Tip 1 Diyabetli Çocuklarda Glisemik Kontrolü Etkileyen Faktörler

Yıl 2010, Cilt: 8 Sayı: 2, 7 - 19, 01.09.2010

Seher Çakır Halil Sağlam Taner Özgür Erdal Eren Ömer Tarım

Öz

Giriş: Tip 1 diyabetli hastalarda glisemik kontrol etkileyen çok sayıda faktör söz konusudur. Bu çalışmada, tip 1 diabetes mellituslu DM çocuklarda metabolik kontrolü etkileyen faktörleri belirlemek amaçlanmıştır. Gereç ve Yöntem: Tip 1 DM tanısı ile takip edilen 0-18 yaş arasında 200 hastaya sosyodemografik özelliklerini ve hastalıkla ilgili bilgilerini içeren sorulardan oluşan biranket formu uygulanmış ve hasta dosyaları geriye dönük olarak incelenerek hastaların laboratuvar bulguları ve tıbbi tedavi bilgileri elde edilmiştir.Bulgular: Çalışmaya 104 %52 kız ve 96 %48 erkek olmak üzere toplam 200 tip 1 diyabetli çocuk dahil edilmiştir. Hastaların ortalama HbA1c değeri %8,8 , ortalama yaşı 11,7 ±4,26 yıl ve ortalama diyabet süresi 3,8 yıl 6 ay-14 yıl olarak bulunmuştur. Tüm hastaların %89’u, 12-18 yaş arası hastaların ise tamamı yoğun insülin tedavisi kullanmakta idi. Ortalama insülin dozu 0,84±0,19 ü/kg/gün ve vücut kitle indeksi VKİ z-skor ortalaması -0,06±1,19 olarak saptandı. HbA1c ile insülin dozu arasındapozitif korelasyon olduğu r=0,27 p< 0,01 saptanırken HbA1c ile diyabet süresi ve yaşarasında korelasyon olmadığı saptandı. Yoğun tedavinin HbA1c değerini ve ağır hipoglisemi sıklığını düşürmediği saptandı. Ancak geleneksel tedaviden yoğun tedaviye geçen 72 %36 hastanın HbA1c değerinde düşme saptandı p< 0,05 . Evde dörttenfazla birey olanlarda, poliklinik kontrolüne uzun süredir gelmeyen ve ayda bir gelenhastalarda, diyetine tam uymayan hastalarda, 6 ay içerisinde 3’ten fazla semptomatik hipoglisemi olanlarda, diyabetik ketoasidoz DKA atağı olanlarda, tanı sırasındaadölesan olanlarda, tanıda DKA ile başvuranlarda HbA1c düzeyi yüksek saptandı p< 0,05 . İnsülin dozu ile diyabet süresi arasında korelasyon mevcutken r=0,45 p< 0,05 , VKİ z-skoru arasında ilişki saptanmadı r=0,075 p=0,29 . Tedavi sonrası ortalama VKİ z-skoru tedavi öncesine göre anlamlı olarak yüksek saptandı p< 0,01 .Sonuç: Tip 1 DM’de iyi bir metabolik kontrol elde etmek birçok faktöre bağlıdır. Bu çalışmada kötü metabolik kontrol için en önemli risk faktörlerinin diyabet süresinin 5 yıldan fazla olması, insülin dozu ihtiyacının artması, kalabalık aile, düzensiz poliklinikkontrolü, diyetine uymamak, semptomatik hipoglisemi varlığı, DKA ataklarının varlığı,tanıda DKA varlığı ve tanı sırasında hastanın adölesan olması olduğu ortaya konmuştur

Anahtar Kelimeler

HbA1c, tip 1 diabetes mellitus, metabolik kontrol

Factors Influencing Glycemic Control in Children with Type 1 Diabetes

Öz

There are a plenty of factors influencing glycemic control in children with type 1 diabetes mellitus DM . The aim of this study was to determine the factors influencing metabolic control in children with type 1 DM. Materials and Method: The study was performed in 200 children with type 1 DM between the ages 6 months to 18 years. This study was conducted by interviewing individually with the children and their families and completing the questionnaires related to their demographic features and data associated with their illness. The laboratory findings and medical information of the patients from the charts were also retrospectively recorded. Results: There were a total of 200 patients including 104 52% girls and 96 48% boys. The mean age of the patients was 11.7 ±4.26 years. The mean duration of diabetes was 3.8 years 6 months to 14 years . Eighty-nine percent of all patients and all of the patients between 12 and 18 years of age were on intensive insulin therapy. Mean insulin dose was 0.84±0.19 units/kg/day. The mean HbA1c value was 8.8%. Body mass index BMI mean z-score was -0.06±1.19. There were no correlations between HbA1c and the duration of diabetes or age although a positive correlation was found with insulin dose r=0.27 p< 0.01 . It was found that intensive therapy did not lower HbA1c values or the risk of severe hypoglycemia. Nevertheless, there was a decrease in HbA1c values of 72 36% patients whose therapy was converted from conventional therapy to intensive therapy p< 0.05 . HbA1c values were found to be higher in patients who lived with more than 4 persons in the house, who were non-compliant to follow-up or diet, who had more than 3 symptomatic hypoglycemia in the last 6 months, who had episodes of diabetic ketoacidosis DKA , who were adolescent at the time of diagnosis, and who were admitted with diabetic ketoacidosis at the time of diagnosis p< 0.05 . Although there was a correlation between insulin doses and durations of diabetes r=0.45 p< 0.05 , no correlation was determined with BMI z-score r=0.075 p=0.29 . The BMI z-score was significantly higher after therapy compared with the value before therapy p< 0.01 . Conclusion: In type 1 DM, obtaining a good metabolic control depends on many factors. In this study, duration of diabetes longer than 5 years, crowded families, irregular follow-up visits, poor compliance to diet, presence of symptomatic hypoglycemia, presence of episodes of DKA, presence of DKA at diagnosis, and being an adolescent at the time of diagnosis were found to be the risk factors that associated with poor metabolic control.

Anahtar Kelimeler

HbA1c, type 1 diabetes mellitus, metabolic control

Kaynakça

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