Tip 1 Diyabette Uzun Dönem Glisemik Kontrol ile Remisyon Dönemi Arasındaki İlişki: Retrospektif Bir Çalışma

Öz

Amaç: Parsiyel remisyon (PR), tip 1 diyabet (T1D) tanısından kısa süre sonra izlenen ve diyabet yönetimine dair önemli etkileri olan bir süreçtir. T1D'de PR ile uzun dönem hemoglobin A1c (HbA1c) sonuçları arasındaki ilişkiyi araştırmayı amaçladık. Ayrıca uzun süreli glisemik kontrolü etkileyebilecek demografik ve klinik faktörleri de analiz ettik. Gereç ve yöntem: T1D'li 131 çocuk ve adolesanın 5 yıllık takip süresindeki HbA1c düzeylerini retrospektif olarak değerlendirdik. Hastalar düşük (<%7.5) ve yüksek (≥%7.5) uzun dönem HbA1c gruplarına ayrılarak gruplar uygun istatistiksel yöntemlerle karşılaştırıldı. Bulgular: Ortalama HbA1c±SD tanı anında %12,1±2,4, 1. yılda %8,1±1,3; 2. yılda %8,9±1,6; 3. yılda %9,1±1,6; 4. yılda %9,3±1,7 ve 5. yılda %9,5±1,4 idi. Hastaların %87,8'inde uzun dönem ortalama HbA1c düzeyleri yüksekti. 75 olguda (%57,3) parsiyel remisyon izlendi. Takip sırasında, PR izlenen T1D'lilerde HbA1c düzeyleri diğerlerine göre anlamlı olarak daha düşüktü (%8,9±1,3 ve %9,6 ±1,6; p=0.006). Düşük uzun dönem HbA1c grubu, yüksek HbA1c grubuna göre daha yüksek bazal açlık C-peptid seviyelerine sahipti [0,48 (0,12-1,4) ng/ml ve 0,28 (0,05-1,5) ng/ml; p=0,048]. Ayrıca diğer gruba kıyasla tanıdan 3 ay, 6 ay, 9 ay ve 12 ay sonraki HbA1c seviyeleri de daha düşüktü (p≤0,001 ya da p=0,004). Sonuç: Glisemik kontrol takip süresi boyunca suboptimaldi. HbA1c seviyeleri, T1D teşhisi sonrası ilk 2 yıl boyunca (ilk birkaç aydan sonra) istikrarlı olarak arttı ancak daha sonra stabil seyretti. PR izlenen olguların izlemdeki HbA1c düzeyleri PR izlenmeyenlere göre daha düşüktü. T1D’de HbA1c seyrinin anlaşılması, klinik sonuçları iyileştirmek ve T1D yönetimini düzenlemek için imkânlar sunar.

Anahtar Kelimeler

• Tip 1 diyabet
• parsiyel remisyon
• glisemik kontrol
• hemoglobin A1c

The Relationship Between Long-Term Glycemic Control and Partial Remission in Type 1 Diabetes: A Retrospective Study

Öz

Aim: Partial remission (PR) is a significant period in the early course of type 1 diabetes (T1D) with implications for diabetes management. We aimed to investigate whether long-term hemoglobin A1c (HbA1c) outcomes in T1D differed as a result of experiencing PR. We also analyzed the demographic and clinical factors that may influence long-term glycemic control. Material and methods: We retrospectively tracked the HbA1c values of 131 children and adolescents with T1D over a 5-year period. Patients were stratified into low (<7.5%) and high (≥7.5%) long-term HbA1c groups, and groups were compared using appropriate statistical procedures. Results: Mean HbA1c±SD was 12.1±2.4% at diagnosis, 8.1±1.3% at 1 yr, 8.9±1.6% at 2 yr, 9.1±1.6% at 3 yr, 9.3±1.7% at 4 yr, and 9.5±1.4% at 5 yr from diagnosis. Of the patients, 87.8% had high long-term mean HbA1c levels. There were 75 remitters (%57.3). During follow-up, HbA1c levels were significantly lower in those with T1D who experienced PR than those who did not (8.9±1.3% vs. 9.6% ±1.6%, p=0.006). The group with low long-term HbA1c had higher fasting C-peptide levels at baseline than the higher HbA1c group [0.48 (0.12-1.4) ng/ml vs. 0.28 (0.05-1.5) ng/ml, p=0.048)]. They also had lower HbA1c levels at 3 months, 6 months, 9 months, and 12 months after diagnosis compared to the other group (p≤0.001 or p=0.004). Conclusion: Glycemic control was suboptimal throughout the follow-up period. After the first few months, HbA1c levels increased steadily through the first 2 years of T1D diagnosis but tended to stabilize in a "track" afterward. The trajectory of youth who experienced PR was lower than those who didn't. Understanding the HbA1c trajectory helps to identify opportunities for the intensification of T1D management to improve clinical outcomes.

Anahtar Kelimeler

• Type 1 diabetes
• partial remission
• glycemic control
• hemoglobin A1c

Kaynakça

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