Diyabetik Hastalarda Yaşa Göre A1c Değişimi - Kılavuzların Güncel Uygulamalara Etkisi

Yıl 2018, Cilt: 2 Sayı: 3, 107 - 112, 28.12.2018

Özlem Polat Meral Mert Yıldız Okuturlar Yasemin Şefika Akdeniz Ayşe Esen Hamide Pişkinpaşa Sogol Sadri Denis Sabriye Bozer

Öz

Amaç:
Güncel
rehberlere göre hemoglobin A1c (HbA1c)  hedefleri hastanın yaşı ve komorbiditeleri göz
önüne alınarak kişiselleştirilmelidir. Çalışmamızda, hastanemize başvuran
diyabetik hastalarda cinsiyet ve yaşa göre HbA1c değerlerinin nasıl değiştiğini
belirlemek ve bulguları literatür eşliğinde incelemeyi amaçladık.

Gereç
ve Yöntemler: Bu çalışmamızda Sağlık Bilimleri
Üniversitesi Bakırköy Dr. Sadi Konuk Sağlık Uygulama ve Araştırma Merkezi, İç Hastalıkları
ve Endokrinoloji ve Metabolizma Hastalıkları polikliniklerine son 5 yılda ayaktan
başvuran 18 yaş üstü diyabetik hastalar retrospektif olarak değerlendirildi. Hastaların
ilk başvuruları değerlendirilerek diyabet tipleri,  yaş,  cinsiyet
ve HbA1c değerleri kaydedildi.  Hasta
yaşları dekatlara göre 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, >80 olacak
şekilde gruplandırılarak sonuçlar istatistiksel olarak değerlendirildi.

Bulgular: Çalışmaya
alınan tüm hastalar (n=17.973) incelendiğinde kadın hasta oranı %63,4 iken,
erkek hasta oranı %36,6 bulundu. Tip 1 diyabetes mellitus (DM) hasta oranı %2,8
(n=498),  Tip 2 DM hasta oranı %97,2 (n=17.475)
idi. 18 yaş üstü hastalarda 10 yıllık dekatlara göre HbA1c ortalamaları karşılaştırıldığında,
9 grup arasında istatistiksel olarak anlamlı fark görüldü (p< 0,05). En
düşük Hb A1c düzeyi ortalaması (%7,01±1,78)  2.Dekatta iken, en yüksek HbA1c düzeyi
ortalaması (%7,67±2,09) 5.dekatta gözlendi. Tüm dekatlara bakıldığında hasta sayısı en çok 50-59
yaş arasında (n=5582; %31) idi. 50 yaş üstü erkek hastaların HbA1c düzeyleri kadınlardan
istatistiksel olarak anlamlı daha yüksekti (p< 0,001). 50 yaş altı Tip 2
diyabetik kadınların HbA1c değerleri erkeklerden istatistiksel olarak anlamlı daha
düşüktü (p< 0,001).

Sonuç:
En yüksek HbA1c
değerleri 5. Dekatta, en düşük 2. Dekatta görülmektedir. Yaşla beraber artmakla
birlikte özellikle 50 yaş üstü erkeklerde HbA1c değerleri daha yüksektir

Summary

Aim: According to the current guidelines, hemoglobin A1c (HbA1c) targets should be personalized taking into account patient age and comorbidities. In our study, we aimed to determine how HbA1c values ​​change according to age and sex in diabetic patients who applied to our hospital and to investigate the findings with literature

Material and Methods: In this study, Health Sciences University Bakırköy Dr. Sadi Konuk Health Application and Research Center, Internal Diseases and Endocrinology and Metabolic Diseases outpatient clinics in the last 5 years of outpatients over 18 years of age were evaluated retrospectively. Diabetes types, age, sex and HbA1c values ​​were recorded. The patient ages were grouped as 18-29, 30-39, 40-49, 50-59, 60-69, 70-79,> 80 according to the terms and the results were evaluated statistically.

Results: When all patients were included in the study (n = 17.973, mean age = 73), the rate of female patients was 63.4% and the male patient ratio was 36.6%. The rate of patients with type 1 diabetes mellitus (DM) was 2.8% (n = 498) and the rate of type 2 DM patients was 97.2% (n = 17.475). When HbA1c averages were compared according to 10 year, there was a statistically significant difference between the 9 groups (p <0.05). The lowest HbA1c level (7.01 ± 1.78%) was in the second decate, while the highest HbA1c level (7.67% ± 2.09) was observed in the 5th decate. The number of patients was 50-59 (n = 5582; 31%). HbA1c levels of male patients over 50 years were significantly higher than females (p <0.001). HbA1c values ​​of women with type 2 diabetes under 50 years of age were significantly lower than men (p <0.001).

Conclusion: The highest HbA1c values ​​are in 5th decade, the lowest is in 2nd decate. Although it increases with age, HbA1c values ​​are higher especially in males over 50 years of age.

Anahtar Kelimeler

HbA1c, Yaş, Cinsiyet

Kaynakça

• 1. American Diabetes Association. Standarts of Medical Care in Diabetes-2018. “6. Glycemic Targets: Standards of Medical Care in Diabetes-2018” Diabetes Care 2018;41(Suppl 1):55-64. 2. TEMD Diabetes Mellitus Çalışma ve Eğitim Grubu. Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu. Türkiye Endokrinoloji ve Metabolizma Derneği, 2017, s45-52.3. Ma Q, Liu H, Xiang G, Shan W and Xing W. Association between glycated hemoglobin A1c levels with age and gender in Chinese adults with no prior diagnosis of diabetes mellitus. Biomed Rep 2016;4(6):737-740.4. The International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 2009;32(7):1327-1334. 5. Metzger BE, Buchanan TA, Coustan DR, de Leiva A, Dunger DB, Hadden DR, Hod M, Kitzmiller JL, Kjos SL, Oats JN, et al. Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus. Diabetes care 2007;30(Suppl 2):251-260. 6. Colagiuri S. Glycated haemoglobin (HbA1c) for the diagnosis of diabetes mellitus-practical implications. Diabetes Res Clin Pract 2011;93(3):312-313.7. Davidson MB and Schriger DL. Effect of age and race/ethnicity on HbA1c levels in people without known diabetes mellitus: implications for the diagnosis of diabetes. Diabetes Res Clin Pract 2010;87(3):415-421.8. Selvin E, Francis LM, Ballantyne CM, Hoogeveen RC, Coresh J, Brancati FL and Steffes MW. Nontraditional markers of glycemia: associations with microvascular conditions. Diabetes Care 2011;34(4):960-967.9. Cohen RM, Franco RS, Khera PK, Smith EP, Lindsell CJ, Ciraolo PJ, Palascak MB and Joiner CH. Red cell life span heterogeneity in hematologically normal people is sufficient to alter HbA1c. Blood 2008;112(10):4284-4291.10. Inoue M, Inoue K and Akimoto K. Effects of age and sex in the diagnosis of type 2 diabetes using glycated haemoglobin in Japan: The Yuport Medical Checkup Centre study. PloS One 2012;7(7):e40375.11. Kramer CK, Araneta MRG and Barrett-Connor E. A1C and diabetes diagnosis: The Rancho Bernardo Study. Diabetes Care 2010;33(1):101-103.12. Yang L, Shen X, Yan S, Xu F and Wu P. The effectiveness of age on HbA1c as a criterion for the diagnosis of diabetes in Chinese different age subjects. Clin Endocrinol (Oxf) 2015;82(2):205-212.13. Zhao X, Chang Mei H, Chen L, Jiang L, He M, Chen J, Hu Z, Ye H, Hu H, Zhou L, Li Y and Hu R. An increased level of haemoglobin A1C predicts a poorer clinical outcome in patients with acute pancreatitis. Clin Endocrinol (Oxf) 2012;77(2):241-245.14. Yang L, Shen X, Yan S, Yuan X, Lu J and Wei W. HbA1c in the diagnosis of diabetes and abnormal glucose tolerance in patients with Graves’ hyperthyroidism. Diabetes Res Clin Pract 2013;101(1):28-34.15. Pani LN, Korenda L, Meigs JB, Driver C, Chamany S, Fox CS, Sullivan L, D’Agostino RB and Nathan DM. Effect of aging on A1C levels in individuals without diabetes: evidence from the Framingham Offspring Study and the National Health and Nutrition Examination Survey 2001–2004. Diabetes Care 2008;31(10):1991-1996.16. The Diabetes Control and Complications Trial ResearchGroup. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977-986.17. Adler AI, Stratton IM, Neil HAW, Yudkin JS, Matthews DR, Cull CA, Wright AD, Turner RC and Holman RR. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ 2000;321(7258):412-419.18. Yang YC, Lu FH, Wu JS and Chang CJ. Age and sex effects on HbA1c: a study in a healthy Chinese population. Diabetes care 1997;20(6):988-991.19. Sonmez A1, Haymana C2, Bayram F. Turkish Nationwide SurvEy of Glycemic and OtherMetabolic Parameters of Patients with Diabetes Mellitus (TEMD Study). Diabetes Res Clin Pract. 2018 Sep 20. pii: S0168-8227(18)30715-0. doi: 10.1016/j.diabres.2018.09.010. [Epub ahead of print]