5 Yaş Altında Tip 1 Diabetes Mellitus’lu Olguların Tanıda ve 1 Yıllık İzlemde Klinik ve Laboratuvar Farklılıklarının Belirlenmesi

Abstract

SUBASİ, A., Determination of Clinical and Laboratory Differences in The Diagnosis and One-Year Follow-up of Type 1 Diabetes Mellitus In Children Under 5 Years, Hacettepe University Faculty of Medicine, Departments of Pediatrics, Thesis in Pediatrics, Ankara 2019 Aim: Type 1 diabetes mellitus (T1DM) is a common chronic disease of exogenous insulin-dependent childhood, which is characterized by a deficiency or absolute absence of insulin as a result of the destruction of pancreatic β cells. When the literature findings are examined in recent years, it is pointed out that there is a significant increase in the cases under 5 years of age and the importance of the studies related to these cases. In this study,we aimed to determine the clinical and laboratory differences in terms of the diagnosis and one-year follow-up in our hospital between the cases with T1DM aged 5 and younger and the cases older than 5 years. Material and Methods: 263 patients with T1DM, aged between 6 months and 18 years old, who were diagnosed and followed up one year in Pediatric Endocrinology Department of Hacettepe University İhsan Doğramacı Children's Hospital between January 1, 2000 and December 28, 2018 were analyzed retrospectively. Our patients were divided into two groups as aged 5 and under 5 years of age (73 patients - 27.8%) and the cases older than 5 years (190 patients - 72.2%). The demographic characteristics, complaints and findings at the time of admission, laboratory and imaging findings at diagnosis, hospitalization information, treatments, remission status,concomitant autoimmune diseases, insulin treatments in the one-year followup period, and other follow-up findings were evaluated. Results: At the time of diagnosis, in patients under 5 years old, it was found that fever and infection symptoms were more common, shorter duration of complaints, less frequency and rate of weight loss, higher insulin intake at the external center, lower sodium/corrected sodium levels/osmolarity /C-peptide level, higher BUN and potassium levels. Hospitalization time was longer, frequency of diabetes autoantibody positivity was higher, Anti-İnsulin (IAA) level was higher and it was statistically significant. The ratio of bolus to basal in the patients aged 5 years and younger was higher in the first 3 months. Less remission was observed in patients under 5 years of age, but there was no statistical difference between the groups. Celiac disease (CD) was found to be higher in patients under 5 years of age during a one-year follow-up. There was no statistically significant difference between the two groups in terms of the incidence of Autoimmune Thyroiditis. Conclusion: In our study, patients with T1DM at the age of 5 and younger were diagnosed more frequently during the period of age-specific common infections compared to the older age groups. Although the duration of the complaint was shorter, it was thought that the frequency of diabetes autoantibodies was more common, and the levels of diabetes autoantibodies was higher due to the rapid and aggressive development of pancreatic β cell damage. It was shown that laboratory findings related to metabolic decompensation were higher under 5 years of age at the time of diagnosis. Although it is known that patients under 5 years of age need less insulin compared to older age groups, we found no difference in the treatment doses given in the first-year follow-up. Findings supporting the need for higher bolus treatment in patients aged 5 years because they were in a period of growth and development, in very active period and were fed more frequent and their snacks close to main meals. Although it is reported that autoimmune diseases are very rare in the general population under 5 years of age, the frequency of autoimmune disease in children under 5 years of age shows differences in etiopathogenesis. In our study, many different features of T1DM in terms of the diagnosis, treatment, and follow-up are shown in children under 5 years of age. Both healthcare providers and their parents need to know these features related to this age group.