Factors Associated With Uncontrolled Type 1 Diabetes Mellitus In Children And Adolescents In Thi-Qar 2016-2017
Keywords:Factors, uncontrolled type 1 diabetes mellitus, children, adolescents
AbstractBackground:- T1DM is the most common endocrine-metabolic disorder of childhood and adolescence, with important consequences for physical and emotional development. Individuals with T1DM confront serious lifestyle alterations that include an absolute daily requirement for exogenous insulin, the need to monitor their own glucose level, and the need to pay attention to dietary intake.
Objective:- to assess the main factors and patient characters associated with uncontrolled T1DM that should be aware by Iraqi's Pediatricians.
Patient and method:- A cross sectional analytical study had been conducted on children and adolescents with type1 DM visiting the diabetic clinic in Al- Nasiriya Diabetes and endocrine specialized center (south of Iraq), from 1st of June 2016 to the end of May 2017. The patients selected to be as uncontrolled status ( fair and poor control) according to their HbA1C level results. Demographic factors, disease-related characteristics, checking of blood glucose, dietary control, type, dose and regime of insulin injection and other related aspect, and anthropometric measures were included.
Result: - Two hundred and one( 201) type 1 diabetic patients selected to be uncontrolled status with mean age of( 9.530 year ±3.2526),with no significant difference in sex. Majority of them were with poor control status (71.1%), and 28.9% were with fair control status. The residence, mother education, dietary control, regular follow up and regular checking of blood glucose level, syringe use, insulin injection technique, lipodystrophy at injection sites, and person who give the insulin were the main independent factors that had a significant statistical association with the control status in this study, while multi-variant analysis revealed that dietary control, person who are responsible for giving insulin and changing site of injection were significantly associated with control status.
- Britta M. Svoren and Nicholas Jospe. Diabetes Mellitus in Children. Nelson TEXTBOOK of PEDIATRICS 20TH EDITION. Robert M. Kliegman, Bonita F. Stanton, Joseph W. St Geme, Nina F. Schor. Copyright © 2016 by Elsevier, Inc: 2761-2783.
- American Diabetes Association Standards of Medical Care in Diabetesd2016, Diabetes Care 2016;39(Suppl. 1):S1–S2 | DOI: 10.2337/dc16-S001.
- World Health Organization. [Updated May 2017]. Available at:http://www.who.int/mediacentre/factsheets/fs317/en/index.html.
- R Khardori, G T Griffing, Type 1 Diabetes Mellitus Clinical Presentation, Medescape [Updated: Dec 12, 2017].
- From Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, Diabetes Care 2003 Jan; 26 (suppl 1). 6- Akala FA, El-Saharty S. Public-health challenges in the Middle East and North Africa. Lancet. 2006;367:961–4. [PubMed]. 7- Rosengren A, Wallentin L, Simoons M, et al. Cardiovascular risk factors and clinical presentation in acute coronary syndromes. Heart. 2005;91:1141 [PubMed] 8- Rewers M, Pihoker C, Donaghue K, Hanas R, Swift P, Klingensmith GJ. Assessment and monitoring of glycemic control in children and adolescents with diabetes. Pediatric Diabetes 2009;10 (Suppl. 12): 71–81. 9- Alemzadeh R, Berhe T, Wyatt DT: Flexible insulin therapy with glargine insulin improved glycemic control and reduced severe hypoglycemia among preschool-aged children with type 1 diabetes mellitus. Pediatrics. 2005; 115(5):1320–1324. 10- Nysom K, Mølgaard C, Hutchings B, Michaelsen KF. Body mass index of 0-45 years old Danes: Reference values and comparison with published European reference values. Int J Obes Metab Disord. 2001;25:177–84. [PubMed]
Thi-Qar Medical Journal (TQMJ):Vol.(18),No.(2),2019
Web Site: https://jmed.utq.edu.iq Email:firstname.lastname@example.org
- Mounir GM, Abolfotouh MA. Psychosocial characteristics of diabetic students at sporting student hospital in Alexandria. J Egypt Public Health Assoc. 2005;80:475–93. [PubMed] 12- Urbach SL, LaFranchi S, Lambert L, Lapidus JA, Daneman D, Becher TM. Predictors of glucose control in children and adolescents with type 1 diabetes mellitus. Pediatric Diabetes. 2005;6:69–74.[PubMed] 13- Vanelli M, Cerutti F, Chiarelli F, Lorini R, Meschi F MCDC-Italy Group. Nationwide cross sectional survey of 3560 children and adolescents with diabetes in Italy. J Endocrinol Invest. 2005;28:692–9.[PubMed] . 14- H. A. Mohammad, H. S. Farghaly, K. A. Metwalley, E. M. Monazea,1 H. A. Abd El-Hafeez, Predictors of glycemic control in children with Type 1 diabetes mellitus in Assiut-Egypt Indian J Endocrinol Metab. 2012 Sep-Oct; 16(5): 796–802. 15- Setoodeh A, Mostafavi F, Rabbani A, Hedayat T. Female sex as a risk factor for glycemic control and complications in Iranian patients with type one diabetes mellitus. Iran J Pediat. 2011;21:373–8.[PMC free article] [PubMed]. 16- Loveline L. Niba , Benedikt Aulinger, Wilfred F. Mbacham, and Klaus G. Parhofer. Predictors of glucose control in children and adolescents with type 1 diabetes: results of a cross-sectional study in Cameroon. BMC Res Notes. 2017; 10: 207. 17- Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969;44:291–303. [PMC free article] [PubMed] 18- Craig ME, Handelsman P, Donaghue KC, Chan A, Blades ZB, Laina R, et al. Predictors of glycemic control and hypoglycemia in children and adolescents with type 1 diabetes from NSW and the ATC. Med J Aust. 2002;177:228–9. [PubMed] 19- Petitti DB, Klingensmith GJ, Bell RA, Andrews JS, Dabelea D, Imperatore G, et al. Glycemic control in youth with diabetes: The SEARCH for diabetes in youth study. (e1-3).J Pediatr. 2009;155:668–72. [PubMed] 20- Svensson M, Eriksson J, Dahlquist G. Early glycemic control, age at onset and development of microvascular complications in childhood-onset type 1 diabetes: Apopulation-based study in northern Sweden. Diabetes Care. 2004;27:955–62. [PubMed] 21- Sharplin P, Gordon J, Peters JR, Tetlow AP, Longman AJ, McEwan P. Switch from premixed insulin to glargine-based insulin regimen improves glycemic control in patients with type 1 or type 2 diabetes: a retrospective primary care-based analysis. Cardiovasc Diabetol. 2009;8:9. [PMC free article] [PubMed] 22- Svoren BM, Volkening LK, Bulter DA, Moreland EC, Anderson BJ, Laffel LM. Temporal trends in the treatment of pediatric type 1 diabetes and impact on acute outcomes. J Pediatr. 2007;150:279–85. [PubMed] 23- Holl RW, Swift PG, Mortensen HB, Lynggaard H, Hougaard P, Aanstoot HJ, et al. Insulin injection regimens and metabolic control in an international survey of adolescents with type 1 diabetes over 3 years: Results from the Hvidore study group. Eur J Pediatr. 2003;162:22–9. [PubMed] 24- Haller MJ, Satalvey MS, Silverstein JH. Predictors of control of diabetes: Monitoring may be the key. J Pediatr. 2004;144:660–1. [PubMed] 25- Kaufman FR, Halvorson M, Carpenter S. Association between diabetes control and visits to a multidisciplinary pediatric diabetes clinic. Pediatrics. ;103:948–51. 26- Morris AD, Boyle DI, McMahon AD, Greene SA, MacDonald TM, Newton RW. Adherence to insulin treatment, glycemic control and ketoacidosis in insulin-dependent diabetes mellitus. The DARTS/MEMO Collaboration. Diabetes Audit and Research in Tayside Scotland. Medicines Monitoring Unit. Lancet. 1997;350:1505–10. [PubMed] 27- Saukkonen T, Vaisanen S, Akerblom HK, et al. Coeliac disease in children and adolescents with type 1 diabetes: a study of growth, glycaemic control, and experiences of families. Acta Paediatr 2002;91:297–302.