Tip 1 diabetes mellitus tanısı alan çocuklarda metabolik kontrolü etkileyen faktörler
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Date
2009
Authors
Çakır, Seher
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Publisher
Uludağ Üniversitesi
Abstract
Çalışmamızın amacı, tip 1 Diyabetes Mellitus (DM) tanısı alan çocuklarda metabolik kontrolü etkileyen faktörleri belirlemektir.Bu çalışma Uludağ Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Çocuk Endokrin Polikliniği'nde tip 1 DM tanısı ile takip edilen 0 -18 yaş arasında 200 olgu incelenerek gerçekleştirildi. Çalışma hasta ve aileleri ile yüz yüze görüşülerek, soru-cevap şeklindeki anket formunun doldurulması ile ve retrospektif olarak dosya incelemesi ile yapıldı. Anket formu, hastaların sosyodemografik özelliklerini, hastalıkla ilgili bilgilerini içeren sorulardan oluşmaktaydı. Retrospektif olarak dosyalardan hastaların laboratuvar bulguları ve tıbbi tedavi bilgileri kaydedildi.Çalışmamıza 104 (%52) kız, 96 (%48) erkek olmak üzere toplam 200 hasta alındı. Hastaların ortalama HbA1c değeri %8,8 olarak bulundu. Hastaların ortalama yaşı 11,7 yıl idi. Diyabet süresi 3,8 yıldı (6 ay - 14 yıl). Toplam hastaların % 89 u, 12-18 yaş arası hastaların ise tamamı yoğun insülin tedavisi kullanmakta idi. Kullanılan insülin doz ortalaması 0,84±0,19 ü/kg/gün, vücut kitle indeksi (VKİ) z skor ortalaması -0,06±1,19 olarak saptandı. HbA1c ile ilişkili faktörler incelendiğinde; insülin dozu ile pozitif korelasyon olduğu (r:0,27 p:<0,01), diyabet süresi ve yaş ile korelasyon olmadığı saptandı. Yoğun tedavinin HbA1c değerini düşürmediği ancak ağır hipoglisemi riskini artırdığı saptandı. Ancak geleneksel tedaviden yoğun tedaviye geçen 72 (%36) hastanın HbA1c değerinde düşme saptandı (p<0,05). Evde dörtten fazla birey olanlarda, poliklinik kontrolüne uzun süredir gelmeyen ve ayda bir gelen hastalarda, diyetine tam uymayan hastalarda, 6 ay içerisinde 3 ten fazla semptomatik hipoglisemi olanlarda, diyabetik ketoasidoz (DKA) atağı olanlarda, tanı sırasında adolesan olanlarda, tanıda DKA ile başvuranlarda HbA1c düzeyi yüksek saptandı (p<0,05). Yoğun tedavi alan hastalarda ortalama insülin dozu 0,88±0,18 ü/kg, geleneksel tedavi alanlarda ise 0,58±0,12 ü/kg olarak saptandı (p:<0,01). İnsülin dozu ile diyabet süresi arasında korelasyon mevcuttu (r: 0,45 p:<0,05), ancak VKİ z skoru arasında ilişki saptanmadı (r:0,075 p: 0,29). VKİ z skoru tedaviden sonra tedavi öncesine göre anlamlı olarak yüksek saptandı (p<0,01).Tip 1 DM da metabolik kontrolün sağlanması birçok faktöre bağlıdır. Çalışmamızda kötü metabolik kontrol için risk faktörleri; diyabet süresinin 5 yıldan fazla olması, insülin dozu ihtiyacının artması, kalabalık aile, düzensiz poliklinik kontrolü, tam olarak diyetine uymamak, semptomatik hipoglisemi varlığı, DKA ataklarının varlığı, tanıda DKA varlığı ve tanı sırasında hastanın adolesan olması gibi etkenler saptandı.
The aim of our study was to explain factors influencing metabolic control in children with type 1 Diabetes Mellitus ( DM ) .The study was performed in 200 children with type 1 DM between the aged 0 to 18 years whom were followed in Uludağ University, Faculty of Medicine, Departmant of Pediatric Endocrinology. This study was performed by talking individually with children and their families, completing the questionnaire and also retrospectively collecting data from patient charts. The questionnaire form included characteristics of demographic features and data associated with their illnes. The laboratory findings and medical information of the patients from the charts were also retrospectively recorded.There were a total of 200 patients including 104 (%52) girls and 96 (%48) boys. The mean HbA1c value was 8,8 %. The mean age of the patients was 11,7 years. The duration of diabetes was 3,8 years (6 month-14 years). Eighty-nine percent of all patients and all of the patients between 12-18 years old had intensive insülin therapy. Mean insülin dose was 0,84±0,19 u/kg/day, body mass index (BMI) mean z score was -0,06±1,19. When factors associated with HbA1c was evaluated, although a positive correlation was found with insülin dosage (r:0,27 p:<0,01), there were no correlation with duration of diabetes and age. İt was found that intensive therapy did not lower HbA1c values, however increased the risk of severe hypoglycemia. Nevertheless, there was a decrease in HbA1c values of 72 (%36) patients whose therapy was converted to intensive therapy from conventional therapy (p<0,05). HbA1c values were found to be higher in people who were living more than 4 person in the house, did not come to routine follow-up for long term, come to routine follow-up monthly, poor compliance to diet, had more than 3 symptomatic hypoglycemia in the last 6 months, had attacks of diabetic ketoasidosis (DKA), were adolescent at time of diagnosis and admitted with diabetic ketoacidosis at time of diagnosis (p<0,05). The mean insülin dosage was 0,88±0,18 u/kg and 0,58±0,12 u/kg in patients with intensive therapy and conventional therapy, respectively (p:<0,01). Although there was a correlation between insülin dosage and duration of diabetes (r: 0,45 p:<0,05), no correlation was determined in BMI z score (r:0,075 p: 0,29). The BMI z score was significantly higher after therapy compared with the value before therapy (p<0,01).İn type 1 DM , obtaining metabolic control is multifactorial. İn this study the following risk factors were found to be associated with poor metabolic control; duration of diabetes longer than 5 years, need of insülin dosage increase, crowded families, irregüler follow-up visits, poor compliance to diet, presence of symptomatic hypoglycemia, presence of attacks of DKA, presence of DKA at diagnosis and being adolescence at the of diagnosis.
The aim of our study was to explain factors influencing metabolic control in children with type 1 Diabetes Mellitus ( DM ) .The study was performed in 200 children with type 1 DM between the aged 0 to 18 years whom were followed in Uludağ University, Faculty of Medicine, Departmant of Pediatric Endocrinology. This study was performed by talking individually with children and their families, completing the questionnaire and also retrospectively collecting data from patient charts. The questionnaire form included characteristics of demographic features and data associated with their illnes. The laboratory findings and medical information of the patients from the charts were also retrospectively recorded.There were a total of 200 patients including 104 (%52) girls and 96 (%48) boys. The mean HbA1c value was 8,8 %. The mean age of the patients was 11,7 years. The duration of diabetes was 3,8 years (6 month-14 years). Eighty-nine percent of all patients and all of the patients between 12-18 years old had intensive insülin therapy. Mean insülin dose was 0,84±0,19 u/kg/day, body mass index (BMI) mean z score was -0,06±1,19. When factors associated with HbA1c was evaluated, although a positive correlation was found with insülin dosage (r:0,27 p:<0,01), there were no correlation with duration of diabetes and age. İt was found that intensive therapy did not lower HbA1c values, however increased the risk of severe hypoglycemia. Nevertheless, there was a decrease in HbA1c values of 72 (%36) patients whose therapy was converted to intensive therapy from conventional therapy (p<0,05). HbA1c values were found to be higher in people who were living more than 4 person in the house, did not come to routine follow-up for long term, come to routine follow-up monthly, poor compliance to diet, had more than 3 symptomatic hypoglycemia in the last 6 months, had attacks of diabetic ketoasidosis (DKA), were adolescent at time of diagnosis and admitted with diabetic ketoacidosis at time of diagnosis (p<0,05). The mean insülin dosage was 0,88±0,18 u/kg and 0,58±0,12 u/kg in patients with intensive therapy and conventional therapy, respectively (p:<0,01). Although there was a correlation between insülin dosage and duration of diabetes (r: 0,45 p:<0,05), no correlation was determined in BMI z score (r:0,075 p: 0,29). The BMI z score was significantly higher after therapy compared with the value before therapy (p<0,01).İn type 1 DM , obtaining metabolic control is multifactorial. İn this study the following risk factors were found to be associated with poor metabolic control; duration of diabetes longer than 5 years, need of insülin dosage increase, crowded families, irregüler follow-up visits, poor compliance to diet, presence of symptomatic hypoglycemia, presence of attacks of DKA, presence of DKA at diagnosis and being adolescence at the of diagnosis.
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Keywords
HbA1c, Tip 1 diabetes mellitus, Metabolik kontrol, Type 1 diabetes mellitus, Metabolic control
Citation
Çakır, S. (2009). Tip 1 diabetes mellitus tanısı alan çocuklarda metabolik kontrolü etkileyen faktörler. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.