Araştırma Makalesi
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Types and clinical features of 140 newly diagnosed cases of diabetes in childhood: a single-center experience

Yıl 2025, Cilt: 18 Sayı: 3, 9 - 9

Öz

Purpose: Type 1 diabetes (T1DM) accounts for the majority of childhood diabetes mellitus (DM). However, in recent years, there has been an increase in the prevalence of type 2 diabetes mellitus (T2DM) and the diagnosis of monogenic diabetes (MD). The aim of this study was to evaluate the clinical and laboratory findings, as well as the types of DM, in patients diagnosed between the ages of 0 and 18.
Materials and methods: In the study, 140 patients diagnosed with DM in our clinic were evaluated retrospectively.
Results: During the 3-year period, 140 patients (n=76, 54.3% male) were diagnosed with diabetes. The mean age at diagnosis of the patients was 10±4.19 years. 93.6% of patients were diagnosed with T1DM, 2.8% of patients with T2DM and 3.6% of patients were diagnosed with MD. It was observed that the cases of T1DM peaked in the 5-9 (36.6%) and 10-14 (37.4%) age groups. the prevalence of diabetic ketoacidosis (DKA) was 61.8%. The majority of patients 64.9% with T1DM were diagnosed in the autumn/winter months. 75% of the patients with T2DM were female, and the mean age at diagnosis was 15.05±1.11years. Two of the cases of MD were neonatal DM, two were GCK-MODY and one was CEL-MODY.
Conclusion: Although the majority of childhood diabetes cases are T1DM, the frequency of T2DM tends to increase, especially in obese adolescents. It should be kept in mind that obesity may also occur in autoantibody-positive T1DM patients. It was determined that T1DM cases were more common in the winter season, in the 10-14 age group, and that DKA was higher. Genetic examination should be performed in cases with suspected MD.

Kaynakça

  • 1. Libman I, Haynes A, Lyons S, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes. 2022;23:1160-1174. doi:10.1111/pedi.13454
  • 2. Shah AS, Nadeau KJ. The changing face of paediatric diabetes. Diabetologia. 2020;63:683-691. doi:10.1007/s00125-019-05075-6
  • 3. İşleyen F, Bolu S. The Epidemiological Characteristics of Diabetic Children in the Province of Adıyaman. J Curr Pediatr. 2019;17:1-16. doi:10.4274/jcp.2019.0001
  • 4. Parviainen A, But A, Siljander H, Knip M, Register TFPD. Decreased incidence of type 1 diabetes in young finnish children. Diabetes Care. 2020;43:2953-2958. doi:10.2337/dc20-0604
  • 5. Yeşilkaya E, Cinaz P, Andıran N, et al. First report on the nationwide incidence and prevalence of Type 1 diabetes among children in Turkey. Diabet Med. 2017;34:405-410. doi:10.1111/dme.13063
  • 6. Candler TP, Mahmoud O, Lynn RM, Majbar AA, Barrett TG, Shield JPH. Continuing rise of Type 2 diabetes incidence in children and young people in the UK. Diabet Med. 2018;35:737-744. doi:10.1111/dme.13609
  • 7. Shah AS, Zeitler PS, Wong J, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Type 2 diabetes in children and adolescents. Pediatr Diabetes. 2022;23:872-902. doi:10.1111/pedi.13409
  • 8. Greeley SAW, Polak M, Njølstad PR, et al. ISPAD Clinical Practice Consensus Guidelines 2022: The diagnosis and management of monogenic diabetes in children and adolescents. Pediatr Diabetes. 2022;23:1188-1211. doi:10.1111/pedi.13426
  • 9. American Diabetes Association. 2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes—2020. Diabetes Care. 2020;43:S14-S31. doi:10.2337/dc20-S002
  • 10. American Diabetes Association Professional Practice Committee 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022 Jan 1;45:S17-S38. doi:10.2337/dc22-S002
  • 11. Bundak R, Furman A, Gunoz H, Darendeliler F, Bas F, Neyzi O. Body mass index references for Turkish children. Acta Paediatr. 2006;95:194-198. doi:10.1080/08035250500334738
  • 12. Glaser N, Fritsch M, Priyambada L, et al. ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2022;23:835-856. doi:10.1111/pedi.13406
  • 13. Magliano DJ, Boyko EJ; IDF Diabetes Atlas 10th edition scientific committee.10th edition. Brussels: International Diabetes Federation; 2021.
  • 14. Maahs DM, West NA, Lawrence JM, Mayer-Davis EJ. Epidemiology of type 1 diabetes. Endocrinol Metab Clin North Am. 2010;39:481-497. doi:10.1016/j.ecl.2010.05.011
  • 15. Poyrazoğlu Ş, Bundak R, Yavaş Abalı Z, et al. Incidence of Type 1 Diabetes in Children Aged Below 18 Years During 2013-2015 in Northwest Turkey. J Clin Res Pediatr Endocrinol. J Clin Res Pediatr Endocrinol. 2018;10:336-342. doi:10.4274/jcrpe.0025
  • 16. Urrutia I, Martınez R, Rica I, et al. Negative Autoimmunity in a Spanish Pediatric Cohort Suspected of Type 1 Diabetes, Could it be Monogenic Diabetes? PloS One. 2019; 14:e0220634. doi:10.1371/journal.pone.0220634
  • 17. Hou L, Li X, Liu L, et al. A Multicenter Survey of Type I Diabetes Mellitus in Chinese Children. Front Endocrinol (Lausanne). 2021;12:583114. doi:10.3389/fendo.2021.583114
  • 18. Gandica RG, Chung WK, Deng L, Goland R, Gallagher MP. Identifying Monogenic Diabetes in a Pediatric Cohort With Presumed Type 1 Diabetes. Pediatr Diabetes. 2015;16:227-233. doi:10.1111/pedi.12150
  • 19. Lezzi M, Aloi C, Salina A, et al. Diabetes Mellitus Diagnosed in Childhood and Adolescence With Negative Autoimmunity: Results of Genetic Investigation. Front Endocrinol (Lausanne). 2022;13:894878. doi:10.3389/fendo.2022.894878
  • 20. Shaltout AA, Channanath AM, Thanaraj TA, et al. Ketoacidosis at first presentation of type 1 diabetes mellitus among children: a study from Kuwait. Sci Rep. 2016;6:27519. doi:10.1038/srep27519
  • 21. Turtinen M, Härkönen T, Ilonen J, Parkkola A, Knip M; Finnish Pediatric Diabetes Register. Seasonality in the manifestation of type 1 diabetes varies according to age at diagnosis in Finnish children. Acta Paediatr. 2022;111:1061-1069. doi:10.1111/apa.16282
  • 22. Hanberger L, Akesson K, Samuelsson U. Glycated haemoglobin variations in paediatric type 1 diabetes: the impact of season, gender and age. Acta Paediatr. 2014;103:398‐403. doi:10.1111/apa.12530
  • 23. Mayer Davis EJ, Kahkoska AR, Jefferies C, et al. Chapter 1: definition, epidemiology, diagnosis and classification of Diabetes in Children and Adolescents. Pediatr Diabetes. 2018;19(suppl 27):7-19. doi:10.1111/pedi.12773
  • 24. Cherubini V, Grimsmann JM, Åkesson K, et al. Temporal trends in diabetic ketoacidosis at diagnosis of pediatric type 1 diabetes between 2006 and 2016: results from 13 countries in three continents. Diabetologia. 2020;63:1530-1541. doi:10.1007/s00125-020-05152-1
  • 25. Jensen ET, Stafford JM, Saydah S, et al. Increase in prevalence of diabetic ketoacidosis at diagnosis among youth with type 1 diabetes: the SEARCH for diabetes in youth study. Diabetes Care. 2021;44:1573-1578. doi:10.2337/dc20-0389
  • 26. Özalkak Ş, Yıldırım R, Tunç S, et al. Revisiting the Annual Incidence of Type 1 Diabetes Mellitus in Children from the Southeastern Anatolian Region of Turkey: A Regional Report.. J Clin Res Pediatr Endocrinol. 2022;14:172-178. doi:10.4274/jcrpe.galenos.2021.2021-10-7
  • 27. Demiral M, Binay Ç, Şimşek E. Eskişehir ilinde tip 1 diyabetes mellitus tanısı ile izlenen hastaların epidemiyolojik özellikleri. Çocuk Sağlığı ve Hastalıkları Dergisi. 2016;59:14-20.
  • 28. Demir K, Büyükinan M, Dizdarer C, Şimşek DG, Özen S, Asar G. The Frequency and Associated Factors of Diabetic Ketoacidosis at Diagnosis in Children with Type 1 Diabetes.The Journal of Current Pediatrics. 2010;8:52-55.
  • 29. Mameli C, Triolo TM, Chiarelli F, Rewers M, Zuccotti G, Simmons KM. Lessons and gaps in the prediction and prevention of type 1 diabetes. Pharmacol Res. 2023;193:106792. doi:10.1016/j.phrs.2023.106792
  • 30. Unal E, Demiral M, Baysal B, et al. Frequency of Celiac Disease and Spontaneous Normalization Rate of Celiac Serology in Children and Adolescent Patients with Type 1 Diabetes. J Clin Res Pediatr Endocrinol. 2021;13:72-79. doi:10.4274/jcrpe.galenos.2020.2020.0108
  • 31. Valaiyapathi B, Gower B, Ashraf AP. Pathophysiology of Type 2 Diabetes in Children and Adolescents. Curr Diabetes Rev. 2020;16:220-229. doi:10.2174/1573399814666180608074510
  • 32. Baldi JC, Manning PJ, Hofman PL, Walker RJ. TODAY Study Group. Effects of metformin, metformin plus rosiglitazone, and metformin plus lifestyle on insulin sensitivity and β-cell function in TODAY. Diabetes Care. 2013;36:1749-1757. doi:10.2337/dc13-1426
  • 33. Peña AS, Curran JA, Fuery M, et al. Screening, assessment and management of type 2 diabetes mellitus in children and adolescents: Australasian Paediatric Endocrine Group guidelines. Med J Aust. 2020;213:30-43. doi:10.5694/mja2.50666
  • 34. Kawakita R, Hosokawa Y, Fujimaru R, et al. Molecular and clinical characterization of glucokinase maturity-onset diabetes of the young (GCK-MODY) in Japanese patients. Diabet. Med. 2014;31:1357-1362. doi:10.1111/dme.12487
  • 35. Salina A, Bassi M, Aloi C, et al. "Pesto" Mutation: Phenotypic and Genotypic Characteristics of Eight GCK/MODY Ligurian Patients. Int J Mol Sci. 2023;24:4034. doi:10.3390/ijms24044034
  • 36. Johansson BB, Torsvik J, Bjørkhaug L, et al. Diabetes and pancreatic exocrine dysfunction due to mutations in the carboxyl ester lipase gene-maturity onset diabetes of the young (CEL-MODY): a protein misfolding disease. J Biol Chem. 2011;286:34593-34605. doi:10.1074/jbc.M111.222679

Çocukluk çağında yeni tanı almış 140 diyabet olgusunun tanı tipleri ve klinik özellikleri: tek merkez deneyimi

Yıl 2025, Cilt: 18 Sayı: 3, 9 - 9

Öz

Amaç: Çocukluk çağındaki diyabetes mellitusun (DM) çoğunluğunu tip 1 diyabet (T1DM) oluşturur. Ancak son yıllarda tip 2 diyabetes mellitus (T2DM) sıklığında ve monogenik diyabet (MD) tanısı koymada artış gözlenmektedir. Bu çalışmada 0-18 yaş arasında tanı konulan diyabetli hastalarda klinik ve laboratuvar bulgularının, DM tiplerinin değerlendirilmesi amaçlandı.
Gereç ve yöntem: Çalışmada kliniğimizde DM tanısı alan 140 hasta retrospektif olarak değerlendirildi.
Bulgular: Üç yıllık süreçte 140 hastaya (76 erkek, %54,3) diyabet tanısı konuldu. Hastaların ortalama tanı yaşı 10±4,19 yıldı. Hastaların %93,6'sına T1DM, %2,8'ine T2DM, %3,6'sına MD tanısı konuldu. Tip 1 diyabetes mellitus vakalarının 5-9 (%36,6) ve 10-14 (%37,4) yaş gruplarında zirve yaptığı görüldü. Diyabetik ketoasidoz (DKA) prevalansı %61,8 idi. Yine bu olguların %64,9'u sonbahar/kış aylarında tanı aldı. Tip2 diyabetli hastaların %75'i kadındı ve ortalama tanı yaşı 15,05±1,11 idi. Monogenik diyabetli olgularının ikisi neonatal DM, ikisi GCK-MODY ve biri CEL-MODY idi.
Sonuç: Çocukluk çağı diyabet vakalarının çoğunluğu T1DM olmasına rağmen, özellikle obez ergenlerde T2DM sıklığı artma eğilimindedir. Otoantikor pozitif T1DM’li hastalarda da obezitenin olabileceği akılda tutulmalıdır. Tip1 diyabet olgularının daha çok kış mevsiminde, 10-14 yaş grubunda başvurduğu ve DKA sıklığının yüksek olduğu saptandı. Monogenik diyabet şüphesi olan olgulara genetik inceleme yapılmalıdır.

Kaynakça

  • 1. Libman I, Haynes A, Lyons S, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes. 2022;23:1160-1174. doi:10.1111/pedi.13454
  • 2. Shah AS, Nadeau KJ. The changing face of paediatric diabetes. Diabetologia. 2020;63:683-691. doi:10.1007/s00125-019-05075-6
  • 3. İşleyen F, Bolu S. The Epidemiological Characteristics of Diabetic Children in the Province of Adıyaman. J Curr Pediatr. 2019;17:1-16. doi:10.4274/jcp.2019.0001
  • 4. Parviainen A, But A, Siljander H, Knip M, Register TFPD. Decreased incidence of type 1 diabetes in young finnish children. Diabetes Care. 2020;43:2953-2958. doi:10.2337/dc20-0604
  • 5. Yeşilkaya E, Cinaz P, Andıran N, et al. First report on the nationwide incidence and prevalence of Type 1 diabetes among children in Turkey. Diabet Med. 2017;34:405-410. doi:10.1111/dme.13063
  • 6. Candler TP, Mahmoud O, Lynn RM, Majbar AA, Barrett TG, Shield JPH. Continuing rise of Type 2 diabetes incidence in children and young people in the UK. Diabet Med. 2018;35:737-744. doi:10.1111/dme.13609
  • 7. Shah AS, Zeitler PS, Wong J, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Type 2 diabetes in children and adolescents. Pediatr Diabetes. 2022;23:872-902. doi:10.1111/pedi.13409
  • 8. Greeley SAW, Polak M, Njølstad PR, et al. ISPAD Clinical Practice Consensus Guidelines 2022: The diagnosis and management of monogenic diabetes in children and adolescents. Pediatr Diabetes. 2022;23:1188-1211. doi:10.1111/pedi.13426
  • 9. American Diabetes Association. 2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes—2020. Diabetes Care. 2020;43:S14-S31. doi:10.2337/dc20-S002
  • 10. American Diabetes Association Professional Practice Committee 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022 Jan 1;45:S17-S38. doi:10.2337/dc22-S002
  • 11. Bundak R, Furman A, Gunoz H, Darendeliler F, Bas F, Neyzi O. Body mass index references for Turkish children. Acta Paediatr. 2006;95:194-198. doi:10.1080/08035250500334738
  • 12. Glaser N, Fritsch M, Priyambada L, et al. ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2022;23:835-856. doi:10.1111/pedi.13406
  • 13. Magliano DJ, Boyko EJ; IDF Diabetes Atlas 10th edition scientific committee.10th edition. Brussels: International Diabetes Federation; 2021.
  • 14. Maahs DM, West NA, Lawrence JM, Mayer-Davis EJ. Epidemiology of type 1 diabetes. Endocrinol Metab Clin North Am. 2010;39:481-497. doi:10.1016/j.ecl.2010.05.011
  • 15. Poyrazoğlu Ş, Bundak R, Yavaş Abalı Z, et al. Incidence of Type 1 Diabetes in Children Aged Below 18 Years During 2013-2015 in Northwest Turkey. J Clin Res Pediatr Endocrinol. J Clin Res Pediatr Endocrinol. 2018;10:336-342. doi:10.4274/jcrpe.0025
  • 16. Urrutia I, Martınez R, Rica I, et al. Negative Autoimmunity in a Spanish Pediatric Cohort Suspected of Type 1 Diabetes, Could it be Monogenic Diabetes? PloS One. 2019; 14:e0220634. doi:10.1371/journal.pone.0220634
  • 17. Hou L, Li X, Liu L, et al. A Multicenter Survey of Type I Diabetes Mellitus in Chinese Children. Front Endocrinol (Lausanne). 2021;12:583114. doi:10.3389/fendo.2021.583114
  • 18. Gandica RG, Chung WK, Deng L, Goland R, Gallagher MP. Identifying Monogenic Diabetes in a Pediatric Cohort With Presumed Type 1 Diabetes. Pediatr Diabetes. 2015;16:227-233. doi:10.1111/pedi.12150
  • 19. Lezzi M, Aloi C, Salina A, et al. Diabetes Mellitus Diagnosed in Childhood and Adolescence With Negative Autoimmunity: Results of Genetic Investigation. Front Endocrinol (Lausanne). 2022;13:894878. doi:10.3389/fendo.2022.894878
  • 20. Shaltout AA, Channanath AM, Thanaraj TA, et al. Ketoacidosis at first presentation of type 1 diabetes mellitus among children: a study from Kuwait. Sci Rep. 2016;6:27519. doi:10.1038/srep27519
  • 21. Turtinen M, Härkönen T, Ilonen J, Parkkola A, Knip M; Finnish Pediatric Diabetes Register. Seasonality in the manifestation of type 1 diabetes varies according to age at diagnosis in Finnish children. Acta Paediatr. 2022;111:1061-1069. doi:10.1111/apa.16282
  • 22. Hanberger L, Akesson K, Samuelsson U. Glycated haemoglobin variations in paediatric type 1 diabetes: the impact of season, gender and age. Acta Paediatr. 2014;103:398‐403. doi:10.1111/apa.12530
  • 23. Mayer Davis EJ, Kahkoska AR, Jefferies C, et al. Chapter 1: definition, epidemiology, diagnosis and classification of Diabetes in Children and Adolescents. Pediatr Diabetes. 2018;19(suppl 27):7-19. doi:10.1111/pedi.12773
  • 24. Cherubini V, Grimsmann JM, Åkesson K, et al. Temporal trends in diabetic ketoacidosis at diagnosis of pediatric type 1 diabetes between 2006 and 2016: results from 13 countries in three continents. Diabetologia. 2020;63:1530-1541. doi:10.1007/s00125-020-05152-1
  • 25. Jensen ET, Stafford JM, Saydah S, et al. Increase in prevalence of diabetic ketoacidosis at diagnosis among youth with type 1 diabetes: the SEARCH for diabetes in youth study. Diabetes Care. 2021;44:1573-1578. doi:10.2337/dc20-0389
  • 26. Özalkak Ş, Yıldırım R, Tunç S, et al. Revisiting the Annual Incidence of Type 1 Diabetes Mellitus in Children from the Southeastern Anatolian Region of Turkey: A Regional Report.. J Clin Res Pediatr Endocrinol. 2022;14:172-178. doi:10.4274/jcrpe.galenos.2021.2021-10-7
  • 27. Demiral M, Binay Ç, Şimşek E. Eskişehir ilinde tip 1 diyabetes mellitus tanısı ile izlenen hastaların epidemiyolojik özellikleri. Çocuk Sağlığı ve Hastalıkları Dergisi. 2016;59:14-20.
  • 28. Demir K, Büyükinan M, Dizdarer C, Şimşek DG, Özen S, Asar G. The Frequency and Associated Factors of Diabetic Ketoacidosis at Diagnosis in Children with Type 1 Diabetes.The Journal of Current Pediatrics. 2010;8:52-55.
  • 29. Mameli C, Triolo TM, Chiarelli F, Rewers M, Zuccotti G, Simmons KM. Lessons and gaps in the prediction and prevention of type 1 diabetes. Pharmacol Res. 2023;193:106792. doi:10.1016/j.phrs.2023.106792
  • 30. Unal E, Demiral M, Baysal B, et al. Frequency of Celiac Disease and Spontaneous Normalization Rate of Celiac Serology in Children and Adolescent Patients with Type 1 Diabetes. J Clin Res Pediatr Endocrinol. 2021;13:72-79. doi:10.4274/jcrpe.galenos.2020.2020.0108
  • 31. Valaiyapathi B, Gower B, Ashraf AP. Pathophysiology of Type 2 Diabetes in Children and Adolescents. Curr Diabetes Rev. 2020;16:220-229. doi:10.2174/1573399814666180608074510
  • 32. Baldi JC, Manning PJ, Hofman PL, Walker RJ. TODAY Study Group. Effects of metformin, metformin plus rosiglitazone, and metformin plus lifestyle on insulin sensitivity and β-cell function in TODAY. Diabetes Care. 2013;36:1749-1757. doi:10.2337/dc13-1426
  • 33. Peña AS, Curran JA, Fuery M, et al. Screening, assessment and management of type 2 diabetes mellitus in children and adolescents: Australasian Paediatric Endocrine Group guidelines. Med J Aust. 2020;213:30-43. doi:10.5694/mja2.50666
  • 34. Kawakita R, Hosokawa Y, Fujimaru R, et al. Molecular and clinical characterization of glucokinase maturity-onset diabetes of the young (GCK-MODY) in Japanese patients. Diabet. Med. 2014;31:1357-1362. doi:10.1111/dme.12487
  • 35. Salina A, Bassi M, Aloi C, et al. "Pesto" Mutation: Phenotypic and Genotypic Characteristics of Eight GCK/MODY Ligurian Patients. Int J Mol Sci. 2023;24:4034. doi:10.3390/ijms24044034
  • 36. Johansson BB, Torsvik J, Bjørkhaug L, et al. Diabetes and pancreatic exocrine dysfunction due to mutations in the carboxyl ester lipase gene-maturity onset diabetes of the young (CEL-MODY): a protein misfolding disease. J Biol Chem. 2011;286:34593-34605. doi:10.1074/jbc.M111.222679
Toplam 36 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Endokrinoloji
Bölüm Araştırma Makalesi
Yazarlar

Amine Aktar Karakaya 0000-0001-7004-6803

Ruken Yıldırım 0000-0002-9558-3856

Gül Trabzon 0000-0002-9262-5678

Mehmet Nuri Özbek 0000-0002-3203-741X

Özhan Orhan 0000-0002-3042-6972

Erken Görünüm Tarihi 20 Ocak 2025
Yayımlanma Tarihi
Gönderilme Tarihi 19 Ağustos 2024
Kabul Tarihi 20 Ocak 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 18 Sayı: 3

Kaynak Göster

AMA Aktar Karakaya A, Yıldırım R, Trabzon G, Özbek MN, Orhan Ö. Types and clinical features of 140 newly diagnosed cases of diabetes in childhood: a single-center experience. Pam Tıp Derg. Ocak 2025;18(3):9-9.
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