Diyabetimle Barıştım Projesi : Bir Çocuk Endokrinoloji Kliniğinde Yaşanan Başarı Öyküsü

Yıl 2012, Cilt: 6 Sayı: 1, 31 - 35, 01.12.2012

Fatma Demirel Nazlı Büber İhsan Esen Derya Acar Özlem Kara Nevra Koç

Öz

Amaç: Tip 1 diyabette (T1DM) uzun dönem komplikasyonların azaltılması ve/veya geciktirilmesi için iyi metabolik kontrol zorunludur. Tip 1 diyabetli çocuk ve ergenlerde motivasyon kaybı, bıkkınlık ve psikolojik sorunlar metabolik kontrolü güçleştirmektedir. Bu çalışmada, genellikle orta-alt gelir grubu ailelerin çocuklarının izlendiği bir çocuk endokrin kliniğinde diyabetli olgularda metabolik kontrolün iyileştirilmesi amaçlandı.Hastalar ve Yöntem: Proje kapsamında tüm diyabetli çocuklarda esnek ve yoğun insülin tedavisine geçildi, beslenme eğitimleri tekrarlandı, tüm çocuklara diyabet eğitim kitapları dağıtıldı. Kötü kontrollü diyabetlilere endokrin polikliniğinde daha çok zaman ayrıldı. Zorunlu durumlarda kan şekeri regülasyonu için hastaneye yatış yapıldı. Başlangıçtaki ve bir yılın sonundaki ortalama HbA1c değerleri karşılaştırıldı.Bulgular: Çalışmada ortalama diyabet süresi 6.0±3.2 yıl olan 91 (46’sı erkek) tip 1 diyabetli çocuk ve ergen yer aldı. Çalışma başlangıcında ortalama HbA1c % 8.2 iken bir yılın sonunda % 7.8’e geriledi (p<0.001). Başlangıçta HbA1c’si % 9.0 ve üzeri olan 25 kötü metabolik kontrollü olgu var iken çalışma sonunda bu sayı 15’e düştü (p<0,001). Çalışmada yer alan kızların daha yüksek başarı gösterdikleri ve başlangıçta % 8.3 olan HbA1c düzeyinin 1 yılın sonunda % 7.7’ye gerilediği görüldü (p=0,002). Kızlarda 12 olan kötü kontrollü diyabetli sayısı 4’e düşmüştü. Ancak erkek çocuklarda başlangıç ve bir yılın sonundaki ortalama HbA1c düzeyleri arasında anlamlı fark yoktu.Sonuç: Diyabetlilere yeterli zaman ayrılması, yoğun insülin ve beslenme tedavileri ile birlikte metabolik kontrolde düzelme sağlayabilmektedir. Erkek çocuklarda iyi metabolik kontrol sağlanması kızlara göre daha büyük güçlük göstermektedir. Erkek tip 1 diyabetlilerde daha iyi metabolik kontrol sağlanması için farklı stratejilerin geliştirilmesi gerekmektedir.

Anahtar Kelimeler

Tip 1, diyabet, ergen, HbA1c, metabolik kontrol

THE PROJECT OF MAKE PEACE WITH DIABETES: THE SUCCESS STORY IN ONE OF THE PEDIATRIC ENDOCRINOLOGY CLINIC

Öz

Objective: In type 1 diabetes (T1DM), a good metabolic control is important to reduce and/or postpone complications. Achieving better metabolic control in children and adolescent with T1DM is difficult due to loss of motivation, psychological problems, getting bored and tired. The aim of this study was improvement of the metabolic control in patients with diabetes who come from middle and low income families. Patient and Methods: Within the project; all diabetic children were passed to flexible and intensive insulin treatment. Nutrition education was repeated by a dietitian and education books about diabetes were distributed to all children. Poorly controlled diabetics were allowed more times in their visits. If it was necessary for the glycemic regulation, patients were hospitalized. Mean HbA1c was compared at the beginning and at one year follow up examination.Results: Ninety-one children (46 boys) with mean diabetes duration of 6.0±3.2 years participated in this study. At the end of the year mean HbA1c was reduced from 8.2% to 7.8% and number of poorly controlled patients (HbA1c ı %9) decreased from 25 to 15 (p<0.001). The girls have shown higher success and their mean HbA1c level was reduced from 8.3% to 7.7%, and number of poorly controlled patients had fallen from 12 to 4 (p=0.002). However, there were no significant improvements in the mean HbA1c levels of the boys at the end of the year. Conclusions: To allow enough time to the diabetic children with intensive insulin and nutritional therapies can improve their metabolic controls. Achievement of good control in the diabetic boys shows a greater challenge. Different strategies must be developed to reach better metabolic control in boys with T1DM

Anahtar Kelimeler

Type 1, diabetes, adolescent, HbA1c, metabolic control

Kaynakça

• Hanas R, Donaghue KC, Klingensmith G, Swift PG. ISPAD clini- cal practice consensus guidelines 2009 compendium. Introduction. Pediatr Diabetes 2009;10 Suppl 12:1-2.
• Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Comp- lications Trial. Diabetes Control and Complications Trial Research Group. J Pediatr 1994;125(2):177-88.
• Crook ED, Patel S. Glycemic control predicts diabetic extrare- nal microvascular complications but not renal survival in patients with moderate to severe chronic kidney disease. Ethn Dis 2006; 16(4):865-71.
• Helgeson VS, Siminerio L, Escobar O, Becker D. Predictors of me- tabolic control among adolescents with diabetes: a 4-year longitu- dinal study. J Pediatr Psychol 2009;34(3):254-70.
• Araujo MB, Mazza CS. Assessment of risk factors of poor metabo- lic control in type 1 diabetic children assisted in a public hospital in Argentina. Pediatr Diabetes 2008;9(5):480-7.
• Jaser SS. Psychological problems in adolescents with diabetes. Adolesc Med State Art Rev 2010;21(1):138-51.
• Urbach SL, LaFranchi S, Lambert L, Lapidus JA, Daneman D, Becker TM. Predictors of glucose control in children and adoles- cents with type 1 diabetes mellitus. Pediatr Diabetes 2005;6(2):69- 74.
• Bott U, Jörgens V, Grüsser M, Bender R, Mühlhauser I, Berger M. Predictors of glycaemic control in type 1 diabetic patients after par- ticipation in an intensified treatment and teaching programme. Dia- bet Med 1994;11(4):362-71.
• Valerio G, Spagnuolo MI, Lombardi F, Spadaro R, Siano M, Fran- zese A. Physical activity and sports participation in children and adolescents with type 1 diabetes mellitus. Nutr Metab Cardiovasc Dis 2007;17(5):376-82.
• Giannini C, Mohn A, Chiarelli F. Physical exercise and diabetes during childhood. Acta Biomed 2006;77 Suppl 1:18-25.
• D’hooge R, Hellinckx T, Van Laethem C, Stegen S, De Schepper J, Van Aken S, et al. Influence of combined aerobic and resistan- ce training on metabolic control, cardiovascular fitness and quality of life in adolescents with type 1 diabetes: a randomized controlled trial. Clin Rehabil 2011;25(4):349-59.
• Chiarelli F, Verrotti A, di Ricco L, de Martino M, Morgese G. App- roaches to quality of control in diabetes care. Horm Res 1998;50 Suppl 1:41-7.
• Aman J, Skinner TC, de Beaufort CE, Swift PG, Aanstoot HJ, Ca- meron F, et al. Associations between physical activity, sedentary behavior, and glycemic control in a large cohort of adolescents with type 1 diabetes: the Hvidoere Study Group on Childhood Di- abetes. Pediatr Diabetes 2009;10(4):234-9.
• Mehta SN, Quinn N, Volkening LK, Laffel LM. Impact of carbohy- drate counting on glycemic control in children with type 1 diabe- tes. Diabetes Care 2009;32(6):1014-6.
• Lowe J, Linjawi S, Mensch M, James K, Attia J. Flexible ea- ting and flexible insulin dosing in patients with diabetes: Results of an intensive self-management course. Diabetes Res Clin Pract 2008;80(3):439-43.
• Iafusco D, Galderisi A, Nocerino I, Cocca A, Zuccotti G, Prisco F, et al. Chat line for adolescents with type 1 diabetes: a useful tool to improve coping with diabetes: a 2-year follow-up study. Diabetes Technol Ther 2011;13(5):551-5.
• Chiari G, Ghidini B, Vanelli M. Effectiveness of a toll-free telep- hone hotline for children and adolescents with type 1 diabetes. A 5-year study. Acta Biomed 2003; 74 Suppl 1:45-8.
• Mancuso M, Caruso-Nicoletti M. Summer camps and quality of life in children and adolescents with type 1 diabetes. Acta Biomed 2003;74 Suppl 1:35-7.