Evaluation of patients diagnosed with diabetes mellitus hospitalized in pediatric endocrinology service between 2015-2019

Yıl 2021, Cilt: 12 Sayı: 3, 334 - 340, 29.09.2021

Selin Elmaoğulları Nurdan Yildirim Şenay Savaş Erdeve Zehra Aycan Semra Çetinkaya

https://doi.org/10.18663/tjcl.833021

Öz

Aim: We planned to determine the reasons for the hospitalization of patients with diabetes mellitus (DM) in the pediatric endocrinology service and examine the distribution of diabetes types by years.
Material and method: Patients diagnosed with DM hospitalized in pediatric endocrinology service between January 2015 and January 2019 were retrospectively reviewed. Patients were grouped according to their diabetes types and diagnosis time as new or old diagnoses. The metabolic status of the newly diagnosed cases (hyperglycemia / ketosis / ketoacidosis) and reasons for rehospitalization of formerly diagnosed patients were recorded. Each of the repeated hospitalizations of the same patient was evaluated as a separate hospitalization.
Results: A total of 787 admissions for patients with DM were identified. 90.6% of hospitalizations belonged to patients with Type 1 DM (T1DM) and 4.2% Type 2 DM (T2DM). The number of newly diagnosed T1DM patients has increased in the last 2 years. However, it was determined that the rate of referrals with ketoacidosis was gradually decreasing (p=0.03). 72.4% of the patients on diabetes follow-up were hospitalized for regulation of treatment and repeating of diabetes education because of the irregularity in blood glucose values and/or patient incompatibility during outpatient clinic controls and 6.3% were hospitalized due to the development of ketosis /ketoacidosis.
Conclusion: As the prevalence of diabetes in children increases, the frequency of hospitalizations due to diabetes also increases. In relation to the increased awareness of diabetes in families, the rate of presentation with ketoacidosis has decreased in newly diagnosed T1DM. School studies and spots on this subject should continue to increase awareness about T2DM and obesity. Compliance with treatment should be evaluated regularly in followed-up patients and continuity of diabetes education should be ensured.

Anahtar Kelimeler

Children, Type 1 Diabetes Mellitus, Type 2 Diabetes mellitus

2015-2019 yılları arasında çocuk endokrinoloji servisine yatırılmış diyabetes mellitus tanılı olguların yatış durumlarının değerlendirilmesi

Öz

Amaç: Bu çalışmada 4 yıl süresince çocuk endokrinoloji servisinde yatırılarak izlenmiş diyabetes mellitus (DM) tanılı hastaların yatış nedenlerinin belirlenmesi ve diyabet tiplerininin yıllara göre dağılımının incelenmesi planlandı.
Gereç ve Yöntemler: Ocak 2015-Ocak 2019 tarihleri arasında çocuk endokrinoloji servisine yatışı yapılmış DM tanılı hastaların dosyaları geriye dönük olarak incelendi. Hastalar diyabet tiplerine ve yeni/eski tanı olmalarına göre gruplandırıldıktan sonra, yeni tanı alan olguların başvurudaki metabolik durumları (hiperglisemi/ketoz/ketoasidoz) ve eski tanılı hastaların yeniden yatış nedenleri kaydedildi. Aynı hastanın tekrarlayan hastane yatışlarının her biri ayrı yatış olarak değerlendirildi.
Bulgular: Diyabetes Mellitus tanılı hastalara ait toplamda 787 yatış belirlendi. Yatışların %90,6’sı Tip 1 diyabet (T1DM) ve %4,2’si Tip 2 diyabet (T2DM) tanılı hastalara aitti. Yeni tanı T1DM sayısının son 2 yılda arttığı ancak ketoasidozla başvurma oranının giderek düştüğü belirlendi (p=0,03). Takipli hastaların yatış nedenleri incelendiğinde yatışların %72,4’ünün poliklinik kontrolleri sırasında kan şekeri değerlerinde düzensizlik ve/veya hasta uyumsuzluğu görülmesi nedeniyle regülasyon ve diyabet eğitimi tekrarı amaçlı, %6,3’ünün ketoz/ketoasidoz gelişmesi nedeniyle yapıldığı gözlendi.
Sonuçlar: Çocuklarda diyabet sıklığının artmasıyla birlikte diyabet nedeniyle hastaneye yatış sıklığı da artmaktadır. Ailelerde artan diyabet farkındalığı ile ilişkili olarak yeni tanı T1DM’de ketoasidozla başvuru oranı azalmıştır. Bu konudaki okul çalışmaları ve kamu spotlarına devam edilmeli ayrıca T2DM ve obezite konusunda bilinçliliğin arttırılması hedeflenmelidir. Takipli hastalarda tedaviye uyum düzenli olarak değerlendirilmeli ve diyabet eğitiminin sürekliliği sağlanmalıdır.

Anahtar Kelimeler

Çocuklar, Tip 1 diyabetes mellitus, Tip 2 Diyabetes Mellitus

Kaynakça

• 1. Cho N, Shaw J, Karuranga S, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes research and clinical practice 2018;138:271-81.
• 2. Pulgaron ER, Delamater AM. Obesity and type 2 diabetes in children: epidemiology and treatment. Curr Diab Rep 2014;14:508.
• 3. Bohn B, Schwandt A, Ihle P, et al. Hospital admission in children and adolescents with or without type 1 diabetes from Germany: An analysis of statutory health insurance data on 12 million subjects. Pediatr Diabetes 2018;19:721-6.
• 4. Mayer-Davis EJ, Kahkoska AR, Jefferies C, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes 2018;19 Suppl 27:7-19.
• 5. Mobasseri M, Shirmohammadi M, Amiri T, Vahed N, Hosseini Fard H, Ghojazadeh M. Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis. Health Promot Perspect 2020;10:98-115.
• 6. Jasinski CF, Rodriguez-Monguio R, Tonyushkina K, Allen H. Healthcare cost of type 1 diabetes mellitus in new-onset children in a hospital compared to an outpatient setting. BMC Pediatr 2013;13:55.
• 7. Liese AD, D'Agostino RB, Jr., Hamman RF, et al. The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study. Pediatrics 2006;118:1510-8.
• 8. Wolfsdorf J, Glaser N, Sperling MA. Diabetic ketoacidosis in infants, children, and adolescents: A consensus statement from the American Diabetes Association. Diabetes Care 2006;29:1150-9.
• 9. 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:e938-45.
• 10. Rabbone I, Maltoni G, Tinti D, et al. Diabetic ketoacidosis at the onset of disease during a national awareness campaign: a 2-year observational study in children aged 0-18 years. Arch Dis Child 2020;105:363-6.
• 11. Souza L, Kraemer GC, Koliski A, et al. DIABETIC KETOACIDOSIS AS THE INITIAL PRESENTATION OF TYPE 1 DIABETES IN CHILDREN AND ADOLESCENTS: EPIDEMIOLOGICAL STUDY IN SOUTHERN BRAZIL. Rev Paul Pediatr 2020;38:e2018204.
• 12. İşleyen F, Semih B. Adıyaman İlindeki Diyabetik Çocukların Epidemiyolojik Özellikleri. Güncel Pediatri 2019;17:1-16.
• 13. Demir K, Büyükinan M, Dizdarer C, et al. Tip 1 diyabetli çocuklarda tanıda diyabetik ketoasidoz sıklığı ve ilişkili faktörler. Güncel Pediatri 2010;8:52-5.
• 14. Acar S, Gören Y, Paketçi A, et al. Tip I Diabetes Mellitus Olgularinin Tani Anindaki Diyabetik Ketoasidoz Sikliginin Degisimi: On Bes Yillik Tek Merkez Deneyimi/Changes in the Frequency of Diabetic Ketoacidosis in Type I Diabetes Mellitus Cases at Diagnosis: A Fifteen-Year Single Center Experience. The Journal of Pediatric Research 2017;4:143-9.
• 15. Hatun Ş. Diabetes program at schools in Turkey. J Clin Res Pediatr Endocrinol 2012;4:114-5.
• 16. Dabelea D, Bell RA, D'Agostino RB, Jr., et al. Incidence of diabetes in youth in the United States. Jama 2007;297:2716-24.
• 17. Rosenbloom AL, Silverstein JH, Amemiya S, Zeitler P, Klingensmith GJ. ISPAD Clinical Practice Consensus Guidelines 2006-2007. Type 2 diabetes mellitus in the child and adolescent. Pediatr Diabetes 2008;9:512-26.
• 18. Mayer-Davis EJ, Beyer J, Bell RA, et al. Diabetes in African American youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care 2009;32 Suppl 2:S112-22.
• 19. Jefferies C, Carter P, Reed PW, et al. The incidence, clinical features, and treatment of type 2 diabetes in children <15 yr in a population-based cohort from Auckland, New Zealand, 1995–2007. Pediatr Diabetes 2012;13:294-300.
• 20. Fajans SS, Bell GI, Polonsky KS. Molecular mechanisms and clinical pathophysiology of maturity-onset diabetes of the young. N Engl J Med 2001;345:971-80.
• 21. Shields BM, Hicks S, Shepherd MH, Colclough K, Hattersley AT, Ellard S. Maturity-onset diabetes of the young (MODY): how many cases are we missing? Diabetologia 2010;53:2504-8.
• 22. Ganie MA, Bhat D. Current developments in Wolfram syndrome. J Pediatr Endocrinol Metab 2009;22:3-10.
• 23. Pallotta MT, Tascini G, Crispoldi R, et al. Wolfram syndrome, a rare neurodegenerative disease: from pathogenesis to future treatment perspectives. J Transl Med 2019;17:238.
• 24. Auzanneau M, Bohn B, Schiel R, et al. Inpatient Rehabilitation for Children and Adolescents With Diabetes in Germany Between 2006 and 2013. Exp Clin Endocrinol Diabetes 2020;128:325-31.
• 25. Rewers A, Chase HP, Mackenzie T, et al. Predictors of acute complications in children with type 1 diabetes. Jama 2002;287:2511-8.