İshak AYDEMİR, Müge ARSLAN, İndrani KALKAN

Karbonhidrat Sayımı Uygulayan Tip1 Diyabetli Yetişkin Bireylerin, Duygusal İştah Durumlarının Değerlendirilmesi ve Vücut Kütle İndeksi ile İlişkisinin Belirlenmesi

Amaç: Karbonhidrat sayımı uygulayan Tip 1 Diabetes Mellitus’lu (T1DM) yetişkin bireylerin duygusal iştah durumlarının değerlendirilmesini ve Vücut Kütle İndeksi (VKİ) ile ilişkisinin belirlemesidir. Gereç ve Yöntemler: Bu araştırmanın türü betimsel ve ilişkisel tarama modelidir. Araştırma gönüllülük esasına dayanmakta olup, araştırmada, Hatay ilinde bulunan üç özel hastanenin endokrin bölümüne ayakta tedavi olan ve karbonhidrat sayımı yöntemi uygulayan 118 T1DM’ lu bireye 41 sorudan oluşan anket uygulanmıştır. Bulgular: Çalışmaya katılan bireylerin %59,3’ü normal , %24,6 ‘sı fazla kilolu , %11,9’u obez ve %4,2’si zayıftır. VKİ bakımından normal olan bireyler; en fazla %53,4 ile hızlı-uzun etkili insülin kullanmaktadır, fazla kilolular %33,3 ve obezler ise %66,7 ile en fazla kısa etkili insülin kullanmaktadır. Bireylerin, negatif duygu ve olay karşısında duygusal iştahları azalmış, pozitif duygu ve olay durumlarında ise duygusal iştahları değişmemiştir. Bireylerin duygu iştah durumları ile VKİ arasında istatistiksel olarak anlamlı bir farklılık saptanmış olup (p=0,004) negatif olay karşısında fazla kilolular ve obezler de duygusal iştah aynı kalırken, normal ve zayıflar bireylerde ise duygusal iştah azalmıştır. Duygusal iştah durumu ile insülin tipleri arasında istatistiksel olarak anlamlı bir farklılık saptanmıştır (p=0,013) ve kısa etkili insülin kullananların, negatif olay karşısında duygusal iştahları bozulmuş olup, yavaş etkili insülin kullananların ise pozitif olay (p=0,005) ve pozitif duygu (p=0,05) durumlarında, duygusal iştahları bozulmuştur.Sonuç: Normal ve zayıf olan karbonhidrat sayımı uygulayan T1DM’lu bireylerin duygusal iştah durumları, olumsuz olaylarda azalmaktadır.

Anahtar Kelimeler:

Karbonhidrat sayımı, Duygusal iştah, VKİ, İnsülin, T1DM

Assessment of Emotional Appetite Status of Adult Individuals with Type 1 Diabetes Using Carbohydrate Counting and its Relationship with Body Mass Index

Aim: The aim of this study was to evaluate of emotional appetite status of adult individuals with type 1 diabetes mellitus (T1DM) using carbohydrate counting (CC) and its relationship with Body Mass Index. Material and Methods: This is a descriptive and relational survey model study. The patients were chosen on a voluntary basis and 118 individuals with T1DM using CC in the endocrine outpatient clinics of three private hospitals located in Hatay. A questionnaire consisting of 41 questions were applied to the participants.Results: BMI assesment indicated that 59.3 of the individuals were normal, 24.6% were overweight, 11.9% were obese and 4.2% were underweight. Individuals with normal BMI mostly used (53.4%) rapid-long-lasting insulin wheras 33.3% overweight patients and 66.7% obese patients preferred short lasting insulin. The emotional appetite of the individuals decreased during negative emotion and event but remained unaffected during positive emotion and event. A significant relation was found between the individuals’ emotional appetite and BMI (p=0.004). During negative events, appetite remained unchanged in overweight and obese subjects whereas it decreased in normal and underweight. A significant relation (p=0.013) was found between the type of insulin used and emotional events. Emotional appetite was impaired during negative event in short-lasting insulin users wheras in slow acting insulin users the same effect was observed during positive event (p=0.005) and positive emotion (p=0.05). Conclusion: Emotional appetite of normal and underweight patients with T1DM carbohydrate counting decreases during negative events.

Keywords:

Carbohydrate counting, Emotional appetite, Insulin, Type 1 diabetes,

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1. International Diabetes Federation. IDF Diabetes. 7 ed. Brussels, Belgium: International Diabetes Federation; 2015.
2. Guariguata L, Whiting DR, Hambleton I, et al. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014;2:137-149.
3. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complication in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329: 977-986.
4. Anderson EJ, Richardson M, Castle G, Cercone S, Delahanty L, Lyon R, Mueller D, Snetselaar L. Nutrition interventions for intensive therapy in the diabetes control and complications trial. J Am Diet Assoc. 1993;93(7):768-772.
5. Bell KJ, Barclay AW, Petocz P, Colagiuri S, and Brand- Miller JC. Efficacy of carbohydrate counting in type 1 diabetes: A systematic review andmeta-analysis. Lancet Diabetes Endocrinol. 2014;2:133-140.
6. Tascini G, Berioli MG, Cerquiglini L, Santi E, Mancini G, Rogari F, Toni G, Esposito S. Carbohydrate counting in children and adolescents with type 1 diabetes. Nutrients. 2018;10:109-119.
7. Kawamura T. The importance of carbohydrate counting in the treatment of children with diabetes. Pediatr Diabetes. 2007;6:57-62.
8. Sheard NF, Clark NG, Brand-Miller JC, Franz MJ, Pi-Sunyer FX, Mayer-Davis E, Kulkarni K, Geil P. Dietary carbohydrate (amount and type) in the prevention and management of diabetes: a statement by the American diabetes association. Diabetes Care. 2004;27:2266-2271.
9. American Diabetes Association Standards of Medical Care in Diabetes Approaches to Glycemic Treatment. Diabetes Care. 2015;38(1):41-48.
10. Wolever T, Bolognesi C. Source and amount of carbohydrate affect postprandial glucose and insulin in normal subjects. J Nutr. 1996;126(11):2798-2806.
11. Rabasa-Lhoret R, Garon J, Langelier H, Poisson D, Chiasson JL. Effects of meal carbohydrate content on insulin requirements in type 1 diabetic patients treated intensively with the basal- bolus (ultralente-regular) insulin regimen. Diabetes Care. 1999;22(5):667-673.
12. Schmidt S, B Schelde B, and Nørgaard K. Effects of advanced patients with type a systematic review. Diabetic Medicine. 2014;31(8):886-896.
13. Gupta L, Khandelwal D, Singla R, Gupta P, Kalra S. Pragmatic dietary advice for diabetes during Navratris. Indian J Endocrinol Metab. 2017;21:231-237.
14. Duman RS. Neurotropicfactors and regulation of mood: Role of exercise, diet and metabolism. Neurobiol Aging. 2005;26(1): 88-93.
15. Slochower J. Excessive eating: The role of emotions and environment. Human Sciences Pres, New York. 1983.
16. Macht M, Simons G. Emotions and eating in every day life. Appetite. 2000;35:65-71.
17. Macht M. How emotions affect eating: A fiveway model. Appetite. 2008;50:1- 11.
18. Brinkworth GD, Buckley JD, Noakes M, Clifton PM, Wilson CJ. Long-term effects of a very low-carbohydrate diet and a low-fat diet on mood and cognitive function. Arch Intern Med. 2009;169(20):1873-1880.
19. D’Anci KE, Watts KL, Kanarek RB, Taylor HA. Low- carbohydrate weight loss diets. Effects on cognition and mood. Appetite. 2009;52(1):96-103.
20. World Health Organization, Body mass index - BMI (http:// www.euro.who.int/en/health-topics/disease-prevention/ nutrition / a-healthy-lifestyle / body-mass-index-bmi, Accessed Date:20.10.2019).
21. Nolan L, Halperin L, Geliabter A. Emotional Appetite Questionnaire. Construct validity and relationship with BMI. Appetite. 2010;54(2):314-319
22. Demirel B, Yavuz KF, Karadere ME, Safak Y, Turkcapar MH. Duygusal İştah Anketi’nin Türkçe Geçerlik ve Güvenilirliği, Beden Kitle İndeksi ve Duygusal Şemalarla İlişkisi. Bilişsel Davranışçı Psikoterapi ve Araştırmalar Dergisi. 2014; 3: 171- 181
23. Yıldız K. Türkiye’deki Yoğun İnsülin Tedavisi Alan Diyabetli Bireylerin Karbonhidrat Sayımı Metodunu Kullanım Durumlarının HBA1C Düzeylerine Etkisi. Yüksek Lisans Tezi, İstanbul: İstanbul Üniversitesi Sağlık Bilimleri Enstitüsü, İçhastalıkları Anabilim Dalı, 2018.
24. İlkova H, Damci T, Karsidag K, Çömlekçi A, ve Ayvaz G. The ınternational diabetes management practices study (IDMPS) Turkey’s 5th wave results. Turkish Journal of Endocrinology and Metabolism. 2016;20(3): 88-96.
25. Son O, Efe B, Erenoğlu Son N, Akalin A, Kebapçi N. Investigation on carbohydrate counting method in type 1 diabetic patients. Biomed Res Int. 2014;2014:176564.