Esnek İnsülin Tedavisi Alan Tip 1 Diyabetli Çocuk ve Adolesanların 2 Yıllık İzlem Sonuçları ve Tedaviye Uyumun Değerlendirilmesi

Yıl 2020, , 339 - 347, 26.06.2020

Pelin Çelik , Zeynep Şıklar , Merih Berberoğlu

https://doi.org/10.12956/tchd.683063

Öz

Amaç: Esnek insülin tedavisi, öğünlerin zamanı, yiyecek seçimi ve öğünlerdeki insülin dozunun karbonhidrat sayımı yaparak kişinin yaşam tarzına göre ayarlandığı yoğun insülin tedavisidir. Çalışmamızın amacı tip 1 diyabetli çocuklarda esnek insülin tedavisinin metabolik kontrole, antropometrik özelliklere ve sağlık parametrelerine etkilerinin incelenmesi ve tedaviye uyumun değerlendirilmesidir.
Gereç ve Yöntemler: Esnek insülin tedavisini balayı dönemi sonrası en az 2 yıl süre kullanan tip 1 diyabetli 39 hastanın, dosya verileri retrospektif olarak incelendi. İki yıllık izlemde ortalama HbA1c düzeyi >%7.5 olan hastalar grup 1, ≤%7.5 olan hastalar grup 2 olarak tanımlandı. Her grubun 2 yıllık seyri değerlendirildi, gruplar karşılaştırıldı.
Bulgular: Hastaların ortanca diyabet süresi 52 (25-152) aydı. Grup 1’de 23 (%59) hasta, grup 2’de 16 (%41) hasta mevcuttu. Gruplar arasında diyabet süresi benzerdi(p>0.05). Grup 2’deki olguların, başlangıç HbA1c düzeyleri daha yüksekti (9.3 vs 11.6, p=0.046). Her iki grubun da tedavinin 1. yılında HbA1c düzeyinin azaldığı (p<0.05); tedavinin 2. yılında grup 2’nin iyi kontrollerini sürdürdükleri, ancak grup 1’de HbA1c düzeyinin arttığı saptandı (p<0.001).
Grup 2’deki hastaların boya göre vücut tartı yüzdeleri (%VKİ) tedavinin 2. yılında başlangıca göre artmakla beraber (p=0.031), idealdi. Grup 1’deki hastaların tedavi başlangıcına göre 2 yıllık izlem sonunda %VKİ’leri değişmedi (p>0.05). Her 2 gruptaki olgular da genetiği içinde büyüyen ve yıllık uzamaları normal olan olgulardı. Esnek tedavi alan tüm hastalar değerlendirildiğinde izlemin 2. yılında, ortalama insülin dozlarının arttığı saptandı (p=0). Grup 2’deki hastalar diyetine uyan (p=0.038), karbonhidrat sayımı yapan (p=0.025) ve daha az hazır yemek tüketen (p=0.018) hastalardı.

Gruplar arasında ciddi hipoglisemi ve diyabetik ketoasidoz sıklığı benzerdi(p>0.05). Grup 1’deki trigliserid, total kolesterol, LDL, VLDL düzeyleri grup 2’den yüksek, HDL düzeyi düşük olmasına rağmen, fark saptanmadı (p>0.05). Dislipidemi gelişen hastaların ortanca diyabet süresi, dislipidemi gelişmeyen hastalardan daha uzundu(p=0.018).
Sonuç: Esnek insülin tedavisi, sağlıklı beslenen ve etkili karbonhidrat sayımı yapan çocuklarda, %VKİ’inde anormal artış yapmadan HbA1c düzeyini ≤%7.5 düşürebilir.

Anahtar Kelimeler

Tip 1 diyabet, esnek insülin tedavisi, karbonhidrat sayımı, HbA1c

Flexible Insulin Therapy of Children and Adolescents with Type 1a Diabetes After 2 Years: Follow-up Results and Compliance of Treatment

Öz

Objective: Flexible insulin therapy is intensive insulin therapy where the time of meals, food selection, and the dose of insulin in meals are adjusted to the patient’s lifestyle by carbohydrate counting. The aim of our study is to investigate the effects of flexible insulin treatment on metabolic control, anthropometric properties and health parameters in children with type 1 diabetes and to evaluate compliance with treatment.
Material and Methods: Medical records of 39 children who used flexible insulin treatment at least 2 years after honeymoon period were retrospectively evaluated. Patients were grouped according to mean HbA1c as group 1 (HbA1c >7.5%) and group 2 (<7.5%). The 2-year follow-up of each group was evaluated, groups were compared.
Results: Median diabetes duration was 52 (25-152) months. Group 1 and 2 included 23 (59%) and 16 (41%) patients, respectively. Diabetes duration was similar (p>0.05). Group 2 had higher initial HbA1c levels (9.3 vs 11.6, p=0.046). HbA1c levels of both groups were decreased at first year (p<0.05). In the second year of treatment, group 2 maintained good glycemic control whereas group 1 had increased HbA1c level (p<0.001). Although mean relative weight index ( RWI) increased in the second year of treatment (p=0.031) in group 2, their mean RWI was ideal. RWI did not changed in group 1 after 2 year follow-up of treatment (p>0.05). All patients had normal growth according to their genetic potential. Mean insulin dose of patients was increased in second year (p=0). Compliance of diet (p=0.038), carbohydrate count (p=0.025) and less fast food consumption(p=0.018) were more common in group 2.
Conclusion: The frequency of severe hypoglycemia and diabetic ketoacidos were similar (p>0.05). Group 1 had higher triglyceride, total cholesterol, LDL, VLDL and lower HDL levels but not statistically significant (p>0.05). Patients with dyslipidemia had longer median diabetes duration than without dyslipidemia (p=0.018).

Anahtar Kelimeler

Type 1 diabetes, flexible insulin therapy, carbohydrate counting

Kaynakça

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