Endokrinoloji bölümünde takip edilen diyabetik hastaların kan şekeri regülasyonu ve metabolik kontrol durumlarının değerlendirilmesi
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Dosyalar
Tarih
2011
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Diyabetes mellitus (DM), toplumda sık rastlanan, ömür boyu süren, komplikasyonlarının fazla olması ve tedavi maliyetinin yüksek olmasından dolayı sadece hastayı değil tüm toplumu ilgilendiren kronik, ilerleyici bir hastalıktır. Teşhis ve tedavide gecikme olması durumunda hastanın yaşam kalitesini düşürmekte, iş gücü ve ekonomik kayıba sebep olmakta ve geriye dönüşü olmayan sekeller bırakarak hastanın ömrünü kısaltmaktadır. Diyabette temel hedef hastanın yaşam kalitesini yükselterek, gelişebilecek komplikasyonları önlemek ve geciktirmektir. Diyabet tedavisinde başarılı olmak için geliştirilen yeni ilaçlar ve teknolojik gelişmelerin yanı sıra hedef populasyonun tanınması klinik ve demografik özelliklerinin belirlenmesi de önemlidir. Bu çalışmada amacımız DM açısından kliniğimize ait demografik bilgileri oluşturmak ve bu verileri kullanarak hastaların eğitim, takip ve tedavi önceliklerini belirlemek ve düzenlemektir.Materyal-metod: Ocak 2010 - Aralık 2010 tarihleri arasında Düzce Üniversitesi Tıp Fakültesi Endokrinoloji Polikliniğine başvuran ve rutin takipleri 3 aylık aralıklarla yapılan, en az 6 aylık diyabet tanısı olan 500 diyabetik hastanın muayene, laboratuar, tedavi bilgilerinin yazıldığı dosyalar retrospektif olarak incelendi. Hastaların; yaşı, cinsiyeti, boy, kilo, vücut kitle indeksleri (VKİ), diyabet tipleri, diyabet süreleri, antidiyabetik tedavi şekilleri, ilaç yan etkileri, diyabetin mikrovasküler-makrovasküler komplikasyonları, diyabet dışındaki ek hastalıkları kaydedildi. Hastaların muayenelerinin yapıldığı gündeki açlık kan şekeri (AKŞ), tokluk kan şekeri (TKŞ), glikozile hemoglobin (HbA1c), kreatin, tiroid stimüle eden hormon (TSH), albumin/kreatin oranı ya da 24 saatlik idrarda proteinüri, elektrolitler (Na, K), ürik asit ve lipid parametreleri kaydedildi. İstatistiksel analizde, bağımsız student t testi, one-way ANOVA (tek yönlü varyans analizi) testi, post hoc Tukey testi ve Likelihood ki-kare testi kullanıldı.Bulgular: Araştırma grubunda hastaların %39,6'sı erkek, %60,4'ü kadın olup yaş ortalamaları 56,6±11,8 yıldır. VKİ ortalamaları 31,7±6,9'dır. Hastaların 14'ü Tip 1 (%2,8), 484'ü Tip 2 (%97,2) diyabetlidir. Tip 1 diyabetli hastaların ortalama hastalık süreleri 9,3±7,3 yıl, Tip 2 diyabetli hastaların ortalama hastalık süreleri ise 8,1±7,2 yıldır. Hastaların %20'si insülin, %26,5'i insülin ile beraber oral antidiyabetik (OAD), %53,5'i OAD ilaçlarla tedavi edilmekteydiler. Hastalara uygulanan tedavi şekli ile diyabet süreleri arasında anlamlı bir ilişki vardı (p<0,001). OAD ile tedavi edilen hastalarda ortalama diyabet süresi 5,1±5,0 yıldır. Hastalık süresi arttıkça insülin kullanım oranları da artmaktadır. Diyabetin geç komplikasyonları araştırıldığında retinopati %31,9, nöropati %50,6, nefropati %37,1, aterosklerotik değişiklikler açısından hipertansiyon (HT) %70,8, hiperkolesterolemi (HL) %69,8 oranlarında saptanmıştır. OAD tedavi alan hastalarda komplikasyon daha az saptanmıştır (%63,4), oysa insülin ve insülin ile beraber OAD tedavi alan hastaların yaklaşık %85'inde diyabetin kronik komplikasyonu mevcuttu. Yaş ilerledikçe (p<0,001) ve diyabet süresi uzadıkça (p<0,001) komplikasyon oranı artmaktadır. Hastaların %68'inin metabolik kontrolü kötü, %32'sinin ise iyi olarak değerlendirildi. HbA1c değerleri ortalaması 8,1±2,0 idi. Diyabet süresi uzadıkça metabolik kontrolü iyi olanların oranı azalmaktadır (p<0,001). İnsülin kullananların metabolik kontrolü diğer tedavi yöntemlerini kullananlara göre daha kötüdür (p<0,001).Sonuç: Bu bulgular diyabetli bireylerin metabolik kontrol düzeyleri ve takiplerinin genel olarak kötü olduğunu göstermektedir. Diyabetli bireylerde metabolik kontrolü etkileyen çok sayıda tıbbi ve sosyal faktör olup, hem hastalar hem de sağlık personeli bu konuya gereken önemi vermelidir. Diyabet tedavisinde başarılı olmak için geliştirilen yeni ilaçlar ve teknolojik gelişmelerin yanı sıra hedef popülasyonun tanınması klinik, demografik özelliklerinin belirlenmesi, eğitim ve tedavi yaklaşımlarının bu verilere göre düzenlenmesi gerekir.
Introduction: Diabetes mellitus (DM) is a common and chronic disease and due to its complications, progressive pattern and high cost of the treatment it is concerning the whole society. The delay in the diagnosis and treatment reduces patients? quality of life, causes labor and economic loss and also leads to irreversible sequelae and shortening of the survival. The main goal in diabetes is to delay and prevent subsequent complications by increasing the life quality of the patients. To be successful in the treatment of diabetes, as well as the new drugs and technological developments, the recognition of the target population and identification of the clinical and demographic characteristics are also important. Our aim in this study was to create demographic information of our clinic in DM patients and by using these data is to determine and organize the patients education, follow-up and treatment priorities.Material-Method: 500 diabetic patients those admitted to endocrinology clinic of Duzce University Faculty of Medicine between January 2010-December 2010 and who had diagnosed as diabetes for at least 6 months and routinely follow upped at intervals of 3-months were included in the study and their physical examination, laboratory, treatment datas were retrospectively reviewed. Patients; age, gender, height, weight, body mass index (BMI), diabetes type, duration of diabetes, antidiabetic treatment modalities, medication side effects, microvascular-macrovascular complications of diabetes, additional diseases other than diabetes were recorded. On the day of admission patients; fasting blood glucose (FBG), postprandial blood glucose (PBG), and glycated hemoglobin (HbA1c), creatinine, thyroid-stimulating hormone (TSH), albumin/creatinine ratio or 24-hour urine proteinuria, electrolytes (Na, K), uric acid and lipid parameters were recorded. For statistical analysis, independent Student's t test, one-way ANOVA (one-way analysis of variance) test, post hoc Tukey test, and likelihood chi-square test were used.Results: In research group, 39.6% of the patients were male and 60.4% were female, mean age was 56.6±11.8 years. Mean BMI was 31.7±6.9. While there was Type 1 DM in 14 (%2.8) of the patients, 484 (97.2%) of them had Type 2 DM. Mean disease duration of the patients was 9.3±7.3 years in Type 1 and 8.1±7.2 years in Type 2 DM. 20% of the patients were being treated with insulin, 26.5% of them with insulin and oral antidiabetic (OAD) and 53.5% of them with only OAD. There was a significant relationship between the form of the treatment and duration of the diabetes in patients (p<0.001). In OAD-treated patients, median duration of the diabetes was 5.1±5.0 years. It was found as when the duration of diabetes increased, the usage of insulin was also increased. When the late complications of diabetes were investigated; 31.9% retinopathy, 50.6% neuropathy, 37.1% nephropathy, in terms of atherosclerotic changes; 70.8% hypertension (HT), 69.8% hypercholesterolemia (HL) was detected. Complications were seen less in patients receiving OAD treatment (63.4%) whereas there was chronic complications of diabetes in %85 of the patients who were receiving insulin or insulin and OAD treatments. Complicaton rates were increasing with advancing age (p<0,001) and longer duration of diabetes (p<0,001). Metabolic control of 68% of the patients were assessed as poor, while 32% of them were assessed as well. The mean HbA1c value was 8.1±2.0. As the duration of diabetes prolonged, the rates of well metabolic controlled patients was decreased (P<0.001). Metabolic control of the insulin users was worse than those using other methods of treatment (p<0.001).Conclusion: These findings shows that metabolic control levels and follow-ups of diabetic individuals are generally poor. In diabetic individuals there is numerous medical and social factors that affect metabolic control so both of the patients and health personnel should give adequate consideration to this matter. To be successful in the treatment of diabetes, as well as the new drugs and technological developments, the recognition of the target population and identification of the clinical and demographic characteristics are also important.
Introduction: Diabetes mellitus (DM) is a common and chronic disease and due to its complications, progressive pattern and high cost of the treatment it is concerning the whole society. The delay in the diagnosis and treatment reduces patients? quality of life, causes labor and economic loss and also leads to irreversible sequelae and shortening of the survival. The main goal in diabetes is to delay and prevent subsequent complications by increasing the life quality of the patients. To be successful in the treatment of diabetes, as well as the new drugs and technological developments, the recognition of the target population and identification of the clinical and demographic characteristics are also important. Our aim in this study was to create demographic information of our clinic in DM patients and by using these data is to determine and organize the patients education, follow-up and treatment priorities.Material-Method: 500 diabetic patients those admitted to endocrinology clinic of Duzce University Faculty of Medicine between January 2010-December 2010 and who had diagnosed as diabetes for at least 6 months and routinely follow upped at intervals of 3-months were included in the study and their physical examination, laboratory, treatment datas were retrospectively reviewed. Patients; age, gender, height, weight, body mass index (BMI), diabetes type, duration of diabetes, antidiabetic treatment modalities, medication side effects, microvascular-macrovascular complications of diabetes, additional diseases other than diabetes were recorded. On the day of admission patients; fasting blood glucose (FBG), postprandial blood glucose (PBG), and glycated hemoglobin (HbA1c), creatinine, thyroid-stimulating hormone (TSH), albumin/creatinine ratio or 24-hour urine proteinuria, electrolytes (Na, K), uric acid and lipid parameters were recorded. For statistical analysis, independent Student's t test, one-way ANOVA (one-way analysis of variance) test, post hoc Tukey test, and likelihood chi-square test were used.Results: In research group, 39.6% of the patients were male and 60.4% were female, mean age was 56.6±11.8 years. Mean BMI was 31.7±6.9. While there was Type 1 DM in 14 (%2.8) of the patients, 484 (97.2%) of them had Type 2 DM. Mean disease duration of the patients was 9.3±7.3 years in Type 1 and 8.1±7.2 years in Type 2 DM. 20% of the patients were being treated with insulin, 26.5% of them with insulin and oral antidiabetic (OAD) and 53.5% of them with only OAD. There was a significant relationship between the form of the treatment and duration of the diabetes in patients (p<0.001). In OAD-treated patients, median duration of the diabetes was 5.1±5.0 years. It was found as when the duration of diabetes increased, the usage of insulin was also increased. When the late complications of diabetes were investigated; 31.9% retinopathy, 50.6% neuropathy, 37.1% nephropathy, in terms of atherosclerotic changes; 70.8% hypertension (HT), 69.8% hypercholesterolemia (HL) was detected. Complications were seen less in patients receiving OAD treatment (63.4%) whereas there was chronic complications of diabetes in %85 of the patients who were receiving insulin or insulin and OAD treatments. Complicaton rates were increasing with advancing age (p<0,001) and longer duration of diabetes (p<0,001). Metabolic control of 68% of the patients were assessed as poor, while 32% of them were assessed as well. The mean HbA1c value was 8.1±2.0. As the duration of diabetes prolonged, the rates of well metabolic controlled patients was decreased (P<0.001). Metabolic control of the insulin users was worse than those using other methods of treatment (p<0.001).Conclusion: These findings shows that metabolic control levels and follow-ups of diabetic individuals are generally poor. In diabetic individuals there is numerous medical and social factors that affect metabolic control so both of the patients and health personnel should give adequate consideration to this matter. To be successful in the treatment of diabetes, as well as the new drugs and technological developments, the recognition of the target population and identification of the clinical and demographic characteristics are also important.
Açıklama
YÖK Tez No: 293431
Anahtar Kelimeler
Endokrinoloji ve Metabolizma Hastalıkları, Endocrinology and Metabolic Diseases, Diabetes mellitus, Diabetes mellitus, Glisemik indeks, Glycemic index, Hemoglobin A-glikolize, Hemoglobin A-glycosylated, Kan glükozu, Blood glucose, Vasküler hastalıklar, Vascular diseases
