Diabetes Care, Glycemic Control, Complications, and Concomitant Autoimmune Diseases in Children with Type 1 Diabetes in Turkey: A Multicenter Study

Abstract

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.Conflict of interest:None declared.

Hyperthyroidism in 276 Children and Adolescents with Type 1 Diabetes from Germany and Austria

“…A rate of approximately 20% positivity for thyroid antibodies has previously been reported for T1DM children in Germany and Austria [2], this rate being slightly higher than in other European countries (Poland 10%, Turkey 12%) [7,18]. …”

“…In children and adolescents with T1DM, the lifetime prevalence of hyperthyroidism appears to be quite low: 0.2% in Turkey [18], 0.53% in Italy [3], and 0.7% in Poland [7]. Only in the Madrid area (Spain) were T1DM children found to be subclinically hyperthyroid in 3% and overtly hyperthyroid in 6% of cases [19].…”

Associated auto-immune disease in type 1 diabetes patients: a systematic review and meta-analysis

“…For example, reference values for TSH indicating (auto-immune) hypothyroidism varied from >4.0 up to >10 mU/L (48,49,50,51), usually but not always (49,51,52) dependent on fT4 levels to determine if the condition was classified as clinical overt or subclinical disease. In most studies, only hypothyroid patients with antibody positivity were considered as having autoimmune hypothyroidism (9,41,44,53,54,55,56,57) and others included ultrasound to confirm the diagnosis (58) or both (59,60,61,62,63). Two studies counted cases that were treated for their thyroid disease irrespective of antibodies (12,64).…”

Association between Dyslipidemia and Glycemic control in Children with Type 1 Diabetes Mellitus: A Cross-Sectional Study

“…In patients with T1DM, chronic complications including nephropathy, neuropathy, retinopathy, peripheral vascular, and cardiovascular diseases (CVD) directly affect the expectancy and long term quality of life [3]. The presence of dyslipidemia increases the frequency and severity of these complications [4].…”