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Besli GE, Hepokur MN, Sahin SE, Onder A, Yildiz M, Bulut I, Emeksiz HC. Implementation and Outcome of a Protocol-Based Treatment for Diabetic Ketoacidosis in a Tertiary Care Pediatric Emergency Department. J Emerg Med 2025; 71:10-22. [PMID: 39988493 DOI: 10.1016/j.jemermed.2024.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 10/19/2024] [Accepted: 10/27/2024] [Indexed: 02/25/2025]
Abstract
BACKGROUND The standardization of clinical practice in emergency treatment of diabetic ketoacidosis (DKA) is a prerequisite for improving patient care. For this purpose, a standardized DKA protocol incorporating a two-bag system has been implemented since January 2020 in our center. OBJECTIVES To assess the impact of the development and utilization of the standard treatment pathway for DKA on patient outcomes. METHODS This retrospective cohort study involved patients diagnosed with DKA and admitted to the pediatric emergency department (PED). The entire period of the study was from January 2017 to September 2022. Patients with DKA managed before and after implementation of the protocol were compared in terms of clinical outcomes. RESULTS Out of 145 patients, 77 (53%) patients were in the pre-protocol group, 68 (47%) were in the protocol group. Age, sex, and severity of DKA were similar between the groups. Implementation of the protocol resulted in shorter resolution time of acidosis and ketosis (p = 0.007, p < 0.001, respectively), higher correction rates of bicarbonate and blood ketones (p = 0.003, p < 0.001, respectively), shorter duration of IV insulin treatment (p = 0.008), more appropriate potassium dosage administrating to IV fluids (p < 0.001), lower incidence of hypokalemia, hypophosphatemia, and hypoglycemia (p = 0.008, p = 0.002, p = 0.036, respectively), and smaller number of IV bags use (p < 0.001). CONCLUSION Implementation of a protocol-based pathway for DKA involving a two-bag system provided earlier correction of ketoacidosis, decreased the risk of complications, and reduced resource utilization in the PED.
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Affiliation(s)
- Gulser Esen Besli
- Faculty of Medicine, Istanbul Medeniyet University, Üsküdar, İstanbul, Turkey; Department of Pediatric Emergency Medicine, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Kadikoy, Istanbul, Turkey.
| | - Merve Nur Hepokur
- Department of Pediatric Endocrinology, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Kadikoy, Istanbul, Turkey
| | - Sibel Ergin Sahin
- Department of Pediatric Endocrinology, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Kadikoy, Istanbul, Turkey
| | - Asan Onder
- Department of Pediatric Endocrinology, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Kadikoy, Istanbul, Turkey
| | - Metin Yildiz
- Department of Pediatric Endocrinology, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Kadikoy, Istanbul, Turkey
| | - Irem Bulut
- Department of Pediatrics, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Kadikoy, Istanbul, Turkey
| | - Hamdi Cihan Emeksiz
- Faculty of Medicine, Istanbul Medeniyet University, Üsküdar, İstanbul, Turkey; Department of Pediatric Endocrinology, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Kadikoy, Istanbul, Turkey
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Mohd Nor NS, Anuar Zaini A, Jalaludin MY. Self-care management among children and adolescents with diabetes mellitus in Malaysia. J Child Health Care 2024; 28:804-814. [PMID: 37029637 DOI: 10.1177/13674935231168911] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
The study aimed to evaluate diabetes self-care among diabetic children and adolescents and compare with glycaemic control. Summary of Diabetes Self-Care Activities (SDSCA) questionnaire was distributed to patients aged 10-18 years with types 1 and 2 diabetes mellitus (DM) at paediatric diabetes clinics in Malaysia. Haemoglobin A1c levels were measured after questionnaire completion. A total of 106 patients completed the questionnaire with a mean age of 13.91 (± SD 2.48) years. Mean haemoglobin A1c and SDSCA score were 9.78 (± SD 2.43)% and 19.09 (± SD 5.81), respectively. Type 1 DM patients had significantly higher haemoglobin A1c (10.11 95% CI [9.62, 10.59] vs 8.38 95% CI [7.13, 9.62]). Total score was higher in type 1 DM although not statistically significant (19.32 95% CI [18.21, 20.43] vs 18.08 95% CI [14.28, 21.87]). Blood glucose testing score was significantly higher in type 1 DM (5.24 95% CI [4.82, 5.66] vs 3.50 95% CI [2.23, 4.77]). There was statistically significant negative correlation between score in diet subcategory and haemoglobin A1c. In conclusion, self-care activities among diabetic children and adolescents are still suboptimal. Self-care activities on blood glucose testing are significantly better in type 1 DM. Diet section correlated well with glycaemic control necessitating further research.
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Affiliation(s)
- Noor Shafina Mohd Nor
- Department of Paediatrics, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sungai Buloh, Malaysia
| | - Azriyanti Anuar Zaini
- Division of Paediatric Endocrinology, Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Muhammad Yazid Jalaludin
- Division of Paediatric Endocrinology, Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
- University Malaya Paediatric and Child Health Research Group, University Malaya, Kuala Lumpur, Malaysia
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Ceran MA, Bektaş M, Eklioğlu BS. Development and psychometric evaluation of the type 1 diabetes mellitus self-management scale for parents. Eur J Pediatr 2024; 183:3767-3776. [PMID: 38864877 PMCID: PMC11322394 DOI: 10.1007/s00431-024-05650-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/29/2024] [Accepted: 06/10/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND/AIM Diabetes has become a global epidemic, necessitating effective self-management strategies. This is particularly crucial for parents of children with type 1 diabetes mellitus, as they must make numerous daily decisions and perform complex care activities. Therefore, the aim of this study was to develop a comprehensive diabetes self-management scale specifically for parents of children with type 1 diabetes. This scale aims to holistically address behaviors impacting diabetes self-management and to evaluate its psychometric properties. MATERIALS AND METHODS A methodological, correlational, and cross-sectional study was conducted with a sample of 190 parents of children with type 1 diabetes mellitus. The scale items were reviewed by five experts to ensure they adequately covered the parents' evaluation of their children's diabetes self-management. Following this, a Turkish language expert assessed the draft scale for language accuracy, comprehensibility, and grammar. The data were analyzed using descriptive statistics (numbers and percentages), Cronbach's α reliability coefficient, factor analysis, and correlation analysis. RESULTS The Cronbach's alpha for the overall scale was 0.893, and the Cronbach's alpha for the subscales was between 0.757 and 0.845. The item-total score correlations ranged between 0.408 and 0.660 (p < .05). The exploratory factor analysis showed that the scale explained 61.427% of the total variance, and the factor loadings of items ranged from 0.574 to 0.859. The confirmatory factor analysis also showed that the factor loadings of the scale items ranged from 0.574 to 0.859. CONCLUSION The validity and reliability analyses revealed that the scale is a valid and reliable measurement tool for the Turkish culture.
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Affiliation(s)
- Merve Aşkın Ceran
- Department of Pediatric Nursing, Institute of Health Sciences, Dokuz Eylul University, İzmir, Türkiye.
- KTO Karatay University, Vocational School of Health Services, Konya, Türkiye.
| | - Murat Bektaş
- Department of of Pediatric Nursing, Dokuz Eylul University, Faculty of Nursing, İzmir, Türkiye
| | - Beray Selver Eklioğlu
- Division of Pediatric Endocrinology, Necmettin Erbakan University Faculty of Medicine, Konya, Türkiye
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Askin Ceran M, Keser MG, Bektas M, Unusan N, Selver Eklioglu B. The Impact of Dietary Habits on Sleep Deprivation and Glucose Control in School-Aged Children with Type 1 Diabetes: A Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:779. [PMID: 39062227 PMCID: PMC11276351 DOI: 10.3390/children11070779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/22/2024] [Accepted: 06/23/2024] [Indexed: 07/28/2024]
Abstract
Diet plays a crucial role in managing type 1 diabetes (T1DM). Background/Objectives:This study aimed to determine the impact of nutritional habits on sleep deprivation and glucose control in school-aged children with T1DM. Methods: In this cross-sectional study, nutritional habits and sleep deprivation were assessed in 100 school-aged children with T1DM, aged 7-13 years. The Dietary Habits Index and the Sleep Deprivation Scale for Children and Adolescents were used to evaluate nutritional habits and the level of sleep deprivation. Patients' sociodemographic and nutritional variables were collected through researcher-composed questionnaires. HbA1c levels over the past 6 months were obtained from the patient data system. Results: The study found a moderately strong positive correlation between the Dietary Habits Index score and HbA1c (p < 0.001), with 28% of the variation in HbA1c explained by changes in the Dietary Habits Index score. However, no correlation was found between the Dietary Habits Index score and the level of sleep deprivation. Conclusions: The nutritional habits of school-aged children with T1DM may affect glucose control and sleep deprivation. Therefore, it is important to educate children with T1DM on making healthy food choices to manage their condition effectively.
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Affiliation(s)
- Merve Askin Ceran
- Department of Pediatric Nursing, Health Science Institute, Dokuz Eylul University, İzmir 35340, Türkiye;
- Vocational School of Health Services, KTO Karatay University, Konya 42020, Türkiye
| | - Muteber Gizem Keser
- Department of Nutrition and Dietetics, Faculty of Health Sciences, KTO Karatay University, Konya 42020, Türkiye;
| | - Murat Bektas
- Department of Pediatric Nursing, Faculty of Nursing, Dokuz Eylul University, İzmir 35340, Türkiye;
| | - Nurhan Unusan
- Department of Nutrition and Dietetics, Faculty of Health Sciences, KTO Karatay University, Konya 42020, Türkiye;
| | - Beray Selver Eklioglu
- Division of Pediatric Endocrinology, Faculty of Medicine, Necmettin Erbakan University, Konya 42090, Türkiye;
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Kandemir N, Vuralli D, Ozon A, Gonc N, Ardicli D, Jalilova L, Gulcek ON, Alikasifoglu A. Epidemiology of type 1 diabetes mellitus in children and adolescents: A 50-year, single-center experience. J Diabetes 2024; 16:e13562. [PMID: 38664892 PMCID: PMC11045915 DOI: 10.1111/1753-0407.13562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 12/07/2023] [Accepted: 03/10/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Global variations in epidemiology of type 1 diabetes mellitus (T1DM) exist. This study is designed to examine demographic and clinical features of T1DM over the past 3 decades as well as evolving trends in epidemiology over last 50 years. METHODS Clinical characteristics of 925 patients with T1DM over last 30 years (1990-2019) were evaluated and compared to previously published data of 477 patients diagnosed between 1969 and 1990 from one of the major referral centers for diabetes in Turkey. RESULTS Mean age at diagnosis decreased from 9.5 ± 4.0 to 7.1 ± 3.6 years within the past 50 years (p < .001). Age at diagnosis peaked at 12-14 years between 1969 and 1990, then fell to 10-11.9 years between 1990 and 1999, and to 4-5.9 years between 2000-2009 and 2010-2019 (p = .005). Although the percentage of patients diagnosed <6 years of age is gradually increasing, the percentage between the ages of 6 and 11.9 years is decreasing, and the percentage diagnosed ≥12 years remained stable. A total of 47.5% of patients had ketoacidosis, 38.2% had ketosis, and 14.3% had only hyperglycemia. 23% of patients had severe diabetic ketoacidosis (DKA), whereas 42% had moderate. Over last 3 decades, there has been no change in frequency of ketoacidosis at presentation, but there has been significant decline in severity (p = .865, and p < .001, respectively). Although the frequency of patients with mild DKA increased over time, frequency of patients with moderate DKA decreased; however, no significant difference was observed among patients with severe ketoacidosis. DKA was more frequent and severe in patients <6 years of age (p = .005, and p < .001, respectively). CONCLUSION Age at diagnosis shifted to younger ages in T1DM in the past 50 years. Half of patients had ketoacidosis at diagnosis and frequency of presentation with DKA did not decrease, but severity decreased slightly. Increase in prevalence of T1DM in the younger age group and the fact that half of patients present with DKA indicate that awareness should be increased in terms of early diagnosis and treatment.
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Affiliation(s)
- Nurgun Kandemir
- Hacettepe University Faculty of MedicineDepartment of Pediatric EndocrinologyAnkaraTurkey
| | - Dogus Vuralli
- Hacettepe University Faculty of MedicineDepartment of Pediatric EndocrinologyAnkaraTurkey
| | - Alev Ozon
- Hacettepe University Faculty of MedicineDepartment of Pediatric EndocrinologyAnkaraTurkey
| | - Nazlı Gonc
- Hacettepe University Faculty of MedicineDepartment of Pediatric EndocrinologyAnkaraTurkey
| | - Didem Ardicli
- Hacettepe University Faculty of MedicineDepartment of PediatricsAnkaraTurkey
| | - Lala Jalilova
- Hacettepe University Faculty of MedicineDepartment of PediatricsAnkaraTurkey
| | - Omer Nazim Gulcek
- Hacettepe University Faculty of MedicineDepartment of PediatricsAnkaraTurkey
| | - Ayfer Alikasifoglu
- Hacettepe University Faculty of MedicineDepartment of Pediatric EndocrinologyAnkaraTurkey
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Sari SA, Agadayi E, Celik N, Karahan S, Komurluoglu Tan A, Doger E. The Turkish version of the problem areas in diabetes-parents of teens (P-PAID-T): Cross-cultural adaptation, reliability, and validity. J Pediatr Nurs 2023; 73:e146-e153. [PMID: 37573154 DOI: 10.1016/j.pedn.2023.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE To examine the Turkish validity and reliability of the Problem Areas in Diabetes- Parents of Teens (P-PAID-T) scale and its psychometric properties for determining the parents' diabetes-related distress. METHODS The study included the parents of 200 adolescents with T1DM for at least a year. P-PAID-T and a demographic data form were used for data collection. Davis technique was used for the content validity of the scale. The scale's reliability was tested using test-retest, and its internal reliability was analyzed with Cronbach's alpha test. Exploratory Factor Analysis (EFA) was used to analyze the factor structure. Confirmatory Factor Analysis (CFA) was used to evaluate the fit of the scale. RESULTS 69.5% (n = 139) of the participants were mothers. Compared to the fathers, the mothers' mean P-PAID-T score was significantly higher. Parents of sons, who used insulin injections for their children, and had a college degree or higher education level had higher P-PAID-T scores. The test-retest correlation coefficient of the scale was 0.977. The Cronbach α value of the scale was 0.901. The results of confirmatory factor analysis were x2/df = 2.931, GFI = 0.736, CFI = 0.711, NFI = 0.628, NNFI = 0.660, RMSEA = 0.141. CONCLUSION The Turkish version of P-PAID-T was a valid and reliable screening tool for measuring diabetes stress in parents of adolescents with T1DM. PRACTICE IMPLICATIONS Nurses could use the Turkish version of P-PAID-T to monitor parental diabetes distress and organize interventions; also Turkish P-PAID-T could facilitate research on diabetes distress for parents of adolescents with T1DM.
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Affiliation(s)
- Seda Aybuke Sari
- Department of Child and Adolescent Psychiatry, Hatay Mustafa Kemal University Faculty of Medicine Hatay/Turkey (prev: Department of Child and Adolescent Psychiatry, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey.
| | - Ezgi Agadayi
- Department of Medical Education, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Nurullah Celik
- Department of Pediatric Endocrinology, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Seher Karahan
- Department of Medical Education, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Ayça Komurluoglu Tan
- Department of Pediatrics, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Esra Doger
- Department of Pediatric Endocrinology, Gazi University Faculty of Medicine, Ankara, Turkey
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Jin M, Liu J, Liu K, Zhao Z, Sun S. Evaluation of sympathetic skin response for early diagnosis and follow-up of diabetic peripheral neuropathy in children. BMC Pediatr 2023; 23:483. [PMID: 37741963 PMCID: PMC10517453 DOI: 10.1186/s12887-023-04323-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/20/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND The morbidity of type 1 diabetes mellitus (T1DM) in children is increasing and diabetic peripheral neuropathy (DPN) is one of the main microvascular complications of T1DM. The aim of this study was to explore sympathetic skin response (SSR) characteristics in children with T1DM and analyze the value of early diagnosis and follow-up in T1DM complicated with DPN. METHODS Our prospective study enrolling 85 participants diagnosed with T1DM and 30 healthy controls (HCs) in the Children's Hospital of Hebei Province from 2017 to 2020. Compared the outcomes of SSR and nerve conduction study (NCS) in T1DM, and evaluated the variations in SSR and NCS of different durations, as well as changes after six months of therapy. RESULTS SSR latency of T1DM group showed statistical difference as compared to HCs (p < 0.05). The SSR test was more sensitive than the NCS test in the early diagnosis of T1DM with DPN (p < 0.05). The abnormal rates of SSR and NCS in long duration of disease were higher than those in short duration of disease (p < 0.05). Among 65 participants with diabetic neuropathy, the onset latencies of SSR were shortened and the NCS were improved after treatment (p < 0.05). CONCLUSIONS SSR could provide the accurate early diagnosis and follow-up of pediatric diabetic peripheral neuropathy.
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Affiliation(s)
- Mei Jin
- The Children Hospital of Hebei Province, Shijiazhuang, Hebei, 050000, China
- The Key Laboratory of Pediatric Epilepsy and Neurological Disorders of Hebei Province, Shijiazhuang, Hebei, 050000, China
| | - Jing Liu
- The Children Hospital of Hebei Province, Shijiazhuang, Hebei, 050000, China
| | - Kang Liu
- The Children Hospital of Hebei Province, Shijiazhuang, Hebei, 050000, China
- The Key Laboratory of Pediatric Epilepsy and Neurological Disorders of Hebei Province, Shijiazhuang, Hebei, 050000, China
| | - Ziwei Zhao
- The Children Hospital of Hebei Province, Shijiazhuang, Hebei, 050000, China
| | - Suzhen Sun
- The Children Hospital of Hebei Province, Shijiazhuang, Hebei, 050000, China.
- The Key Laboratory of Pediatric Epilepsy and Neurological Disorders of Hebei Province, Shijiazhuang, Hebei, 050000, China.
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İpar N, Boran P, Barış HE, Us MC, Aygün B, Haliloğlu B, Gökçe T, Can E, Eviz E, İnan NG, Mutlu GY, Bereket A, Hatun Ş. Associations between sleep characteristics and glycemic variability in youth with type 1 diabetes. Sleep Med 2023; 109:132-142. [PMID: 37437493 DOI: 10.1016/j.sleep.2023.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE This study aimed to determine sleep characteristics and their associations with glycemic variability in youth with type 1 diabetes (T1D). MATERIAL AND METHODS This cross-sectional study conducted at two pediatric diabetes centers in Istanbul, Turkey, included 84 children with T1D (mean age 10.5 years). Sleep characteristics and glycemic variability were determined by actigraphy, DSM-5 Level 2-Sleep Disturbance Scale Short Form and continuous glucose monitoring. Circadian preference was evaluated by the Children's Chronotype Questionnaire. Sleep disturbances were assessed by the. The sleep quality was determined by actigraphy-derived sleep measures. RESULTS Eighty-eight percent of participants had insufficient age-appropriate total sleep time (TST) (<9 h for 6-13-year-olds and <8 h for 14-17-year-olds). Chronotype was classified as intermediate in 50%, evening in 45.2%, and morning in 4.8%. A higher chronotype score indicating a stronger eveningness preference was associated with more time spent in hypoglycemia (β = 0.433, p = 0.002). On nights when participants had lower sleep efficiency and longer sleep onset latency, they had significantly higher overnight glycemic variability (β = -0.343, p = 0.016, β = 0.129, p = 0.017, respectively). Prolonged nocturnal wake duration was significantly associated with more time spent in daytime hypoglycemia (β = 0.037, p = 0.046) and higher overnight glycemic variability (J index, β = 0.300, p = 0.015). The associations between TST and glycemic variability indices were not significant. CONCLUSIONS Sleep quality rather than TST was significantly associated with glycemic variability in children with T1D. Eveningness preference might contribute to an increased risk of hypoglycemia. Addressing sleep patterns and chronotypes can be crucial in management plans for youth with T1D.
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Affiliation(s)
- Necla İpar
- Institute of Health Sciences, Social Pediatrics PhD Program, Marmara University, Istanbul, Turkey; Department of Pediatrics, Koc University School of Medicine, Istanbul, Turkey.
| | - Perran Boran
- Institute of Health Sciences, Social Pediatrics PhD Program, Marmara University, Istanbul, Turkey; Department of Pediatrics, Division of Social Pediatrics, Marmara University School of Medicine, Istanbul, Turkey.
| | - Hatice Ezgi Barış
- Institute of Health Sciences, Social Pediatrics PhD Program, Marmara University, Istanbul, Turkey; Department of Pediatrics, Division of Social Pediatrics, Marmara University School of Medicine, Istanbul, Turkey.
| | - Mahmut Caner Us
- Institute of Health Sciences, Social Pediatrics PhD Program, Marmara University, Istanbul, Turkey.
| | - Burcu Aygün
- Institute of Health Sciences, Social Pediatrics PhD Program, Marmara University, Istanbul, Turkey.
| | - Belma Haliloğlu
- Department of Pediatrics, Division of Pediatric Endocrinology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Tuğba Gökçe
- Department of Pediatrics, Division of Pediatric Endocrinology, Koç University School of Medicine, Istanbul, Turkey.
| | - Ecem Can
- Department of Pediatrics, Division of Pediatric Endocrinology, Koç University School of Medicine, Istanbul, Turkey.
| | - Elif Eviz
- Department of Pediatrics, Division of Pediatric Endocrinology, Koç University School of Medicine, Istanbul, Turkey.
| | - Neslihan Gökmen İnan
- College of Engineering, Department of Computer Engineering, Koc University, Istanbul, Turkey.
| | - Gül Yeşiltepe Mutlu
- Department of Pediatrics, Division of Pediatric Endocrinology, Koç University School of Medicine, Istanbul, Turkey.
| | - Abdullah Bereket
- Department of Pediatrics, Division of Pediatric Endocrinology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Şükrü Hatun
- Department of Pediatrics, Division of Pediatric Endocrinology, Koç University School of Medicine, Istanbul, Turkey.
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ÇİFTCİ N, ÇAMTOSUN E, DÜNDAR İ, AKINCI A. Ana sınıfında veya ilkokulda okuyan tip 1 diabetes mellitus tanılı çocukların okulda hastalık yönetimi ile ilgili yaşadıkları sorunlar. EGE TIP DERGISI 2023. [DOI: 10.19161/etd.1262450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Amaç: Tip 1 diabetes mellitus (T1DM) tanılı çocuklar diyabet öz bakımında gözetime ihtiyaç duymaktadırlar ve günün önemli bir kısmını geçirdikleri okuldaki koşullar hastalık yönetimini
etkilemektedir. Bu çalışmanın amacı, T1DM tanılı ana sınıfı ve ilkokul çağındaki çocukların okulda hastalık yönetimi ile ilgili karşılaştıkları sorunları ortaya koymaktır.
Gereç ve Yöntem: Bu kesitsel çalışmaya T1DM tanılı 5-10 yaş aralığındaki 50 hasta dahil edildi. Literatür doğrultusunda araştırmacı tarafından geliştirilen okulda diyabet yönetimiyle ilgili anket,
Google anket formu aracılığıyla hasta ve/veya ebeveynleri tarafından dolduruldu. Elde edilen veriler tanımlayıcı istatistiksel yöntemlerle analiz edildi.
Bulgular: Hastaların ortalama diyabet süreleri 5,39±2,56 yıldı. Olguların %94’ü devlet okuluna gidiyordu. Okulların %78’inde sağlık bakım odası, %92’sinde hemşire/sağlık personeli yoktu. Olguların %86’sı okulda ana öğün alıyordu, ancak bunların büyük çoğunluğu öğününü evden getiriyor veya eve gidip yiyordu. Beslenme ile ilgili en sık sorun okulda diyete uygun olmayan gıdaların tüketilmesiydi. Çocukların %6’sında okulda kan şekeri ölçümü yapılmıyordu. Okulda hipoglisemi yaşamış olanların sıklığı %40 olup en sık müdahale eden kişi öğretmendi (%55). Okulda insülin uygulanan çocukların %77,5’inde uygulamayı anne veya baba yapıyordu. İnsülin uygulamada yaşanan en sık sorunlar okulda uygulayabilecek kişinin ve uygun ortamın olmaması idi. Beden eğitimine katılım %98’di. Çocuklar öğretmen ve okul yönetiminden yüksek oranda olumlu yaklaşım görürken, %18 çocuk,arkadaşlarının olumsuz yaklaşımına maruz kalmaktaydı.
Sonuç: T1DM tanılı çocuklar okulda beslenme, kan şekeri ölçümü ve insülin uygulama konularında zorluklar yaşamaktadırlar. Okullarda sağlık bakım odası ve/veya sağlık personeli çoğunlukla
bulunmamaktadır. Okulda insülin uygulama konusunda deneyimli kişi olmaması nedeniyle bunu genellikle ebeveynler yapmaktadır.
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Affiliation(s)
- Nurdan ÇİFTCİ
- Malatya Eğitim ve Araştırma Hastanesi Pediatrik Endokrinoloji Kliniği, Malatya, Türkiye
| | - Emine ÇAMTOSUN
- İnönü Üniversitesi Tıp Fakültesi Pediatrik Endokrinoloji Kliniği, Malatya, Türkiye
| | - İsmail DÜNDAR
- İnönü Üniversitesi Tıp Fakültesi Pediatrik Endokrinoloji Kliniği, Malatya, Türkiye
| | - Ayşehan AKINCI
- İnönü Üniversitesi Tıp Fakültesi Pediatrik Endokrinoloji Kliniği, Malatya, Türkiye
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Hashemipour M, Maracy M, Javanmard SH, Zamaneh F, Mostofizadeh N, Hovsepian S. Trends in incidence rates of childhood type 1 diabetes mellitus: A retrospective study in Isfahan province, Iran. J Diabetes Investig 2023; 14:376-386. [PMID: 36695001 PMCID: PMC9951581 DOI: 10.1111/jdi.13975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/20/2022] [Accepted: 12/27/2022] [Indexed: 01/26/2023] Open
Abstract
AIMS/INTRODUCTION We aimed to determine the incidence trend of childhood type 1 diabetes mellitus in Isfahan province over a period of 12 years. MATERIALS AND METHODS In this retrospective study, children aged <20 years at the time of type 1 diabetes mellitus diagnosis, from March 2007 to March 2019, were included. The crude and adjusted incidence rate of type 1 diabetes mellitus is calculated as the number of cases per 100,000 person-years by the period. The cumulative, age- and sex-specific incidence rates were also calculated. Age-specific incidence rates were calculated for age and sex groups. RESULTS A total of 1,954 (983 boys and 971 girls) cases of type 1 diabetes mellitus were identified. The mean age at diagnosis in all studied populations was 9.89 (standard deviation 4.76). There were no significant differences between the proportion of boys and girls in different years (P = 0.12) and different age groups (P = 0.19). The average annual percent change of incidence rate for the total population, for girls and boys, was 6.9%, 6.7% and 6.3% respectively. The type 1 diabetes mellitus incidence rate had a significant trend to be increased from 2007 to 2019 (P < 0.001, t = 3.6). CONCLUSION Our findings showed that currently our region is considered a region with a high incidence rate of type 1 diabetes mellitus. Although we have had fluctuations in the incidence rate over the 12 years, the overall trend is increasing.
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Affiliation(s)
- Mahin Hashemipour
- Metabolic Liver Diseases Research Center, Isfahan Endocrine and Metabolism Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Mohammadreza Maracy
- Department of Epidemiology and Biostatistics, School of HealthIsfahan University of Medical SciencesIsfahanIran
| | | | - Farzane Zamaneh
- Metabolic Liver Diseases Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Neda Mostofizadeh
- Department of Pediatric Endocrinology, Isfahan Endocrine and Metabolism Research Center, Imam Hossein Children's HospitalIsfahan University of Medical SciencesIsfahanIran
| | - Silva Hovsepian
- Metabolic Liver Diseases Research Center, Imam Hossein Children's HospitalIsfahan University of Medical SciencesIsfahanIran
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Onder Camas A, Özel ŞK, Kocabey Sütçü Z, Hepokur M, Emeksiz HC. Evaluation of bladder dysfunction in children and adolescents with type 1 diabetes mellitus by uroflowmetry. J Pediatr Endocrinol Metab 2023; 36:25-28. [PMID: 36412007 DOI: 10.1515/jpem-2022-0503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/05/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Diabetic cystopathy is a condition characterized by decreased bladder sensitivity, increased bladder capacity, decreased bladder contractility and increased residual urine volume. It can also be considered as an early indicator of autonomic dysfunction. In this study, it was aimed to evaluate bladder functions by uroflowmetry in children and adolescents with the diagnosis of type 1 diabetes mellitus. METHODS Type 1 diabetes mellitus children and adolescents were applied uroflowmetry and post-void residual urine volumes were evaluated. The physical examination findings of the patients and the laboratory data of diabetes control were obtained from the clinic files. RESULTS A total of 51 cases aged 72-216 (155.6 ± 35.4) months were enrolled into the study. Diabetes age of the cases was 66.5 ± 46.2(13-180) months. The last one year average of HbA1c of the patients was found to be 9.7 ± 1.9%. A total of 9.8% had good, 39.2% moderate and 51% poor metabolic control, respectively. While urodynamic evaluation was normal in 36 (70.6%) of 51 participants, voiding dysfunction was found in 15. There was no statistically significant difference between groups with and without voiding dysfunction in terms of age, gender, duration of diabetes, metabolic control and HbA1c values. CONCLUSIONS It is very important to follow up patients with type 1 diabetes mellitus in terms of autonomic dysfunction. Diabetic bladder clinic, which can be observed independently of diabetes duration and metabolic control, is also included in this status. Urodynamic evaluation will be helpful both in demonstrating bladder dysfunction and in preventing possible complications.
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Affiliation(s)
- Asan Onder Camas
- Pediatric Endocrinology Clinic, Medeniyet University Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Şeyhmus Kerem Özel
- Pediatric Surgery Clinic, Medeniyet University Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Zümrüt Kocabey Sütçü
- Pediatric Endocrinology Clinic, Medeniyet University Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Merve Hepokur
- Pediatric Endocrinology Clinic, Medeniyet University Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Hamdi Cihan Emeksiz
- Pediatric Endocrinology Clinic, Medeniyet University Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
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12
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Yalcın SO, Kaplan AT, Sobu E. Corneal endothelial cell morphology and optical coherence tomography findings in children with type 1 diabetes mellitus. Eur J Ophthalmol 2022; 33:1331-1339. [PMID: 36544297 DOI: 10.1177/11206721221145983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose To evaluate central macular thickness, retinal nerve fibre layer thickness, corneal endothelial cell density and central corneal thickness in children with Type 1 Diabetes Mellitus (DM). Methods Thirty children with Type 1 DM and 30 age-matched children as controls were examined. Central macular thickness (CMT) and four quadrants of retinal nerve fibre layer thickness (RNFLT) were measured by optical coherence tomography (OCT), while endothelial cell density (ECD), coefficient of variation in cell size (CV), hexagonality (HEX) and central corneal thickness (CCT) were measured by noncontact specular microscopy. Results The mean ECD was 2810.77 ± 273.47 cells/mm2 and the mean hexagonality ratio was 49.77 ± 13.2 both were significantly lower (p < 0.001, p = 0.037 respectively) in the diabetic group compared to the control group. The mean CV was 37.6 ± 7.27, it was significantly higher (p = 0.024) in the diabetic group than the control group. The mean corneal thickness was greater in the DM group than the controls, but the difference was not significant (p = 0.176). There were no significant differences in CMT or RNFLT between the two groups. There was a negative correlation between the HbA1c levels and the thickness of the superior quadrants of RNFL (r = -0.406, p = 0.026). The duration of diabetes had no significant correlations with the corneal and retinal parameters. Conclusion The diabetic children had changes in corneal endothelial morphology and there was a negative correlation between HbA1c levels and superior quadrant of RNFLT.
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Affiliation(s)
- Sibel Oskan Yalcın
- Department of Ophthalmology, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Aysin Tuba Kaplan
- Department of Ophthalmology, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Elif Sobu
- Department of Pediatric Endocrinology, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
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Varol Fİ, Çamtosun E, Selimoğlu MA, Güngör Ş. Is There a Predictive Factor for an Association with Autoimmune Glandular Disease in Children Diagnosed with Celiac Disease? J Clin Res Pediatr Endocrinol 2022; 14:409-414. [PMID: 35770950 PMCID: PMC9724048 DOI: 10.4274/jcrpe.galenos.2022.2022-2-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE A close relationship has been suggested between Celiac disease (CD) and glandular autoimmunity. The aim of this study was to determine the predictive factors for autoimmune glandular disease (AGD) in children with CD. METHODS The study included 228 pediatric patients, diagnosed with CD between 2010 and 2019. The cases with AGD (Group 1) and those without AGD (Group 2) and the patients with type 1 diabetes mellitus (T1DM) (Group A) and those without T1DM (Group B) were retrospectively reviewed and compared in terms of clinical and laboratory features. RESULTS AGD was detected in 8.8% (n=20) of the patients: T1DM in 13 (65%), T1DM and Hashimoto’s thyroiditis (HT) in 3 (15%), HT only in 2 (10%), T1DM and Graves disease (GD) in 1 (5%), and GD only in 1(5%). The mean age at the diagnosis of CD was significantly higher in Group 1 (10.93±4.15 years) compared to Group 2 (8.10±4.19 years) (p<0.05) and also was significantly higher in Group A compared to Group B (p<0.05). Most of the diagnoses of AGD were made before the diagnosis of CD and age was an effective factor. There was no difference between Group 1 and Group 2 and Group A and Group B in terms of gender, typical/atypical CD ratio, tissue transglutaminase IgA (TTGA) level, human leucocyte antigen (HLA)-DQ2 and/or HLA-DQ8 positivity rate, and histopathological stage. CONCLUSION Although patients with a diagnosis of co-existent CD and AGD were significantly older than patients with isolated CD, gender, celiac symptoms, TTGA level, HLA type, and histopathological stage had no predictive value for the coexistence of AGD in patients with CD.
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Affiliation(s)
- Fatma İlknur Varol
- İnönü University Faculty of Medicine, Departments of Pediatric Gastroenterology, Hepatology, and Nutrition, Malatya, Turkey,* Address for Correspondence: İnönü University Faculty of Medicine, Departments of Pediatric Gastroenterology, Hepatology, and Nutrition, Malatya, Turkey Phone: +90 505 398 79 85 E-mail:
| | - Emine Çamtosun
- İnönü University Faculty of Medicine, Department of Pediatric Endocrinology, Malatya, Turkey
| | - Mukadder Ayşe Selimoğlu
- Memorial Ataşehir and Bahçelievler Hospitals, Clinic of Pediatric Gastroenterology, İstanbul, Turkey
| | - Şükrü Güngör
- İnönü University Faculty of Medicine, Departments of Pediatric Gastroenterology, Hepatology, and Nutrition, Malatya, Turkey
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Özalkak Ş, Yıldırım R, Tunç S, Ünal E, Taş FF, Demirbilek H, Özbek MN. Revisiting the Annual Incidence of Type 1 Diabetes Mellitus in Children from the Southeastern Anatolian Region of Turkey: A Regional Report. J Clin Res Pediatr Endocrinol 2022; 14:172-178. [PMID: 35014245 PMCID: PMC9176090 DOI: 10.4274/jcrpe.galenos.2021.2021-10-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/15/2021] [Indexed: 12/01/2022] Open
Abstract
Objective The incidence of type 1 diabetes mellitus (T1D) in children has an increasing trend globally, with a variable rate depending on region and ethnicity. Our group first reported T1D incidence in Diyarbakır in 2011. The aim of this study was to evaluate the current incidence rate of pediatric T1D in Diyarbakır, and compare the incidence, and clinical and presenting characteristics of more recent cases with those reported in our first report. Methods Hospital records of patients diagnosed with T1D in Diyarbakır city between 1st January 2020 and 31st December 2020 and aged under 18 years old were retrieved, and their medical data was extracted. Demographic population data were obtained from address-based census records of the Turkish Statistical Institution (TSI). Results Fifty-seven children and adolescents were diagnosed with T1D. Of those, 34 were female (59.6%), indicating a male/female ratio of 1.47. The mean age at diagnosis was 9.5±3.9 years (0.8-17.9). TSI data indicated a population count of 709,803 for the 0-18 years age group. Thus the T1D incidence was 8.03/105 in the 0-18 age group and was higher in the 0-14 age group at 9.14/105. The cumulative increase in the incidence of T1D in the 0-14 age group was 26.9% suggesting an increasing rate of 2.7% per year. The frequency of presentation with diabetic ketoacidosis was 64.9%. Conclusion The annual incidence of pediatric T1D in Diyarbakır city increased from 7.2/105 to 9.14/105 within the last decade. The rate of annual increase was 2.7% in the 0-14 age group comparing this study with our earlier report, with a predominance in male subjects and a shift of peak incidence from the 5-9 year age group in the first study to the 10-14 year age group in this one.
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Affiliation(s)
- Şervan Özalkak
- Diyarbakır Gazi Yaşargil Training and Research Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Ruken Yıldırım
- Diyarbakır Child Diseases Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Selma Tunç
- Diyarbakır Child Diseases Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Edip Ünal
- Dicle University Faculty of Medicine, Department of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Funda Feryal Taş
- Diyarbakır Gazi Yaşargil Training and Research Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Huseyin Demirbilek
- Hacettepe University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Mehmet Nuri Özbek
- Diyarbakır Gazi Yaşargil Training and Research Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
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TURAN H, GÜNEŞ KAYA D, TARÇIN G, EVLİYAOĞLU SO, ERCAN O. Adölesanlarda diyabete özgü yeme bozukluğu:‘Diabulimia’ riskinin ve metabolik etkilerinin araştırılması. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1085617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Gökçe T, Sakarya S, Muradoğlu S, Mutlu GY, Can E, Cemhan K, Kurtulmuş MF, Gülşen M, Aycan Z, Darendeliler F, Ülger Ö, Bulanık M, Yardım N, Hatun Ş. An evaluation of the knowledge and attitudes of school staff related to diabetes care at school: The 10th year of the "diabetes program at school" in Turkey. Pediatr Diabetes 2021; 22:233-240. [PMID: 33205857 DOI: 10.1111/pedi.13157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/16/2020] [Accepted: 11/08/2020] [Indexed: 11/28/2022] Open
Abstract
The aim of this study was to measure the knowledge and attitudes of school staff regarding care in school for children with type 1 diabetes and to evaluate the contribution of the "Diabetes Program at School"(DPS). The data were collected through an online survey consisting of 55 questions, which included 39 knowledge and 16 attitude questions. The survey was delivered to the participating school staff via a link. A total of 55,677 people who completed 100% of the survey were included. Of the participants, 76% were teachers, 23% were school administrators and 0.1% were school nurses. 73% (40732) of the participants stated that they had heard about the "DPS". Of the participants who were aware of the DPS 75%, 50%, and 41% stated an increase in their knowledge level, self-confidence, and awareness respectively. Both scores were positively associated with being female and school nurse, having students with diabetes in the school, having been trained in childhood diabetes, being familiar with the program and being from the Western region of Turkey. The DPS is well known among school staff including teachers, school administrators, and school nurses. However, there are clear regional differences in the knowledge and attitude of school staff regarding diabetes care at school. Therefore, regional differences should be taken into account when planning the necessary interventions to prevent any further increase in the current inequalities. In addition, increasing the number of school nurses, together with strengthening the knowledge and attitude of school staff, can improve the level of diabetes care at school.
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Affiliation(s)
- Tuğba Gökçe
- Division of Pediatric Endocrinology and Diabetes, Koc University, Istanbul, Turkey
| | - Sibel Sakarya
- Public Health Department, Koc University School of Medicine, Istanbul, Turkey
| | - Serra Muradoğlu
- Division of Pediatric Endocrinology and Diabetes, Koc University, Istanbul, Turkey
| | - Gül Yeşiltepe Mutlu
- Pediatric Endocrinology and Diabetes Department, Koc University School of Medicine, Istanbul, Turkey
| | - Ecem Can
- Division of Pediatric Endocrinology and Diabetes, Koc University, Istanbul, Turkey
| | | | - Mehmet Fatih Kurtulmuş
- Workplace Health and Safety Unit, Istanbul Directorate of National Education, Istanbul, Turkey
| | - Murat Gülşen
- General Directorate of Support Services, Republic of Turkey Ministry of National Education, Ankara, Turkey
| | - Zehra Aycan
- Pediatric Endocrinology Department, Ankara University, School of Medicine, Ankara, Turkey
| | - Feyza Darendeliler
- Faculty of Medicine, Pediatric Endocrinology Department, Istanbul University, Istanbul, Turkey
| | - Özlem Ülger
- General Directorate of Public Health, Ministry of Health of Turkey, Ankara, Turkey
| | - Melek Bulanık
- General Directorate of Public Health, Ministry of Health of Turkey, Ankara, Turkey
| | - Nazan Yardım
- General Directorate of Public Health, Ministry of Health of Turkey, Ankara, Turkey
| | - Şükrü Hatun
- Pediatric Endocrinology and Diabetes Department, Koc University School of Medicine, Istanbul, Turkey.,Coordinator of Diabetes Program at School, Turkey
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Khater S, Aouar A, Bensmain N, Bendedouche S, Chabni N, Hamdaoui H, Moussouni A, Moqaddem Z. Very High Incidence of Type 1 Diabetes Among Children Aged Under 15 Years in Tlemcen, Northwest Algeria (2015-2018). J Clin Res Pediatr Endocrinol 2021; 13:44-51. [PMID: 32938578 PMCID: PMC7947720 DOI: 10.4274/jcrpe.galenos.2020.2020.0073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/07/2020] [Indexed: 02/02/2023] Open
Abstract
Objective In Algeria, there is a lack of epidemiological data concerning childhood type 1 diabetes (T1D). The International Diabetes Federation estimated in 2019 that Algeria ranked 7th among countries with the highest prevalence of T1D. This study aimed to determine the incidence of T1D in children <15 years, living in Tlemcen in Northwest Algeria. Methods A retrospective study using data from children (<15 years) who have been diagnosed with T1D in Tlemcen between 2015 and 2018, using the two-source capture–recapture method to estimate the completeness of ascertainment (%). Total average incidences, by sex, by onset age group, and by season of onset were calculated per 100,000 and per year. Results During the study period, 437 new cases of T1D were registered, among them, 233 boys and 204 girls, with a sex ratio of 1.14. The average annual incidence rate of childhood T1D was 38.5/100,000 with a 95% confidence interval (CI): 35.20-41.79; boys: 40.51, 95% CI: 38.16-42.85; girls: 36.49, 95% CI: 34.17-38.80. Overall incidence rates in 2015, 2016, 2017 and 2018 were respectively 36.6 (95% CI: 33.72-39.48), 38.7 (95% CI: 35.43-41.97), 39.3 (95% CI: 35.97-42.62) and 39.5 (95% CI: 36.12-42.87)/100,000. Newly diagnosed children were more likely to present in winter and autumn. Ketoacidosis at diagnosis was diagnosed in 29.2%. Conclusion The mean incidence of childhood T1D in Tlemcen was 38.5/100,000, this incidence is in the “extremely high” category of the World Health Organization DiaMond project classification of diabetes giving this region a very high risk.
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Affiliation(s)
- Sarra Khater
- Abou Beker Belkaid University, Valorisation of Human Actions for the Protection of the Environment and Application in Public Health Laboratory, Tlemcen, Algeria
| | - Ammaria Aouar
- Abou Beker Belkaid University, Valorisation of Human Actions for the Protection of the Environment and Application in Public Health Laboratory, Tlemcen, Algeria
| | - Nawel Bensmain
- Abou Beker Belkaid University, Statistics and Random Models Laboratory, Tlemcen, Algeria
| | - Salih Bendedouche
- Abou Beker Belkaid University, Tlemcen University Hospital, Department of Pediatrics, Tlemcen, Algeria
| | - Nafissa Chabni
- Abou Beker Belkaid University, Tlemcen University Hospital, Department of Epidemiology, Tlemcen, Algeria
| | - Houari Hamdaoui
- Abou Beker Belkaid University, Valorisation of Human Actions for the Protection of the Environment and Application in Public Health Laboratory, Tlemcen, Algeria
| | | | - Zakarya Moqaddem
- Abou Beker Belkaid University, Valorisation of Human Actions for the Protection of the Environment and Application in Public Health Laboratory, Tlemcen, Algeria
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Ata A, Er E, Evin F, Işıklar H, Abdullayev N, Demir G, Özen S, Altınok YA, Darcan Ş, Gökşen D. Treatment and long-term follow-up of patients diagnosed with type 1 diabetes mellitus before age 5. J Pediatr Endocrinol Metab 2021; 34:201-207. [PMID: 33544547 DOI: 10.1515/jpem-2020-0205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 11/19/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aimed to determine the effects of continuous subcutaneous insulin infusion (CSII) treatment on anthropometric measurements, mean HbA1c, and insulin dosage in patients diagnosed under 5 years of age and compare with multiple-dose injection therapy (MDI). METHODS Children with type 1 diabetes mellitus, diagnosed <5 years since 2000 and their 19-year follow-up were evaluated retrospectively. Weight, height, body mass index (BMI), blood pressure, and HbA1c values were recorded for each visit. RESULTS Hundred and five patients (58.1% female, 41.9% male) were included in the study. Sixty-three (60 %) patients were treated by CSII and 42 (40%) by MDI. Mean age at diagnosis was 2.68 ± 1.42 and 3.29 ± 1.30 years respectively. Mean follow-up was 7.42 ± 4.76 and 6.01 ± 4.41 years respectively. For each group, weight standard deviation score (SDS) increased significantly in the first year after the diagnosis (p<0.001), and with the onset of puberty weight SDS decreased significantly (p<0.001). The trend of weight and BMI SDS changes over the years showed similar characteristics in both groups. During follow-up height SDS was similar in both groups except in Tanner stage 5. When puberty was completed, mean height SDS was 0.51 ± 1.03 in CSII and -0.31 ± 0.75 in the MDI group (p: 0.029). Mean HbA1c was significantly lower in the CSII group (7.62 ± 0.82 and 8.17 ± 1.22 respectively). Systolic and diastolic blood pressure change trends during the follow-up were also similar in both groups. CONCLUSIONS CSII treatment had positive effects on metabolic control and height SDS in patients with early-onset diabetes without increasing BMI.
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Affiliation(s)
- Aysun Ata
- Department of Pediatrics, Division of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Eren Er
- Department of Pediatrics, Division of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ferda Evin
- Department of Pediatrics, Division of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Hafize Işıklar
- Department of Pediatrics, Division of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Nushaba Abdullayev
- Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Günay Demir
- Department of Pediatrics, Division of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Samim Özen
- Department of Pediatrics, Division of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Yasemin Atik Altınok
- Department of Pediatrics, Division of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Şükran Darcan
- Department of Pediatrics, Division of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Damla Gökşen
- Department of Pediatrics, Division of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
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Cerit MN, Sendur HN, Bolayır B, Cerit ET, Cindil E, Yaşım Aktürk M, Baloş Törüner F, Özhan Oktar S. Evaluation of common carotid artery in type 1 diabetes mellitus patients through speckle tracking carotid strain ultrasonography. Diagn Interv Radiol 2021; 27:195-205. [PMID: 33599210 DOI: 10.5152/dir.2021.20025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE We aimed to evaluate the effectiveness of speckle tracking carotid strain (STCS) technique, which enables measurement of arterial stiffness and strain parameters, in the detection of early atherosclerotic findings in type 1 diabetes mellitus (T1DM). METHODS We prospectively enrolled 30 T1DM patients and 30 age- and sex-matched control participants with no history of cardiovascular disease. All study population underwent carotid ultrasonography. Radial and circumferential movement of the common carotid artery (CCA) in the transverse plane as the well as the radial movement of the CCA in the longitudinal plane were calculated automatically by using the STCS method. In addition, the strain (%), strain rate (per second), and peak circumferential and radial displacements (mm) were calculated. Arterial stiffness parameters, such as elastic modulus, distensibility, arterial compliance, and β-stiffness index, were calculated using the radial measurements. The mean value of the carotid intima media thickness (CIMT) was calculated semi-automatically for each CCA, in the longitudinal plane. We also analyzed the patients' overall body composition. RESULTS T1DM and control groups were compared in terms of strain and stiffness parameters and no statistically significant difference was found (p > 0.05). CIMT was higher in diabetic patients than in the control group (p = 0.039). In both groups, age was correlated with all arterial stiffness and strain parameters (p < 0.05). The duration of diabetes was also correlated with β-stiffness index, distensibility, and elastic modulus in the longitudinal plane (p < 0.05). In the diabetic group, abdominal fat ratio, whole body fat ratio, and fat mass were correlated with radial and circumferential displacement and strain parameters in transverse plane, and radial displacement in longitudinal plane (p < 0.05, for each). Diabetic patients were divided into subgroups according to the presence of nephropathy and dyslipidemia. Although no significant difference was found between the groups in terms of CIMT, patients with nephropathy had higher values for transverse and longitudinal elastic modulus, pulse-wave velocity, and longitudinal β-stiffness index, as well as lower values for longitudinal arterial compliance and distensibility, compared with patients without nephropathy (p < 0.05). Also, patients with dyslipidemia had higher longitudinal β-stiffness and elastic modulus values compared with patients without dyslipidemia (p < 0.05). CONCLUSION STCS ultrasonography is an effective, easy, and noninvasive method for evaluating the arterial elasticity. It may provide an early assessment of atherosclerosis in patients with T1DM, especially in the presence of nephropathy and dyslipidemia; thus, together with CIMT measurement, it may be used more frequently to detect subclinical damage and stratify atherosclerosis.
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Affiliation(s)
- Mahi Nur Cerit
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Halit Nahit Sendur
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Başak Bolayır
- Department of Endocrinology, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | - Emetullah Cindil
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Müjde Yaşım Aktürk
- Department of Endocrinology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Füsun Baloş Törüner
- Department of Endocrinology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Suna Özhan Oktar
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
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Cinaroglu S. Health behaviors and health services accessibility factors associated with diabetes: a propensity score matching analysis. Expert Rev Endocrinol Metab 2021; 16:19-24. [PMID: 33427542 DOI: 10.1080/17446651.2021.1853526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
Background: Despite the increasing burden of diabetes in Turkey, there is a lack of information regarding behaviors and accessibility factors associated with diabetes. This study aims to explore diabetes prevalence and to identify the associated health behaviors and accessibility factors. Research design and methods: Data was gathered from TurkStat-Health Survey for the year 2014. 1996 individuals who had reported diabetes were matched to similar non-diabetes participants in terms of socio-demographic characteristics and comorbidities by using 1:1 nearest matching based on estimated propensity scores. Results: The weighted point prevalence of diabetes among adults was 8.98%. Compared with smokers, non-smokers were less likely to develop diabetes (OR:0.96; 95% CI:0.95-0.97). Individuals engaging in regular physical activity were less likely to have experienced diabetes than individuals not engaging in any physical activity (OR:0.51; 95% CI:0.41-0.52). Conclusions: Improving the health behaviors of individuals and promoting a culture of exercise, healthy food consumption and better planning of preventive services are necessary strategies to fight against diabetes in Turkey. Collaboration between health professionals will result in effective clinical decision making and the development of diabetes self-management programs.
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Affiliation(s)
- Songul Cinaroglu
- Faculty of Economics and Administrative Sciences (FEAS), Department of Health Care Management, Hacettepe University , Ankara, Turkey
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Cetintas I, Akgün Kostak M. Psychometric properties of the Turkish version of the Diabetes Family Impact Scale. J SPEC PEDIATR NURS 2021; 26:e12308. [PMID: 32844587 DOI: 10.1111/jspn.12308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/19/2020] [Accepted: 08/11/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The objective of this study was to examine the psychometric properties of the Turkish version of the Diabetes Family Impact Scale (DFIS). METHODS AND DESIGN The study was carried out methodologically with 121 parents who have 6-18 year-old children with type 1 diabetes (n = 121). The collected data were analyzed by conducting confirmatory factor analysis, t test, and Pearson's correlation analysis and by computing Cronbach's α and intraclass correlation coefficients (ICCs). RESULTS The linguistic validity of the scale was ensured by undertaking translation and back-translation. Expert opinions were analyzed and all the content validity indices were found to be ≥0.80. The factor loadings of all the items ranged from 0.47 to 0.89, and the model fit indices were as follows: χ²/df = 1.21 and RMSEA = 0.04. Scores that were obtained across two temporally separated administrations were not significantly different (p > .05), and there was a strong correlation between the two sets of scores (ICC = 0.892; p < .001). The Cronbach's α of the scale was .881. The item-total correlation coefficients of the scale items ranged from .34 to .72. CONCLUSIONS Similar to the original assessment, the Turkish version of the DFIS consists of 14 items and 4 subscales. It is a valid and reliable measure that is suitable for use with Turkish samples. Researchers can use this scale to assess the effect of type 1 diabetes mellitus on the family of an affected child.
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Affiliation(s)
- Ismail Cetintas
- Department of Pediatric Nursing, Division of Nursing, Trakya University Faculty of Health Sciences, Edirne, Turkey
| | - Melahat Akgün Kostak
- Department of Pediatric Nursing, Division of Nursing, Trakya University Faculty of Health Sciences, Edirne, Turkey
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CAM E, KURUTKAN MN, ARSLANOĞLU İ, BÜTÜNER O. COST OF INPATIENT PEDIATRIC TYPE 1 DIABETES CARE IN TURKEY:SINGLE CENTER EXPERIENCE. KONURALP TIP DERGISI 2020. [DOI: 10.18521/ktd.774512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mousa U, Sav H, Köseoğluları O, Şahin A, Akcan N, Soytaç İnançlı S, Bundak R. The Incidence and Demographic Distribution of Type 1 Diabetes Mellitus in Children Aged 16 or Younger Between 2000 and 2016 in Cyprus. J Clin Res Pediatr Endocrinol 2020; 12:175-179. [PMID: 31552726 PMCID: PMC7291398 DOI: 10.4274/jcrpe.galenos.2019.2019.0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Type 1 diabetes (T1D) is a disease characterized by severe insulin deficiency. In 2008 our group studied the prevalence of diabetes in adults between 20-80 years of age in Cyprus but data regarding this incidence in the pediatric population is lacking. The objective of this study was to report the incidence of T1D among permanent inhabitants aged 16 years or younger between 2001-2016 in Cyprus. METHODS This study was a retrospective analysis. The patients were mainly evaluated and recorded at Dr. Burhan Nalbantoğlu Hospital, Nicosia. Data was also reviewed from Famagusta Government Hospital, Kyrenia Government Hospital, Near East University Hospital and the Cyprus Turkish Diabetes Association. RESULTS A total of 107 subjects were diagnosed as T1D between 2001 and 2016 in the pediatric age group. Forty-nine (45.7%) were girls and 58 (54.3%) were boys. Of these 38.7% were resident in Nicosia, 30.2% Famagusta, 12.3% Kyrenia, 9.4% Guzelyurt and 7.5% Iskele. The proportion of newly diagnosed T1D was highest among children aged 9-12 years (35.5%) followed by children aged 5-8 years (32.7%). Newly diagnosed T1D most frequently presented in March and April. The overall mean incidence rate was 11.1/100,000 between 2001 and 2016. The incidence rates were similar and comparable among the years. CONCLUSION This study is the first to analyze the incidence of T1D in Cyprus. Compared to other countries the incidence rate is intermediate. Our findings are similar to the incidence rates of T1D in South Cyprus and Turkey.
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Affiliation(s)
- Umut Mousa
- Dr. Burhan Nalbantoğlu Hospital, Clinic of Endocrinology and Metabolism, Nicosia, Cyprus,* Address for Correspondence: Dr. Burhan Nalbantoğlu Hospital, Clinic of Endocrinology and Metabolism, Nicosia, Cyprus Phone: +90 548 851 33 19 E-mail:
| | - Hasan Sav
- Dr. Burhan Nalbantoğlu Hospital, Clinic of Endocrinology and Metabolism, Nicosia, Cyprus
| | | | - Ayse Şahin
- Dr. Burhan Nalbantoğlu Hospital, Clinic of Endocrinology and Metabolism, Nicosia, Cyprus
| | - Neşe Akcan
- Near East University, Department of Pediatric Endocrinology, Nicosia, Cyprus
| | | | - Rüveyde Bundak
- Near East University, Department of Pediatric Endocrinology, Nicosia, Cyprus
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Karaoglan M, Keskin M. Incidence of new onset type 1 diabetes in siblings of index cases with type 1 diabetes within the first 11 years in Turkish children. J Paediatr Child Health 2020; 56:791-796. [PMID: 31909514 DOI: 10.1111/jpc.14746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/03/2019] [Accepted: 12/08/2019] [Indexed: 11/28/2022]
Abstract
AIM Although newly diagnosed type 1 diabetes mellitus (T1DM) occurs sporadically in childhood, there is an increased risk of T1DM for first-degree relatives of patients that endure into the advanced years. Determination of T1DM incidence in siblings of children with T1DM helps predict the development of new cases. This study focuses on the incidence of the disease in siblings of children with T1DM. METHOD A total of 1497 siblings of 850 children (403 female; 447 male) diagnosed with T1DM between 2007 and 2018 years were retrospectively screened for T1DM. The patients were divided into four onset age groups: 0-4, 5-9, 10-14 and ≥15. The annual incidence was calculated for the region. RESULTS A total of 34 siblings diagnosed with T1DM were detected. The incidence relating to the years investigated was between 7.42 and 11.73/100 000 for the newly diagnosed indexes while it ranged between 0 and 5.8% for siblings. The 5-9 year group was the most commonly diagnosed onset age group in index (n = 312) and siblings (n = 20). For siblings, the male sex and 5-9 aged at diagnosis of index were significant risk factors for development of T1DM (OR:2.35 and 2.85). CONCLUSION This study shows that in the first years following the diagnosis of an index, incidence of T1DM among the siblings can rise up to 5.8%, and the age group of 5-9 in the index and the male sex in the sibling are the most important risk factors. These findings show that the risk for siblings of children with T1DM remarkably increases in the first years after diagnosis in index cases.
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Affiliation(s)
- Murat Karaoglan
- Faculty of Medicine, Department of Pediatric Endocrinology, Gaziantep University, Gaziantep, Turkey
| | - Mehmet Keskin
- Faculty of Medicine, Department of Pediatric Endocrinology, Gaziantep University, Gaziantep, Turkey
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Esen I, Okdemir D. Trend of type 1 diabetes incidence in children between 2009 and 2019 in Elazig, Turkey. Pediatr Diabetes 2020; 21:460-465. [PMID: 31951309 DOI: 10.1111/pedi.12984] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/09/2019] [Accepted: 01/13/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To assess the incidence of T1D in children aged <15 years in Elazig, Turkey. METHOD The data of children who have been registered as child with T1D in the database of pediatric diabetes clinic was analyzed. Childhood census data were acquired from the Turkish Statistical Institute. The incidence rates of T1D were calculated for the whole group as well as separately for age group, gender, year of diagnosis, and place of residence, viz. either urban or rural per 100 000 persons per year. The change of incidence during the 10 year observation period was analyzed. RESULTS The overall mean incidence of T1D in study period was 16.7/100 000 [95% confidence interval (CI): 14.6-19.0] persons per year. The incidence rates of T1D varied from 10.2 to 24.1/100 000 persons per year, representing 2.4-fold variation between 2009 and 2019. The lowest incidence rate was in children aged 0 to 4 years (9.6/100 000 persons per year; CI: 6.9-12.9). There was no difference in incidence rate between genders, incidence rates was significant higher in urban residents. A significant increasing trend of T1D was detected in the total 10-year observation period; the average annual percent change was 7.8%. Subgroup analysis showed that there was significant increasing trend in boys, urban residents, and children aged 5 to 9 years groups. CONCLUSION This study demonstrated increase in T1D incidence of in children in Elazig and highest regional incidence rate of T1D until now in Turkey compared to previous limited data.
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Affiliation(s)
- Ihsan Esen
- Department of Paediatric Endocrinology, Firat University Hospital, Elazig, Turkey
| | - Deniz Okdemir
- Department of Paediatric Endocrinology, Firat University Hospital, Elazig, Turkey
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26
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Akici N, Aydin V, Donertas B, Alkan A, Akici A. Investigation of injectable drug utilization in primary care: A focus on different age groups in pediatric population. Arch Pediatr 2020; 27:183-188. [PMID: 32331914 DOI: 10.1016/j.arcped.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/31/2019] [Accepted: 03/28/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The suitability of the injectables may vary across different age groups especially for children; therefore, knowledge on their usage patterns is critical in terms of rational pharmacotherapy. This study aimed to investigate pediatric injectable drug utilization in primary care with a focus on different age groups. METHOD By simple sampling method, 100 prescriptions that contained at least one injectable drug were randomly selected for each month of the year in 32 provinces of Turkey (n=38.400). Among these prescriptions, injectable drugs that were for children (<18 years) were analyzed. Patterns of injectable drug utilization were compared according to the pediatric age group of "infants", "children", and "adolescents". RESULTS We identified 5446 patients (14.2%) with a mean age of 7.4±5.2 years and a slight male tendency in distribution (53.8%). The most common indication for these patients was for the respiratory system (65.4%), of which 96.3% were respiratory tract infections. While less pronounced in adolescents than in infants and children, the most commonly prescribed injectable drugs were antibiotics in all age groups (61.5% vs. 78.6% and 79.9%, P<0.0001), which was upheld across all seasons. More than 90% of all prescribed injectable antibiotics consisted of penicillins and cephalosporins; the latter being predominant in infants (67.4%) compared with penicillins in children (53.9%) and adolescents (59.0%). Analgesics and insulin were found to be prescribed more frequently to adolescents than they were to infants and children (P<0.0001 and P<0.0001, respectively). The mean cost of prescription and injectable drugs per encounter was significantly more likely to escalate with increasing age (P<0.0001 and P<0.0001, respectively). CONCLUSION Considering the predominance of antibiotics as well as the substantially higher prescription of third-generation cephalosporins in primary care, which was especially more marked for younger children, our study indicates an inappropriate use of injectable drugs by primary care physicians for managing medical conditions in the pediatric population.
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Affiliation(s)
- N Akici
- Department of Pediatrics, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - V Aydin
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Turkey
| | - B Donertas
- Department of Medical Pharmacology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - A Alkan
- Turkish Medicines and Medical Devices Agency, Ministry of Health, Ankara, Turkey
| | - A Akici
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Turkey.
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Gomez-Lopera N, Pineda-Trujillo N, Diaz-Valencia PA. Correlating the global increase in type 1 diabetes incidence across age groups with national economic prosperity: A systematic review. World J Diabetes 2019; 10:560-580. [PMID: 31915518 PMCID: PMC6944530 DOI: 10.4239/wjd.v10.i12.560] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 10/17/2019] [Accepted: 10/29/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The global epidemiology of type 1 diabetes (T1D) is not yet well known, as no precise data are available from many countries. T1D is, however, characterized by an important variation in incidences among countries and a dramatic increase of these incidences during the last decades, predominantly in younger children. In the United States and Europe, the increase has been associated with the gross domestic product (GDP) per capita. In our previous systematic review, geographical variation of incidence was correlated with socio-economic factors.
AIM To investigate variation in the incidence of T1D in age categories and search to what extent these variations correlated with the GDP per capita.
METHODS A systematic review was performed to retrieve information about the global incidence of T1D among those younger than 14 years of age. The study was carried out according to the PRISMA recommendations. For the analysis, the incidence was organized in the periods: 1975-1999 and 2000-2017. We searched the incidence of T1D in the age-groups 0-4, 5-9 and 10-14. We compared the incidences in countries for which information was available for the two periods. We obtained the GDP from the World Bank. We analysed the relationship between the incidence of T1D with the GDP in countries reporting data at the national level.
RESULTS We retrieved information for 84 out of 194 countries around the world. We found a wide geographic variation in the incidence of T1D and a worldwide increase during the two periods. The largest contribution to this increase was observed in the youngest group of children with T1D, with a relative increase of almost double when comparing the two periods (P value = 2.5 × e-5). Twenty-six countries had information on the incidence of T1D at the national level for the two periods. There was a positive correlation between GDP and the incidence of T1D in both periods (Spearman correlation = 0.52 from 1975-1999 and Spearman correlation = 0.53 from 2000-2017).
CONCLUSION The incidence increase was higher in the youngest group (0-4 years of age), and the highest incidences of T1D were found in wealthier countries.
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Affiliation(s)
- Natalia Gomez-Lopera
- Grupo Mapeo Genetico, Departamento de Pediatría, Facultad de Medicina, Universidad de Antioquia, Medellín 050010470, Colombia
| | - Nicolas Pineda-Trujillo
- Grupo Mapeo Genetico, Departamento de Pediatría, Facultad de Medicina, Universidad de Antioquia, Medellín 050010470, Colombia
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Roze S, Smith-Palmer J, de Portu S, Özdemir Saltik AZ, Akgül T, Deyneli O. Cost-Effectiveness of Sensor-Augmented Insulin Pump Therapy Versus Continuous Insulin Infusion in Patients with Type 1 Diabetes in Turkey. Diabetes Technol Ther 2019; 21:727-735. [PMID: 31509715 DOI: 10.1089/dia.2019.0198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background and Aims: Sensor-augmented pump therapy (SAP) combines continuous glucose monitoring with continuous subcutaneous insulin infusion (CSII). SAP is costlier than CSII but provides additional clinical benefits relative to CSII alone. A long-term cost-effectiveness analysis was performed to determine whether SAP is cost-effective relative to CSII in patients with type 1 diabetes (T1D) in Turkey. Methods: Analyses were performed in two different patient cohorts, one with poor glycemic control at baseline (mean glycated hemoglobin 9.0% [75 mmol/mol]) and a second cohort considered to be at increased risk of hypoglycemic events. Clinical input data and direct medical costs were sourced from published literature. The analysis was performed from a third-party payer perspective over patient lifetimes and future costs and clinical outcomes were discounted at 3.5% per annum. Results: In both patient cohorts, SAP was associated with a gain in quality-adjusted life expectancy but higher costs relative to CSII (incremental gain of 1.40 quality-adjusted life years [QALYs] in patients with poor baseline glycemic control and 1.73 QALYs in patients at increased risk of hypoglycemic events). Incremental cost-effectiveness ratios for SAP versus CSII were TRY 76,971 (EUR 11,612) per QALY gained for patients with poor baseline glycemic control and TRY 69,534 (EUR 10,490) per QALY gained for patients at increased risk for hypoglycemia. Conclusions: SAP is associated with improved long-term clinical outcomes versus CSII, and in Turkey, SAP is likely to represent good value for money compared with CSII in T1D patients with poor glycemic control and/or with frequent severe hypoglycemic events.
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Affiliation(s)
| | | | - Simona de Portu
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | | | | | - Oğuzhan Deyneli
- Department of Endocrinology and Metabolism, School of Medicine, Koc University, Istanbul, Turkey
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ÖZGÜR M, UÇAR A. Karbonhidrat ve Yağ Metabolizmasında D-alluloz (D-psikoz). DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2019. [DOI: 10.33631/duzcesbed.469828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Xia Y, Xie Z, Huang G, Zhou Z. Incidence and trend of type 1 diabetes and the underlying environmental determinants. Diabetes Metab Res Rev 2019; 35:e3075. [PMID: 30207035 DOI: 10.1002/dmrr.3075] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/27/2018] [Accepted: 09/09/2018] [Indexed: 12/15/2022]
Abstract
A wealth of epidemiological studies concerning the distribution of type 1 diabetes (T1D) around the world have pointed to the appreciable variation in the incidence of T1D among disparate age groups, ethnicities, and geographical locations. On the whole, the incidence of childhood T1D has been on the rise, and a plausible inverse relationship between the initial incidence rate and the following annual increase in incidence has been raised. Countries that used to exhibit lower incidences tend to have steep annual increase whereas those with already-established high incidences are more likely to show a modest increase or even stabilization in T1D incidence. Environmental agents considered responsible for the current evolving pattern of T1D incidence will be detailed, mainly including the increasing prevalence of childhood obesity, viral infections in a chronic manner, maternal-child interaction such as breastfeeding, and latitude-ultraviolet B-vitamin D pathway. Certain rationale has been put forward in an attempt to explain the potential association between environmental agents and development of T1D. For instance, accelerator hypothesis regards insulin resistance as the promoter of earlier disease onset in obese children whereas the negative correlation of microbial infections in background populations with incidence of T1D represents the basic component of the hygiene hypothesis. Further investigations are still warranted to verify these theories across multiple ethnic groups and to identify additional contributors to the variation in T1D incidence.
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Affiliation(s)
- Ying Xia
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Zhiguo Xie
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Gan Huang
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Zhiguang Zhou
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
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Poyrazoğlu Ş, Bundak R, Yavaş Abalı Z, Önal H, Sarıkaya S, Akgün A, Baş S, Abalı S, Bereket A, Eren E, Tarım Ö, Güven A, Yıldız M, Karaman Aksakal D, Yüksel A, Seymen Karabulut G, Hatun Ş, Özgen T, Cesur Y, Azizoğlu M, Dilek E, Tütüncüler F, Papatya Çakır E, Özcabı B, Evliyaoğlu O, Karadeniz S, Dursun F, Bolu S, Arslanoğlu İ, Yeşiltepe Mutlu G, Kırmızıbekmez H, İşgüven P, Üstyol A, Adal E, Uçar A, Cebeci N, Bezen D, Binay Ç, Semiz S, Korkmaz HA, Memioğlu N, Sağsak E, Peltek HN, Yıldız M, Akçay T, Turan S, Güran T, Atay Z, Akcan N, Çizmecioğlu F, Ercan O, Dağdeviren A, Baş F, İşsever H, Darendeliler F. Incidence of Type 1 Diabetes in Children Aged Below 18 Years during 2013-2015 in Northwest Turkey. J Clin Res Pediatr Endocrinol 2018; 10:336-342. [PMID: 29789274 PMCID: PMC6280322 DOI: 10.4274/jcrpe.0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/22/2018] [Indexed: 02/07/2023] Open
Abstract
Objective To assess the incidence of type 1 diabetes mellitus (T1DM) in children under 18 years of age in the northwest region of Turkey during 2013-2015. Methods All newly diagnosed T1DM cases were recorded prospectively during 2013-2015. Total, as well as gender and age group specific (0-4, 5-9, 10-14 and 15-17 age) mean incidences per 100,000 per year were calculated. Results There were 1,773 patients diagnosed during 2013-2015 (588 cases in 2013, 592 cases in 2014, 593 cases in 2015). Of these, 862 (48.6%) were girls and 911 (51.4%) were boys. The mean age at diagnosis was 9.2±4.2 years and it was not significantly different between girls (9.0±4.1 years) and boys (9.4±4.4 years) (p=0.052). The crude mean incidence was 8.99/100.000 confidence interval (CI) (95% CI: 8.58-9.42). Although mean incidence was similar between boys [8.98/100.000 (CI: 8.40 to 9.58)] and girls [9.01/100.000 (CI: 8.42 to 9.63)], there was male predominance in all groups except for 5-9 year age group. The standardized mean incidence was 9.02/100.000 according to the World Health Organization standard population. The mean incidence for the 0-4, 5-9, 10-14 and 15-17 age groups was 6.13, 11.68, 11.7 and 5.04/100.000 respectively. The incidence of T1DM was similar over the course of three years (p=0.95). A significant increase in the proportion of cases diagnosed was observed in the autumn-winter seasons. Conclusion The northwest region of Turkey experienced an intermediate incidence of T1DM over the period of the study.
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Affiliation(s)
- Şükran Poyrazoğlu
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Rüveyde Bundak
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
- University of Kyrenia Faculty of Medicine, Department of Pediatric Endocrinology, Kyrenia, Turkish Republic of North Cyprus
| | - Zehra Yavaş Abalı
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Hasan Önal
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology and Metabolic Disease, İstanbul, Turkey
| | - Sevil Sarıkaya
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology and Metabolic Disease, İstanbul, Turkey
| | - Abdurrahman Akgün
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology and Metabolic Disease, İstanbul, Turkey
| | - Serpil Baş
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Saygın Abalı
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
- Kartal Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Abdullah Bereket
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Erdal Eren
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Ömer Tarım
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Ayla Güven
- Amasya University Faculty of Medicine, Department of Pediatric Endocrinology, Amasya, Turkey
- Göztepe Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Metin Yıldız
- Göztepe Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Derya Karaman Aksakal
- Göztepe Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Ayşegül Yüksel
- Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology, Kocaeli, Turkey
| | - Gülcan Seymen Karabulut
- Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology, Kocaeli, Turkey
| | - Şükrü Hatun
- Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology, Kocaeli, Turkey
- Koç University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Tolga Özgen
- Bezmialem Vakıf University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Yaşar Cesur
- Bezmialem Vakıf University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Mehmet Azizoğlu
- Trakya University Faculty of Medicine, Department of Pediatric Endocrinology, Edirne, Turkey
| | - Emine Dilek
- Trakya University Faculty of Medicine, Department of Pediatric Endocrinology, Edirne, Turkey
| | - Filiz Tütüncüler
- Trakya University Faculty of Medicine, Department of Pediatric Endocrinology, Edirne, Turkey
| | - Esra Papatya Çakır
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
- Şevket Yılmaz Training and Research Hospital, Clinic of Pediatric Endocrinology, Bursa, Turkey
| | - Bahar Özcabı
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
- Zeynep Kamil Women’s and Children’s Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Olcay Evliyaoğlu
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Songül Karadeniz
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Fatma Dursun
- Ümraniye Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Semih Bolu
- Düzce University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - İlknur Arslanoğlu
- Düzce University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Gül Yeşiltepe Mutlu
- Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology, Kocaeli, Turkey
- Zeynep Kamil Women’s and Children’s Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Heves Kırmızıbekmez
- Zeynep Kamil Women’s and Children’s Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Pınar İşgüven
- Sakarya University Faculty of Medicine, Department of Pediatric Endocrinology, Sakarya, Turkey
| | - Ala Üstyol
- Haseki Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Erdal Adal
- Medipol University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Ahmet Uçar
- Şişli Etfal Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Nurcan Cebeci
- Derince Training and Research Hospital, Clinic of Pediatric Endocrinology, Kocaeli, Turkey
| | - Didem Bezen
- Okmeydanı Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Çiğdem Binay
- Çorlu State Hospital, Clinic of Pediatric Endocrinology, Tekirdağ, Turkey
| | - Serap Semiz
- Acıbadem University Faculty of Medicine, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Hüseyin Anıl Korkmaz
- Balıkesir Atatürk State Hospital, Clinic of Pediatric Endocrinology, Balıkesir, Turkey
| | - Nihal Memioğlu
- American Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Elif Sağsak
- Gaziosmanpaşa Taksim Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Havva Nur Peltek
- Edirne Sultan 1. Murat State Hospital, Clinic of Pediatric Endocrinology, Edirne, Turkey
| | - Melek Yıldız
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology and Metabolic Disease, İstanbul, Turkey
| | - Teoman Akçay
- Medical Park Gaziosmanpaşa Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Serap Turan
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Tülay Güran
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Zeynep Atay
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
- Medipol University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Neşe Akcan
- Göztepe Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
- University of Near East Faculty of Medicine, Department of Pediatric Endocrinology, Nicosia, Turkish Republic of North Cyprus
| | - Filiz Çizmecioğlu
- Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology, Kocaeli, Turkey
| | - Oya Ercan
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Aydilek Dağdeviren
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Halim İşsever
- İstanbul University İstanbul Faculty of Medicine, Department of Public Health, İstanbul, Turkey
| | - Feyza Darendeliler
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
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Arda Sürücü H, Baran Durmaz G, Turan E. Does Type 1 Diabetic Adolescents' Fear of Stigmatization Predict a Negative Perception Insulin Treatment? Clin Nurs Res 2018; 29:235-242. [PMID: 30472886 DOI: 10.1177/1054773818815258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to investigate stigmatization, sociodemographic/diabetes-related characteristics and parents-related characteristics as predictors of a negative perception of insulin treatment in adolescents with type 1 diabetes in Turkey. The study was carried out using a cross-sectional correlation design. The research sample included 80 adolescents with type 1 diabetes who volunteered to take part. A positive perception of insulin treatment (β = -.38, p < .001), stigmatization (β = -.24, p = .013), informing others about one's type 1 diabetes (β = .24, p = .017) and only using insulin when alone in public places (β = .19, p = .042) were significant predictors of a negative perception of insulin treatment, and these variables explained 35% of the common variance. Diabetes' nurses should take stigmatization into account during their training and plan appropriate measures. Entrepreneurial, randomized, and controlled studies should be conducted to decrease the negative influence of stigmatization on the perception of insulin treatment in individuals with type 1 diabetes.
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Affiliation(s)
| | | | - Engin Turan
- Diyarbakır Gazi Yaşargil Training and Research Hospital, Turkey
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Ahmadov GA, Govender D, Atkinson MA, Sultanova RA, Eubova AA, Wasserfall CH, Mack SJ, Lane JA, Noble JA, Ogle GD. Epidemiology of childhood-onset type 1 diabetes in Azerbaijan: Incidence, clinical features, biochemistry, and HLA-DRB1 status. Diabetes Res Clin Pract 2018; 144:252-259. [PMID: 30218742 PMCID: PMC6384092 DOI: 10.1016/j.diabres.2018.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/10/2018] [Indexed: 01/27/2023]
Abstract
AIMS Determine the incidence and typology of diabetes in children in Azerbaijan. METHODS Clinical features, C-peptide, autoantibodies (glutamic acid decarboxylase 65 (GAD65) and islet antigen 2 (IA-2)), and HLA-DRB1 status were studied in 106 subjects <18 years of age who were recently diagnosed. 104 cases were consecutive. Incidence was determined for Baku and Absheron regions, where ascertainment is estimated to be essentially 100%. RESULTS 104 of the 106 (98%) were diagnosed with type 1 diabetes, one with type 2 diabetes and one with atypical diabetes. Type 1 diabetes incidence in Baku City and Absheron was 7.05 per 100,000 population <15 years per year. Peak age of onset was 10 years. There was a slight male preponderance (male:female 1.17:1), and no temporal association with seasons. Almost all type 1 diabetes subjects presented with classic symptoms including a high incidence (58%) of diabetic ketoacidosis. 86% presented with low C-peptide values (<0.13 nmol/L, <0.40 ng/mL) and 74% were positive for at least one type 1 diabetes-related autoantibody. CONCLUSIONS Azerbaijan has a moderate type 1 diabetes incidence and clinical, biochemical and genetic features similar to that in European populations.
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Affiliation(s)
- Gunduz Ahmad Ahmadov
- Endocrine Centre, Binagadi, Baku City, Azerbaijan; 6th Children's Hospital, Baku City, Azerbaijan; Azerbaijan Medical University, Baku City, Azerbaijan
| | - Denira Govender
- International Diabetes Federation Life for a Child Program, Glebe, NSW 2037, Australia; Sydney Medical School, University of Sydney, Sydney 2006, Australia
| | - Mark Alvin Atkinson
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL 32610, USA; Department of Pediatrics, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL 32610, USA
| | | | | | - Clive Henry Wasserfall
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL 32610, USA
| | - Steven John Mack
- Children's Hospital Oakland Research Institute, Oakland, CA 94609, USA
| | - Julie Ann Lane
- Children's Hospital Oakland Research Institute, Oakland, CA 94609, USA
| | | | - Graham David Ogle
- International Diabetes Federation Life for a Child Program, Glebe, NSW 2037, Australia; Diabetes NSW, Glebe 2037, NSW, Australia.
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34
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Hatun Ş, Demirbilek H, Darcan Ş, Yüksel A, Binay C, Şimşek DG, Kara C, Çetinkaya E, Ünüvar T, Uçaktürk A, Tütüncüler F, Cesur Y, Bundak R, Sağlam H, Şimşek E, Bereket A. Evaluation of therapeutics management patterns and glycemic control of pediatric type 1 diabetes mellitus patients in Turkey: A nationwide cross-sectional study. Diabetes Res Clin Pract 2016; 119:32-40. [PMID: 27423071 DOI: 10.1016/j.diabres.2016.04.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 04/04/2016] [Accepted: 04/21/2016] [Indexed: 11/26/2022]
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.
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Affiliation(s)
- Şükrü Hatun
- Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology, 41100 Kocaeli, Turkey
| | - Hüseyin Demirbilek
- Diyarbakır Children State Hospital, Clinic of Pediatric Endocrinology, 21100 Diyarbakır, Turkey
| | - Şükran Darcan
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, 35100 İzmir, Turkey
| | - Ayşegül Yüksel
- Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology, 41100 Kocaeli, Turkey
| | - Cigdem Binay
- Osmangazi University Faculty of Medicine, Department of Pediatric Endocrinology, 26100 Eskişehir, Turkey
| | - Damla Gökşen Şimşek
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, 35100 İzmir, Turkey
| | - Cengiz Kara
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Endocrinology, 55100 Samsun, Turkey
| | | | - Tolga Ünüvar
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology, 34100 Istanbul, Turkey
| | - Ahmet Uçaktürk
- Maternity and Children's Hospital, Clinic of Pediatric Endocrinology, 33100 Mersin, Turkey
| | - Filiz Tütüncüler
- Trakya University Faculty of Medicine, Department of Pediatric Endocrinology, 22000 Edirne, Turkey
| | - Yaşar Cesur
- Bezmialem University Faculty of Medicine, Department of Pediatric Endocrinology, 34100 Istanbul, Turkey
| | - Ruveyde Bundak
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, 34110 Istanbul, Turkey
| | - Halil Sağlam
- Uludag University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Enver Şimşek
- Osmangazi University Faculty of Medicine, Department of Pediatric Endocrinology, 26100 Eskişehir, Turkey
| | - Abdullah Bereket
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, 34100 İstanbul, Turkey
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