Şükrü Hatun1, Hüseyin Demirbilek2, Şükran Darcan3, Ayşegül Yüksel1, Cigdem Binay4, Damla Gökşen Şimşek3, Cengiz Kara5, Ergun Çetinkaya6, Tolga Ünüvar7, Ahmet Uçaktürk8, Filiz Tütüncüler9, Yaşar Cesur10, Ruveyde Bundak11, Halil Sağlam12, Enver Şimşek4, Abdullah Bereket13. 1. Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology, 41100 Kocaeli, Turkey. 2. Diyarbakır Children State Hospital, Clinic of Pediatric Endocrinology, 21100 Diyarbakır, Turkey. 3. Ege University Faculty of Medicine, Department of Pediatric Endocrinology, 35100 İzmir, Turkey. 4. Osmangazi University Faculty of Medicine, Department of Pediatric Endocrinology, 26100 Eskişehir, Turkey. 5. Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Endocrinology, 55100 Samsun, Turkey. 6. ENDOMER Pediatric Endocrine Center, 06100 Ankara, Turkey. 7. Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology, 34100 Istanbul, Turkey. 8. Maternity and Children's Hospital, Clinic of Pediatric Endocrinology, 33100 Mersin, Turkey. 9. Trakya University Faculty of Medicine, Department of Pediatric Endocrinology, 22000 Edirne, Turkey. 10. Bezmialem University Faculty of Medicine, Department of Pediatric Endocrinology, 34100 Istanbul, Turkey. 11. Istanbul University, Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, 34110 Istanbul, Turkey. 12. Uludag University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey. 13. Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, 34100 İstanbul, Turkey.
Abstract
AIMS: To evaluate the management strategies, glycemic control and complications of pediatric type 1 diabetes mellitus (T1DM) patients in Turkey. METHODS: Study included 498 patients with T1DM between the ages 1-18. Data provided from patients' hospital files were recorded on standard case report forms by applicant clinicians within the 3months of data collection period between October 2012 and July 2013. RESULTS: Mean age of patients was 11.3±3.8years. Mean duration of DM was determined as 3.7±3.1years. Majority of patients (85.5%) used basal/bolus injection (BBI), and 6.5% used continuous subcutaneous insulin infusion pump. Assessment of glycemic control based on HbA1c levels showed that 29.1% of patients had an HbA1c value <7.5% (58mmol/mol), 16.1% had a value between 7.5% (58mmol/mol) and 8% (64mmol/mol), 19.1% had a value between 8.1% (64mmol/mol) and 9%(75mmol/mol) and 35.7% a value >9%(75mmol/mol). Hypoglycemia was reported in 145 (29.1%) patients and the number of severe hypoglycemic attacks in the last 3months was 1.0±2.4. Taking into consideration the carbohydrate count and insulin correction dose and parents with high socioeconomic status was related to have better glycemic control. The most common comorbidities were Hashimoto's thyroiditis/hypothyroidism (6.2%) followed by celiac disease (3.8%), epilepsy(1.2%), and asthma(1.0%). CONCLUSIONS: BBI insulin therapy is widely used among pediatric T1DM patients in Turkey. However, despite improvements in treatment facilities and diabetic care, glycemic control is not at a satisfactory level. Therefore, new and comprehensive initiatives require for pediatric T1DM patients with poor glycemic control. Promoting use of carbohydrate count and insulin correction doses may improve the glycemic control of pediatric T1DM in Turkey.
AIMS: To evaluate the management strategies, glycemic control and complications of pediatric type 1 diabetes mellitus (T1DM) patients in Turkey. METHODS: Study included 498 patients with T1DM between the ages 1-18. Data provided from patients' hospital files were recorded on standard case report forms by applicant clinicians within the 3months of data collection period between October 2012 and July 2013. RESULTS: Mean age of patients was 11.3±3.8years. Mean duration of DM was determined as 3.7±3.1years. Majority of patients (85.5%) used basal/bolus injection (BBI), and 6.5% used continuous subcutaneous insulin infusion pump. Assessment of glycemic control based on HbA1c levels showed that 29.1% of patients had an HbA1c value <7.5% (58mmol/mol), 16.1% had a value between 7.5% (58mmol/mol) and 8% (64mmol/mol), 19.1% had a value between 8.1% (64mmol/mol) and 9%(75mmol/mol) and 35.7% a value >9%(75mmol/mol). Hypoglycemia was reported in 145 (29.1%) patients and the number of severe hypoglycemic attacks in the last 3months was 1.0±2.4. Taking into consideration the carbohydrate count and insulin correction dose and parents with high socioeconomic status was related to have better glycemic control. The most common comorbidities were Hashimoto's thyroiditis/hypothyroidism (6.2%) followed by celiac disease (3.8%), epilepsy(1.2%), and asthma(1.0%). CONCLUSIONS:BBIinsulin therapy is widely used among pediatric T1DM patients in Turkey. However, despite improvements in treatment facilities and diabetic care, glycemic control is not at a satisfactory level. Therefore, new and comprehensive initiatives require for pediatric T1DM patients with poor glycemic control. Promoting use of carbohydrate count and insulin correction doses may improve the glycemic control of pediatric T1DM in Turkey.
Authors: Edip Unal; Meliha Demiral; Birsen Baysal; Mehmet Ağın; Elif Gökçe Devecioğlu; Hüseyin Demirbilek; Mehmet Nuri Özbek Journal: J Clin Res Pediatr Endocrinol Date: 2020-08-21