin 10,19±4,26 yıldı (p=0,252). Çalışmada ailesinde T1DM mevcut olan grubun iyi metabolik kontrol düzeyine sahip olduğu görüldü (p=0,002).
Sonuç: Çalışmada ailesinde diyabet olanların daha iyi metabolik kontrole sahip olduğu saptandı. Bu durum hasta ve ailelerinin tanıdan sonra diyabet yönetimini önemsedikleri, yaşam tarzlarını diyabete uygun düzenledikleri düşündürmektedir. Bu sonuca göre aile içinde diyabet farkındalığının artırılması ve hastalara verilen eğitimlerin motive edici olması diyabet yönetiminde olumlu etki sağlayacaktır.

Anahtar Kelimeler

Çocuk, Farkındalık, Metabolik kontrol, Tip 1 diabetes mellitus

Effect of Baseline Clinical and Laboratory Characteristics of Patients with Type 1 Diabetes Mellitus on Metabolic Control

Öz

Objectives: Type 1 diabetes mellitus (T1DM) is a chronic metabolic disease that is common in childhood. Good metabolic control slows down and even prevents development of diabetes-related micro-vascular complications. Therefore determination of the affecting factors for metabolic control is important. To evaluate effect of at the time of diagnosis demographic, clinical and laboratory characteristics of children and adolescents with T1DM on metabolic control.
Materials and Methods: The metabolic control status was evaluated according to the mean hemoglobin A1c (HbA1c) values of the recent one year as good (HbA1c <7.5%), moderate (HbA1c 7.5-9%) and poor (HbA1c >9%). The patient data and the mean HbA1c levels were compared.
Results: Data were collected on 144 patients with T1DM. The peak ages at diagnosis were determined to be 4-6 years (21.52%) and 12-14 years (20.83%). The first-degree relatives had the diagnosis of T1DM in 10% of the patients. The mean HbA1c value was determined as 7.7% (7.2-8.8) in girls and 7.8% (7.0-8.6) in boys. Metabolic control was good in 38.19%, moderate in 41.68% and poor in 20.13%. The mean age at diagnosis was 9.13±4.30 years in the patients with good metabolic control and 10.19±4.26 years in patients with poor metabolic control (p=0.252). Metabolic control was found to be better in the patients who had T1DM in the family (p=0.002).
Conclusion: Metabolic control was found to be good in patients who had DM in the family. It is thought that patients and their families care about diabetes management after diagnosis, regulate their lifestyle according to diabetes. According to the result, increasing the awareness of diabetes in the family and continuing the motivating trainings for the patients will have a positive effect on the management of diabetes.

Anahtar Kelimeler

Awareness, Childhood, Metabolic control, Type 1 diabetes mellitus

Kaynakça

• Atkinson MA, Eisenbarth GS. Type 1 diabetes: new perspectives on disease pathogenesis and treatment. Lancet 2001;358(9277):221-9.
• Diabetes Control and Complicatons Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993:329(14):977–86.
• Urbach SL, LaFranchi S, Lambert L, Lapidus JA, Daneman D, Becker TM. Predictors of glucose control in children and adolescents with type 1 diabetes mellitus. Pediatric Diabetes 2005;6:69–74.
• Maahs DM, West NA, Lawrence JM, Mayer-Davis EJ. Epidemiology of type 1 diabetes. Endocrinol Metab Clin North Am 2010;39(3):481-97.
• Daneman D, Wolfson DH, Becker DJ, Drash AL. Factors affecting glycosylated hemoglobin values in children with insulin-dependent diabetes. J Pediatr 1981;99(6):847–53.
• Mortensen HB, Robertson KJ, Aanstoot HJ et al. Insulin management and metabolic control of type 1 diabetes mellitus in childhood and adolescence in 18 countries. Diabet Med 1998;15:752–9.
• Jacobson AM, Hauser ST, Willett J, Wolfsdorf JI, Herman L. Consequences of irregular versus continuous medical follow-up in children and adolescents with insulin- dependent diabetes mellitus. J Pediatr 1997;131(5):727–33.
• Levine BS, Anderson BJ, Butler DA, Antisde JE, Brackett J, Laffel LM. Predictors of glycemic control and short-term adverse outcomes in youth with type 1 diabetes. J Pediatr. 2001;139(2):197–203.
• Rosilio M, Cotton J-B, Wieliczko M-C et al. Factors associated with glycemic control. A cross-sectional nationwide study in 2,579 French children with type 1 diabetes. The French Pediatric Diabetes Group. Diabetes Care 1998;21(7):1146–53.
• Kaufman FR, Halvorson M, Carpenter S. Association between diabetes control and visits to a multidisciplinary pediatric diabetes clinic. Pediatrics 1999;103:948–51.
• Rovet JF, Ehrlich RM. Effect of temperament on metabolic control in children with diabetes mellitus. Diabetes Care 1988;11:77–82.
• Songer TJ, Laporte RE, Lave JR, Dorman JS, Becker DJ. Health insurance and the financial impact of IDDM in families with a child with IDDM. Diabetes Care 1997:20 (4):577–84.
• Craig ME, Hattersley A, Donaghue K. Definition, epidemiology and classification in Global IDF/ISPAD Guideline for Diabetes in Childhood and Adolescence, R. Hanas, et al., Editors. 2011:8-16.
• Rewers M, Pihoker C, Donaghue K, Hanas R, Swift P, Klingensmith GJ. Assesment and monitoring of glycemic control, in Global IDF/ISPAD Guideline for Diabetes in Childhood and Adolescence, R. Hanas, et al., Editors. 2011:50-9.
• Soltesz G. Diabetes in the young: A paediatric and epidemiological perspective. Diabetologia 2003;46:447-54.
• Dabelea D, Mayer-Davis EJ, Saydah, et al. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. Jama, 2014;311(17):1778-86.
• Gale EA, Gillespie KM. Diabetes and gender. Diabetologia. 2001;44(1):3-15.
• Quinn M, Fleischman A, Rosner B, et al. Characteristics at diagnosis of type 1 diabetes in children younger than 6 years. J Pediatr. 2006;148(3):366-71.
• Moltchanova EV, Schreier N, Lammi N, Karvonen M. Seasonal variation of diagnosis of Type 1 diabetes mellitus in children worldwide. Diabet Med. 2009;26(7):673-8.
• Demirbilek H, Özbek MN, Baran RT. Incidence of type 1 diabetes mellitus in Turkish children from the Southeastern region of the country: A regional report. J Clin Res Pediatr Endocrinol 2013;5:98-103.
• Kandemir N, Açıkgöz E, Yordam N. The epidemiology of juvenile onset insuline-dependent diabetes mellitus in Turkish children. A retrospective analysis of 477 cases. Turk J Pediatr 1994;36(3):191-5.
• Kocabaş A, Kocabaş AB, Karagüzel G, Akçurin S. Tip 1 diyabetes mellitus olgularımızın antropometrik ve metabolik izlem özelliklerinin değerlendirilmesi. Turkish Journal of Pediatric Disease2013;3:113-8.
• Shalitin S, Fisher S, Yackbovitch-Gavan M, et al. Ketoacidosis at onset of type 1 diabetes is a predictor of long-term glycemic control. Pediatr Diabetes. 2018;19(2):320-8.
• Dorchy H, Roggemans MP, Willems D. Glycated hemoglobin andrelatedfactors in diabetic children and adolescents under 18 years of age: a Belgian experience. Diabetes Care 1997;20(1):2–6.
• Dabelea D, Rewers A, Stafford JM, et al. Trends in the prevalence of ketoacidosis at diabetes diagnosis: the SEARCH for diabetes in youth study. Pediatrics. 2014;133(4):e938-e945.
• Usher-Smith JA, Thompson MJ, Sharp SJ, Walter FM. Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review. BMJ 2011;343: d4092.
• Pinkey JH, Bingley PJ, Sawtell PA, Dunger DB, Gale EA. Presentation and progress of childhood diabetes mellitus: a prospective population-based study. The Bart's-Oxford Study Group. Diabetologia 1994;37(1):70-4.
• Fredheim S, Johannesen J, Johansen A, et al. Diabetic ketoacidosis at the onset of type 1 diabetes is associated with future HbA1c levels. Diabetologia 2013;56:995–1003.