Özlem Gül KİRKAŞ, Fatma DEMİREL, Gülşen KÖSE, İhsan ESEN

Tip 1 Diyabetli 6 Yaştan Küçük ve Büyük Çocukların Tanı Anındaki Farklılıkları

Amaç: Son zamanlarda özellikle 6 yaş altındaki çocuklarda Tip 1 diabetes mellitus (T1DM) insidansında artış olmuştur. Bu çalışmanın amacı, küçük yaş ve daha büyük yaşlardaki T1DM’lu çocukların tanı anındaki klinik ve laboratuvar farklılıklarını analiz etmektir.Gereç ve Yöntemler: Ankara Çocuk Sağlığı Hastalıkları Hematoloji Onkoloji Hastanesi pediatrik endokrin bölümünde geçen 10 yılda T1DM tanısı alan 99 çocuğun dosyası (49 hasta ≤6 yaş, 50 hasta >6 yaş) geriye dönük incelendi. Kliniğe ilk başvuru anındaki klinik ve laboratuvar bulguları değerlendirildi.Bulgular: Yaşça küçük olan grupta, ortalama semptomların ortaya çıkış süresi daha kısa (15.2±1.9 ve 27.7±5.1 gün) ancak insülin infüzyonundan subkutan insülin geçiş süresi daha uzun (17.1±1.3 ve 13.6±1.2 saat)’di. Kilo kaybı semptomu büyük çocuklarda daha sık ve HbA1c düzeyi küçük çocuklarda anlamlı olarak daha düşüktü. Küçük çocuklarda diyabet ilişkili antikorlardan en az birinde pozitiflik anlamlı olarak daha fazlaydı (p<0,05).Sonuç: Bu çalışma, küçük ve daha büyük yaştaki diyabetik çocukların hastaneye ilk başvuru anındaki klinik ve laboratuvar bulgularındaki farklılıkları göstermektedir ve bu farklılıkların ortaya konması, diyabet ekibinin bu hastaların tanı, tedavi ve izleminde yol gösterici olacaktır.

Anahtar Kelimeler:

Çocuk, HbA1c, Ketoasidoz, Tip 1 diyabetes mellitus

Differences in Children with Type 1 Diabetes Aged ifferences in Children with Type 1 Diabetes Aged ≤6 and >6 Years at the Time of Diagnosis

Objective: There has recently been an increase in the incidence of Type 1 diabetes mellitus (T1DM), particularly among younger children. The purpose of the present study was to analyze the differences in the clinical and laboratory fi ndings at presentation between the younger (≤6 years of age) and older (>6 years of age) groups of patients with T1DM. Material and Methods: A retrospective scan was performed on the hospital data of 99 children with T1DM registered during the past 10 years at the pediatric endocrinology clinic of Ankara Children’s Haematology Oncology Training Hospital (49 patients were ≤6 years old and 50 were >6 years old). The clinical and laboratory fi ndings at the fi rst presentation to the clinic were reviewed.Results: The mean duration of symptoms before presentation was shorter (15.2±1.9 and 27.7±5.1 days respectively) in the younger age group. The transition time from intravenous insulin to subcutaneous treatment was signifi cantly longer than in the older patients (17.1±1.3 and 13.6±1.2 hours respectively). Weight loss was found to be more signifi cant among older children and HbA1c was signifi cantly lower in the younger age group. A signifi cantly higher proportion of patients in the younger group was found to be positive for at least one of the diabetes-associated antibodies (p<0.05).Conclusion: Elucidation of clinical and laboratory differences between younger and older diabetic children at the time of diagnosis would provide guidance for diabetes care teams in the diagnosis, treatment and monitoring of these patients

Keywords:

Child, HbA1c, Ketoacidosis, Type 1 diabetes mellitus,

PDF

___

Haller MJ, Atkinson MA, Schatz D. Type 1 diabetes mellitus: Etiology, presentation, and management. Pediatr Clin North Am 2005;52:1553-78.
Alemzadeh R, Wyatt DT. Diabetes mellitus. In: Behrman RE, Kliegman M, Jenson HB (eds). Nelson Textbook of Pediatrics. 17th ed. Pennsylvania:Elsevier Saunders, 2004;1947-72.
Norris AW, Wolfsdorf JI. Diabetes mellitus. In: Brook GDC, Clayton PE, Brown RS, Savage MO (eds). Clinical Pediatric Endocrinology. 5th ed. Massachussetts: Blackwell Publishing, 2005;436-91.
Onkamo P, Vananen S, Karvonen M, Tuomilehto J. World-wide increase in incidence of type 1 diabetes; the analysis the data on published incidence trends. Diabetologia 1999;42:1395-403.
Patterson CC, Dahlquist GG, Gyürüs E, Green A, Soltész G; EURODIAB Study Group. Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–20: A multicentre prospective registration study. Lancet 2009;373:2027-33.
Shalitin S, Phillip M. Which factors predict glycemic control in children diagnosed with type 1 diabetes before 6.5 years of age? Acta Diabetol 2012;49:355-62.
Rosenbloom AL, Schatz DA, Krischer JP, Skyler JS, Becker DJ, Laporte RE, et al. Therapeutic controversy: Prevention and treatment of diabetes in children. J Clin Endocrinol Metab 2000;85:494-522.
Kumar AR, Kaplowitz PB. Patient age, race and the type of diabetes have an impact on the presenting symptoms, latency before diagnosis and laboratory abnormalities at time of diagnosis of diabetes mellitus in children. J Clin Res Pediatr Endocrinol 2009;1:227-32.
Roche EF, Menon A, Gill D, Hoey H. Clinical presentation of type 1 diabetes. Pediatr Diabetes 2005;6:75-8.
Samuelson U, Stenhammar L. Clinical characteristics at onset of type 1 diabetes in children diagnosed between 1977 and 2001 in the South–East Region of Sweden. Diabetes Res Clin Practice 2005;68:49-55.
Dunger DB, Sperling MA, Acerini CL, Bohn DJ, Daneman D, Danne TPA, et al. ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents. Arch Dis Child 2004;89:188-94.
Levy – Marchal C, Patterson CC, Green A, EURODIAB ACE Study Group. Europe and Diabetes. Geographical variation of presentation at diagnosis of type 1 diabetes in children: The EURODIAB Study. European and Diabetes. Diabetologia 2001;44:75-80.
Neu A, Ehehalt A, Willasch A, Kehrer M, Hub R, Ranke MB; DIARY Group Baden-Wuerttemberg. Ketoacidosis at onset of type 1 diabetes mellitus in children – frequency and clinical presentation. Pediatr Diabetes 2003;4:77-81.
Sperling MA. Diabetic ketoacidosis in children: The problems continue. Pediatr Diabetes 2005;6:67-8.
Pozzilli P, Visalli N, Buzzetti R, Cavallo MG, Marietti G, Hawa M, et al. Metabolic and immune parameters at clinical onset of insulin- dependent diabetes: A population-based study: IMDIAB Study Group: Immunotherapy Diabetes. Metabolism 1998;47:1205–10.
Salardi S, Zucchini S, Cicognani A, Corbelli E, Santoni R, Ragni L, et al. The severity of clinical presentation of type 1 diabetes in children does not signifi cantly infl uence the pattern of residual beta cell function and long- term metabolic control. Pediatr Diabetes 2003;4:4-9.
Jackson W, Hofman PL, Robinson EM, Elliot RB, Pilcher CC, Cutfi eld WS. The changing presentation of children with newly diagnosed type 1 diabetes mellitus. Pediatr Diabetes 2001;2:154-9.
Komulainen J, Kulmara P, Savola K, Lounamaa R, Ilonen J, Reijonen H, et al. Clinical, autoimmune, and genetic characteristics of very young children with type 1 diabetes. Childhood Diabetes in Finland (DiMe) Study Group. Diabetes Care 1999;22:1950-5.
Hathout EH, Hartwick N, Fagosesaga OR, Colacino AR, Sharkey J, Racine M, et al. Clinical, autoimmune, and HLA characteristics of children diagnosed with type 1 diabetes before 5 years of age. Pediatrics 2003;111:860-3.
Feeney SJ, Myers MA, Mackay IR, Zimmet PZ, Howard N, Verge CF, et al. Evaluation of ICA-512 as in combination with other islet cell autoantibodies at the onset of IDDM. Diabetes Care 1997;20: 1403-7.
Urakami T, Suzuki J, Yoshida A, Saito H, Wada M, Takahashi S, et al. Autoimmune characteristics in Japanese children diagnosed with type 1 diabetes before 5 years of age. Pediatr Int 2009;51:460-3.