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Classification and Treatment Management in New Diagnosed Diabetes Mellitus Patients

Year 2020, Volume: 2 Issue: 3, 62 - 66, 29.10.2019

Abstract

Objective: Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia. Type 1 diabetes is characterized by impaired insulin secretion, and type 2 diabetes is characterized by insulin resistance. In addition, other diabetes types related to single gene disorders, drug use, and genetic syndromes can be seen. In this study, it was aimed to investigate the symptoms and findings of the patients with new diagnosed diabetes and evaluate the classification.


Material and Method:
Family history, clinical findings, diabetes antibodies (anti GAD, islet cell antibody and anti-insulin antibody), HbA1c levels were evaluated retrospectively in 113 patients who were admitted to our clinic between December 2016 and January 2019.

Results: The mean age of 113 patients included in the study was 10,4±4,3 (1,0-17,1) years. 72 (63,7%) had a family history. Obesity was present in 16 (14,1%). The average of HbA1c was %11,6 and C-peptit level was 0,74 ng/mL. Type 2 diabetes mellitus was present in 8 patients, Prader Willi Syndrome was present in 2 patients and monogenic diabetes in 2 patients. All of patients, 65 (57,5%) were presented with ketoacidosis, 11 (9,7%) with ketosis and 37 (32,7%) with hyperglycemia Antibodies were negative in 40 patients (35,3%). Of the 40 patients with negative diabetes antibodies, 21 (52,5%) had ketoacidosis, 3 (7,5%) had ketosis and 16 (40%) had only hyperglycemia.

Conclusion: In our study, it was noteworthy that 57.5% of the patients who were diagnosed with diabetes still presented with a severe clinical status such as ketoacidosis. In addition, it was observed that diabetes antibodies were negative in approximately half of the patients who were diagnosed with type 1 DM and presented with ketoacidosis. Making the correct classification in diabetes management is of great importance in the management of the patient and planning the right treatment. 

References

  • 1-World Health Organisation. Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia: report of a WHO/IDF consultation. Geneva, Switzerland; 2006.
  • 2-Association AD. Standards of medicalcare in diabetes--2014. Diabetes Care. 2014;37 Suppl1:S14-80.
  • 3- Insel RA, Dunne JL, Atkinson MA, Chiang JL, Dabelea D, Gottlieb PA, et al. Stagingpresymptomatictype 1 diabetes: a scientificstatement of JDRF, theEndocrineSociety, andtheAmericanDiabetesAssociation. Diabetescare. 2015;38(10):1964-74.
  • 4- Reinehr T. Type 2 diabetesmellitus in children and adolescents. World journal of diabetes. 2013;4(6):270.
  • 5- Delva J, O’Malley PM, Johnston LD. Racial/ethnic and socioeconomic status differences in overweight and health-related behaviors among American students: national trends 1986–2003. Journal of AdolescentHealth. 2006;39(4):536-45.
  • 6-IDF Diabetes Atlas 8th Edition. 2017
  • 7-Atkinson M. Type 1 diabetes: Immunology. Oxford Textbook of Endocrinology and Diabetes: in eds Wass JAH, Shalet SM, Gale E, Amiel SA. New York; Oxford University Press: 2002;1459-69.
  • 8-Slama G. Type 1 diabetes: An overview. Textbook of diabetes 3. Edition: İn eds: Pickup JC, Williams G. Berlin; Blackwell Publishing Company: 2003;3:1-3.
  • 9- The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Eng J Med 1993; 329: 977-986.
  • 10-UK Prospective Diabetes Study (UKPDS) Group. Intensive blood glucose control with sulphonyureas or insülin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet1998;352:837- 853.
  • 11-Pulgaron ER, Delamater AM. Obesity and type 2 diabetes in children: epidemiology and treatment. Current diabetes reports. 2014;14(8):508.
  • 12-Kahn SE, Cooper ME, Del Prato S. Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. The Lancet. 2014;383(9922):1068-83.
  • 13-Tattersall R. Maturity-onset diabetes of the young: a clinical history. Diabet Med. 1998;15(1):11-4.
  • 14- Fajans SS, Bell GI. MODY: history, genetics, pathophysiology, and clinical decision making. Diabetes Care. 2011;34(8):1878-84.
  • 15-Fajans SS, Bell GI, Polonsky KS. Molecular mechanisms and clinical pathophysiology of maturity-onset diabetes of the young. NEnglJMed. 2001;345(13):971-80.
  • 16- Tattersall RB, Fajans SS. A difference between the inheritance of classical juvenile-onset and maturity-onset type diabetes of young people. Diabetes. 1975;24(1):44-53.

Yeni Tanı Diyabetes Mellitus Hastalarında Sınıflandırma ve Tedavi Yönetimi

Year 2020, Volume: 2 Issue: 3, 62 - 66, 29.10.2019

Abstract

Amaç: Diyabetus mellitus insulin salgılanması, aktivitesindeki bozulmaya bağlı olarak ortaya çıkan kronik hiperglisemi ile karakterize metabolik bozukluktur. Tip 1 diyabet insülin salınmasında bozukluk ile, tip 2 diyabet ise insülin direnci ile karakterizedir. Bunun dışında tek gen bozukluklarına, ilaç kullanımlarına, genetik sendromlara bağlı diyabet sınıfları da görülebilmektedir. Bu çalışmada yeni tanı diyabetli hastalarda başvuru semptom ve bulgularının araştırılması, sınıflamanın değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntem: Aralık 2016-Ocak 2019 döneminde kliniğimize başvurup diyabet tanısı almış 113 hastada aile öyküleri, geliş bulguları, diyabet antikorları (anti GAD, adacık hücre antikoru ve anti- insulin antikoru), HbA1c düzeyleri retrospektif olarak incelendi.

Bulgular: Çalışmaya alınan 113 hastanın yaş ortalaması 10,4 idi. 72’sinde (%63,7) aile öyküsü mevcuttu. 16’sında (%14,1) obezite mevcuttu. HbA1c ortalaması %11,6, C-peptit düzeyleri 0,74 ng/mL idi. 8 hastada tip 2 diyabetes mellitus, 2 hastada Prader Willi ve 2 hastada monogenik diyabet mevcuttu. Tüm hastaların 65’i (%57,5) ketoasidoz tablosu ile, 11’i (%9,7) ketoz ve 37’si (%32,7) hiperglisemi ile başvurmuştu. Hastaların 40’ında (%35,3) diyabet antikorları negatifti. Diyabet antikorları negatif olan 40 hastanın 21’inde (%52,5) ketoasidoz, 3’ünde (%7,5) ketoz ve 16’sında (%40) hiperglisemi mevcuttu.


Sonuç:
Çalışmamızda, diyabet tanısı alan olguların %57,5 gibi önemli bir kısmının halen ketoasiadoz gibi ağır bir klinik tablo ile başvurduğu dikkati çekmekteydi. Ayrıca, tip 1 DM tanısı konulan ve ketoasidoz ile başvuran olguların yaklaşık yarısında diyabet antikorlarının negatif sonuçlandığı gözlendi. Diyabet yönetiminde doğru sınıflama yapmak, hastanın yönetiminde ve doğru tedavinin planlanmasında büyük önem taşımaktadır.
Anahtar Sözcükler: Otoantikor, diyabet, sınıflama

References

  • 1-World Health Organisation. Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia: report of a WHO/IDF consultation. Geneva, Switzerland; 2006.
  • 2-Association AD. Standards of medicalcare in diabetes--2014. Diabetes Care. 2014;37 Suppl1:S14-80.
  • 3- Insel RA, Dunne JL, Atkinson MA, Chiang JL, Dabelea D, Gottlieb PA, et al. Stagingpresymptomatictype 1 diabetes: a scientificstatement of JDRF, theEndocrineSociety, andtheAmericanDiabetesAssociation. Diabetescare. 2015;38(10):1964-74.
  • 4- Reinehr T. Type 2 diabetesmellitus in children and adolescents. World journal of diabetes. 2013;4(6):270.
  • 5- Delva J, O’Malley PM, Johnston LD. Racial/ethnic and socioeconomic status differences in overweight and health-related behaviors among American students: national trends 1986–2003. Journal of AdolescentHealth. 2006;39(4):536-45.
  • 6-IDF Diabetes Atlas 8th Edition. 2017
  • 7-Atkinson M. Type 1 diabetes: Immunology. Oxford Textbook of Endocrinology and Diabetes: in eds Wass JAH, Shalet SM, Gale E, Amiel SA. New York; Oxford University Press: 2002;1459-69.
  • 8-Slama G. Type 1 diabetes: An overview. Textbook of diabetes 3. Edition: İn eds: Pickup JC, Williams G. Berlin; Blackwell Publishing Company: 2003;3:1-3.
  • 9- The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Eng J Med 1993; 329: 977-986.
  • 10-UK Prospective Diabetes Study (UKPDS) Group. Intensive blood glucose control with sulphonyureas or insülin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet1998;352:837- 853.
  • 11-Pulgaron ER, Delamater AM. Obesity and type 2 diabetes in children: epidemiology and treatment. Current diabetes reports. 2014;14(8):508.
  • 12-Kahn SE, Cooper ME, Del Prato S. Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. The Lancet. 2014;383(9922):1068-83.
  • 13-Tattersall R. Maturity-onset diabetes of the young: a clinical history. Diabet Med. 1998;15(1):11-4.
  • 14- Fajans SS, Bell GI. MODY: history, genetics, pathophysiology, and clinical decision making. Diabetes Care. 2011;34(8):1878-84.
  • 15-Fajans SS, Bell GI, Polonsky KS. Molecular mechanisms and clinical pathophysiology of maturity-onset diabetes of the young. NEnglJMed. 2001;345(13):971-80.
  • 16- Tattersall RB, Fajans SS. A difference between the inheritance of classical juvenile-onset and maturity-onset type diabetes of young people. Diabetes. 1975;24(1):44-53.
There are 16 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Articles
Authors

Şeyma Köksal Atış 0000-0002-8597-8889

Asan Önder 0000-0002-5730-3198

Publication Date October 29, 2019
Submission Date May 9, 2020
Acceptance Date October 1, 2020
Published in Issue Year 2020 Volume: 2 Issue: 3

Cite

AMA Köksal Atış Ş, Önder A. Yeni Tanı Diyabetes Mellitus Hastalarında Sınıflandırma ve Tedavi Yönetimi. Hitit Medical Journal. October 2019;2(3):62-66.