Diabetes Care, Glycemic Control, Complications, and Concomitant Autoimmune Diseases in Children with Type 1 Diabetes in Turkey: A Multicenter Study
Damla Gökşen Şimsek1, Zehra Aycan2, Samim Özen1, Semra Çetinkaya2, Cengiz Kara3, Cengiz Kara3, Saygın Abalı4, Korcan Demir5, Özgül Tunç6, Ahmet Uçaktürk3, Gülgün Asar1, Firdevs Baş7, Ergun Çetinkaya6, Murat Aydın3, Gülay Karagüzel8, Zerrin Orbak9, Zeynep Şıklar10, Ayça Altıncık5, Ayşenur Ökten8, Behzat Özkan9, Gönül Öçal11, Serap Semiz11, İlknur Arslanoğlu12, Olcay Evliyaoğlu13, Rüveyde Bundak7, Şükran Darcan11Ege University School of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey2Dr.Sami Ulus Training and Research Hospital, Department of Pediatric Endocrinology, Ankara, Turkey
3Ondokuz Mayıs University School of Medicine, Department of Pediatric Endocrinology, Samsun, Turkey
4Istanbul University School of Medicine, Department of Pediatrics, İstanbul, Turkey
5Dokuz Eylül University School of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
6Dışkapı Pediatric Training and Research Hospital, Department of Pediatric Endocrinology, Ankara, Turkey
7İstanbul University School of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
8Karadeniz Technical University School of Medicine, Department of Pediatric Endocrinology, Trabzon, Turkey
9Atatürk University School of Medicine, Department of Pediatric Endocrinology, Erzurum, Turkey
10Ankara University School of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
11Pamukkale University School of Medicine, Department of Pediatric Endocrinology, Denizli, Turkey
12Düzce University School of Medicine, Department of Pediatric Endocrinology, Düzce, Turkey
13Kırıkkale University School of Medicine, Department of Pediatric Endocrinology, Kırıkkale, Turkey
Objective: Epidemiologic and clinical features of type 1 diabetes mellitus (T1DM) may show substantial differences among countries. The primary goal in the management of T1DM is to prevent micro- and macrovascular complications by achieving good glycemic control. The present study aimed to assess metabolic control, presence of concomitant autoimmune diseases, and of acute and long-term complications in patients diagnosed with T1DM during childhood and adolescence. The study also aimed to be a first step in the development of a national registry system for T1DM, in Turkey.
Methods: Based on hospital records, this cross-sectional, multicenter study included 1 032 patients with T1DM from 12 different centers in Turkey, in whom the diagnosis was established during childhood. Epidemiological and clinical characteristics of the patients were recorded. Metabolic control, diabetes care, complications, and concomitant autoimmune diseases were evaluated.
Results: Mean age, diabetes duration, and hemoglobin A1c level were 12.5±4.1 years, 4.7±3.2 years, and 8.5±1.6%, respectively. Acute complications noted in the past year included ketoacidosis in 5.2% of the patients and severe hypoglycemia in 4.9%. Chronic lymphocytic thyroiditis was noted in 12%, Graves’ disease in 0.1%, and celiac disease in 4.3% of the patients. Chronic complications including neuropathy, retinopathy, and persistent microalbuminuria were present in 2.6%, 1.4%, and 5.4% of the patients, respectively. Diabetic nephropathy was not present in any of the patients. Mean diabetes duration and age of patients with neuropathy, retinopathy and microalbuminuria were significantly different from the patients without these long-term complications (p<0.01). A significant difference was found between pubertal and prepubertal children in terms of persistent microalbuminuria and neuropathy (p=0.02 and p<0.001, respectively). Of the patients, 4.4% (n: 38) were obese and 5% had short stature; 17.4% of the patients had dyslipidemia, and 14% of the dyslipidemic patients were obese.
Conclusions: Although the majority of the patients in the present study were using insulin analogues, poor glycemic control was common, and chronic complications were encountered.
Manuscript Language: English
