Tip 1 diyabetes mellituslu hastalarda tanı gecikmesinin değerlendirilmesi
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Date
2017
Authors
Kocael, Fatma
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Tip 1 Diyabetes Mellitus (Tip 1 DM) çocukluk ve adölesan dönemde en sık görülen endokrin-metabolik bozukluktur. DM'nin erken tanısı ve metabolik kontrolün sağlanması ile birçok komplikasyonun önlenebileceği ve geciktirilebileceği bilinmektedir. Tip 1 DM'li hastalar daha çok poliüri, polidipsi, kilo kaybı gibi semptomlarla başvururlar. Bu çalışmada, tip 1 DM tanılı hastalarda tanıdaki gecikme oranını, gecikmenin nedenlerini ve sonuçlarını saptamak amaçlanmıştır. Bu çalışma Uludağ Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Çocuk Endokrinoloji Polikliniği'nde 2007-2016 tarihleri arasında tip 1 DM tanısı ile takip edilen gönüllü 175 olgu incelenerek yapılmıştır. Hastalara ve ebeveynlerine "Tip 1 DM'li Hastalarda Tanı Gecikmesinin Değerlendirilmesi Anketi" verilmiştir. Hastaların dosyaları retrospektif incelenerek kan gazı parametreleri, HbA1c, GAD 65 ve c-Peptid, tiroid ve çölyak otoantikorları ve uzun dönem izlemdeki komplikasyonlar incelenmiştir. Hastalara mevcut şikayetleriyle konulan ilk tanılar; 139 (%79,4) hasta Tip 1 DM, 14 (%8) hasta üriner sistem enfeksiyonu, 13 (%7,4) hasta üst solunum yolu enfeksiyonu, 5 (%2,9) hasta anemi, 1 (%0,6) hastada ensefalit ve/veya menenjit tanısı almıştı. Hastaların çoğunda semptomların başlangıcından sonraki ilk iki hafta içinde tanı konduğu saptandı. Tanı alma süresi ve HbA1c değerlerinde istatistiksel fark saptanmadı (p>0,05). Tip 1 DM tanı ve tedavisindeki gelişmelere rağmen; hastalarımızın hala önemli bir bölümünün diyabetik ketoasidoz (DKA) ile başvurması dikkat çekicidir. Erken tanı; mortalite ve morbidite oranının düşmesine ve acil tedavide daha yüz güldürücü sonuçlar elde edilmesine olanak vermektedir. Toplumun ve hekimlerin diyabet konusunda bilinçlendiği, hizmet kalitesinin arttığı, ulaşılabilir sağlık merkezlerinin çoğaldığı ve sosyoekonomik olanakların arttığı oranda tip 1 DM'de erken tanı ve tedavi olanaklarının da artacağı düşünülmektedir.
Type 1 diabetes mellitus (type 1 DM) is the most common endocrine-metabolic disease in childhood and adolescence. Early diagnosis and optimum metabolic control can prevent and delay the complications. The most common symptoms at presentation of type 1 DM are polyuria, polydipsia, and weight loss. In this investigation, we aimed to study the frequency of delayed diagnosis as well as the reasons and consequences of the delay. This study was performed on 175 patients with type 1 DM who volunteeredto participate in the study and who were followed at Uludag University Department of Pediatric Endocrinology between 2007-2016. The questionnaire titled "Evaluation of Delayed Diagnosis in Type 1 DM" was given to patients and their parents.The charts of the patients were retrospectively evaluated to record the results of blood gases, HbA1c, GAD65, C-peptide, and autoantibodies for thyroid and celiac disease and the long-term complications were noted. The initial diagnosis of the patients were type 1 DM in 139 (79.4 %); urinary infection in 14 (8%), upper respiratory infection in 13 (7.4%), anemia in 5 (2.9%), and encephalitis and/or meningitis in 1 (0.6%). Most patients received the correct diagnosis in two weeks after the onset of symptoms. There was no correlation between the level of HbA1c and the time that elapsed from the onset of symptoms until diagnosis (p>0.05). Despite advances in diagnosis and treatment of diabetes, a considerable number of patients in our cohort were admitted to hospital with DKA at diagnosis. Early diagnosis enables prevention of mortality and morbidity and improves patient care. We articipate early diagnosis and treatment of type 1 DM will be fasilitated as the awareness of the community and health personel about diabetes is increased, as the number of health centers that the patients can reach is increased and as the socioeconomic status of the community rises.
Type 1 diabetes mellitus (type 1 DM) is the most common endocrine-metabolic disease in childhood and adolescence. Early diagnosis and optimum metabolic control can prevent and delay the complications. The most common symptoms at presentation of type 1 DM are polyuria, polydipsia, and weight loss. In this investigation, we aimed to study the frequency of delayed diagnosis as well as the reasons and consequences of the delay. This study was performed on 175 patients with type 1 DM who volunteeredto participate in the study and who were followed at Uludag University Department of Pediatric Endocrinology between 2007-2016. The questionnaire titled "Evaluation of Delayed Diagnosis in Type 1 DM" was given to patients and their parents.The charts of the patients were retrospectively evaluated to record the results of blood gases, HbA1c, GAD65, C-peptide, and autoantibodies for thyroid and celiac disease and the long-term complications were noted. The initial diagnosis of the patients were type 1 DM in 139 (79.4 %); urinary infection in 14 (8%), upper respiratory infection in 13 (7.4%), anemia in 5 (2.9%), and encephalitis and/or meningitis in 1 (0.6%). Most patients received the correct diagnosis in two weeks after the onset of symptoms. There was no correlation between the level of HbA1c and the time that elapsed from the onset of symptoms until diagnosis (p>0.05). Despite advances in diagnosis and treatment of diabetes, a considerable number of patients in our cohort were admitted to hospital with DKA at diagnosis. Early diagnosis enables prevention of mortality and morbidity and improves patient care. We articipate early diagnosis and treatment of type 1 DM will be fasilitated as the awareness of the community and health personel about diabetes is increased, as the number of health centers that the patients can reach is increased and as the socioeconomic status of the community rises.
Description
Keywords
Tip 1 DM, Tanı, Hatalı tanı, Komplikasyon, Diagnosis, Delayed diagnosis, Complication
Citation
Kocael, F. (2017). Tip 1 diyabetes mellituslu hastalarda tanı gecikmesinin değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.