Araştırma Makalesi
Yıl 2025,
Cilt: 47 Sayı: 1, 26 - 31, 29.03.2025
Öz
Amaç: Bu çalışmada, tip 1 diabetes mellituslu (T1DM) pediatrik hastalarda tanı anı ile bir yıllık izlem sonundaki dislipidemi prevalansı değerlendirildi ve glisemik kontrolün lipid seviyeleri üzerindeki etkileri incelendi.
Materyal ve yöntem: 10-18 yaş aralığındaki 56 (30 erkek, 26 kız) T1DM hastasının verileri retrospektif olarak analiz edildi. En az bir yıl boyunca her üç ayda bir görülen hastaların başlangıçtaki ve bir yıl sonraki lipid profilleri ve glisemik kontrol ile ilgili verileri değerlendirildi.
Bulgular: Dislipidemi prevalansı başlangıçtaki %60.7 iken bir yıl sonra anlamlı bir azalma göstererek %26.8'e geriledi (p < 0.001). Takipte hemoglobin A1c (HbA1c), düşük yoğunluklu lipoprotein (LDL) ve trigliserid (TG) düzeyleri başlangıç değerlerine göre anlamlı azalma gösterdi (%7.95 ± 1.73'e karşı %13.45 ± 2.45, 84.07 ± 27.55 mg/dl'ye karşı 94.84 ± 27.87 mg/dl ve 78.75 ± 29.93 mg/dl'ye karşı 105.98 ± 58.95 mg/dl) (p < 0.001, p = 0.007, p = 0.001). Total kolesterol (TK) değerlerinde istatistiksel anlamlılık sınırında azalma görüldü (151.20 ± 25.55 mg/dl'ye karşı 159.79 ± 29.78 mg/dl, p = 0.05). Yüksek yoğunluklu lipoprotein (HDL) seviyeleri anlamlı artış gösterdi (55.60 ± 11.10 mg/dl'ye karşı 49.63 ± 13.46 mg/dl, p < 0.001). Kızların HDL seviyeleri erkeklerden daha yüksekti (60.08 ± 12.37 mg/dl'ye karşı 51.71 ± 8.24 mg/dl, p = 0.004). HbA1c seviyeleri TK, LDL ve TG seviyeleri ile pozitif korelasyon, HDL ile negatif korelasyon gösterdi.
Sonuç: Bu çalışma, pediatrik T1DM hastaların bir yıllık izleminde dislipidemi prevalansındaki azalmanın, iyileşen glisemik kontrolle bağlantılı olduğunu vurgulamaktadır. Daha iyi lipid profilleri ve kardiyovasküler riskin azalması için etkili HbA1c yönetimi çok önemlidir.
Anahtar Kelimeler
Kaynakça
- 1. Svoren BM, Nicholas J. Diabetes Mellitus in Children. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, Behrman RE, eds. Nelson Textbook of Pediatrics. 20 ed. Elsevier Saunders; 2016:2760-83:chap 589.
- 2. Morales AE, She JX, Schatz DA. Genetics of type 1 diabetes. In: Pescovitz OH, Eugster EA (Eds). Pediatric Endocrinology. 1st ed. Philadelphia: Lippincott Williams & Wilkins; 2004:402-26.
- 3. Buse JB, Ginsberg HN, Bakris GL, et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care. Jan 2007;30(1):162-72. doi:10.2337/dc07-9917
- 4. McGill HC, Jr., McMahan CA, Malcom GT, Oalmann MC, Strong JP. Relation of glycohemoglobin and adiposity to atherosclerosis in youth. Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Arterioscler Thromb Vasc Biol. Apr 1995;15(4):431-40.
- 5. McGill HC, Jr., McMahan CA, Malcom GT, Oalmann MC, Strong JP. Effects of serum lipoproteins and smoking on atherosclerosis in young men and women. The PDAY Research Group. Pathobiological Determinants of Atherosclerosis in Youth. Arterioscler Thromb Vasc Biol. Jan 1997;17(1):95-106.
- 6. Hamad A, Qureshi JH. Dyslipidaemia in recently diagnosed young subjects of type 1 diabetes mellitus with normal/favourable BMI: a risk factor of macrovascular disease. Biomedica. 2008;24:130-133.
- 7. Neal WA, John CC. Disorders of lipoprotein metabolism and transport. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, Behrman RE (Eds.). Nelson Textbook of Pediatrics. 20th ed. Philadelphia: Elsevier Saunders; 2016:691-705.
- 8. Berenson GS, Srinivasan SR, Bao W, Newman WP, 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med. Jun 4 1998;338(23):1650-6. doi:10.1056/NEJM19980604 3382302
- 9. Maahs DM, Maniatis AK, Nadeau K, Wadwa RP, McFann K, Klingensmith GJ. Total cholesterol and high-density lipoprotein levels in pediatric subjects with type 1 diabetes mellitus. J Pediatr. Oct 2005;147(4):544-6. doi:10.1016/ j.jpeds.2005.04.068
- 10. Vergès B. Lipid disorders in type 1 diabetes. In: Liu PC-P (Ed.). Type 1 diabetes - Complications, Pathogenesis and Alternative Treatments. Rijeka: InTech; 2011:45-60.
- 11. Edge JA, James T, Shine B. Longitudinal screening of serum lipids in children and adolescents with Type 1 diabetes in a UK clinic population. Diabet Med. Aug 2008;25(8):942-8. doi:10.1111/j.1464-5491.2008.02518.x
- 12. Dobrovolskiene R, Mockeviciene G, Urbonaite B, Jurgeviciene N, Preiksa RT, Ostrauskas R. The risk of early cardiovascular disease in Lithuanian diabetic children and adolescents: a type 1 diabetes register database based study. Diabetes Res Clin Pract. Apr 2013;100(1):119-25. doi:10.1016/j.diabres.2013.01.022
- 13. Craig ME, Jefferies C, Dabelea D, et al. ISPAD Clinical Practice Consensus Guidelines 2014. Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes. Sep 2014;15 Suppl 20:4-17. doi:10.1111/pedi. 12186
- 14. American Diabetes A. Standards of medical care in diabetes 2016. Diabetes Care. Jan 2016;39 Suppl 1(1):1-102. doi:10.2337/dc16-S001
- 15. Donaghue KC, Wadwa RP, Dimeglio LA, et al. Microvascular and macrovascular complications in children and adolescents. Pediatr Diabetes. 2014:15 (Suppl. 20): 257–269. doi:10.1111/pedi.12180
- 16. Neyzi O, Günöz H, Furman A, et al. Türk çocuklarında vücut ağırlığı, boy uzunluğu, baş çevresi ve vücut kitle indeksi referans değerleri. Çocuk Sağlığı Hast Derg. 2008;51(1):1- 14.
- 17. Tumer N, Yalcinkaya F, Ince E, et al. Blood pressure nomograms for children and adolescents in Turkey. Pediatr Nephrol. Jun 1999;13(5):438-43. doi:10.1007/s004670050 636
- 18. Schwab KO, Doerfer J, Hecker W, et al. Spectrum and prevalence of atherogenic risk factors in 27,358 children, adolescents, and young adults with type 1 diabetes: cross-sectional data from the German diabetes documentation and quality management system (DPV). Diabetes Care. Feb 2006;29(2):218-25.
- 19. Redondo MJ, Foster NC, Libman IM, et al. Prevalence of cardiovascular risk factors in youth with type 1 diabetes and elevated body mass index. Acta Diabetol. Apr 2016;53(2):271-7. doi:10.1007/s00592-015-0785-1
- 20. Homma TK, Endo CM, Saruhashi T, et al. Dyslipidemia in young patients with type 1 diabetes mellitus. Arch Endocrinol Metab. Jun 2015;59(3):215-9. doi:10.1590/2359-3997000000040
- 21. Krantz JS, Mack WJ, Hodis HN, Liu CR, Liu CH, Kaufman FR. Early onset of subclinical atherosclerosis in young persons with type 1 diabetes. J Pediatr. Oct 2004;145(4):452-7. doi:10.1016/ j.jpeds.2004.06.042
- 22. Silva L, Silva S, Oliveira AMS, et al. Hypertriglyceridemic Waist and Associated Factors in Children and Adolescents with Type 1 Diabetes Mellitus. Rev Paul Pediatr. 2020;38:e2019073. doi:10.1590/1984-0462/2020/38/20190 73
- 23. Maahs DM, Wadwa RP, McFann K, et al. Longitudinal lipid screening and use of lipid-lowering medications in pediatric type 1 diabetes. J Pediatr. Feb 2007;150(2):146-50, 150 e1-2. doi:10.1016/j.jpeds.2006.10.054
- 24. Bulut T, Demirel F, Metin A. The prevalence of dyslipidemia and associated factors in children and adolescents with type 1 diabetes. J Pediatr Endocrinol Metab. Feb 1 2017;30(2):181-187. doi:10.1515/jpem-2016-0111
- 25. Guy J, Ogden L, Wadwa RP, et al. Lipid and lipoprotein profiles in youth with and without type 1 diabetes: the SEARCH for Diabetes in Youth case-control study. Diabetes Care. Mar 2009;32(3):416-20. doi:10.2337/dc08-1775
- 26. Reh CM, Mittelman SD, Wee CP, Shah AC, Kaufman FR, Wood JR. A longitudinal assessment of lipids in youth with type 1 diabetes. Pediatr Diabetes. Jun 2011;12(4 Pt 2):365-71. doi:10.1111/j.1399-5448.2010.00733.x
- 27. Shah N, Khadilkar A, Gondhalekar K, Khadilkar V. Prevalence of dyslipidemia in Indian children with poorly controlled type 1 diabetes mellitus. Pediatr Diabetes. Sep 2020;21(6):987-994. doi:10.1111/pedi.13063
- 28. Bjornstad P, Donaghue KC, Maahs DM. Macrovascular disease and risk factors in youth with type 1 diabetes: time to be more attentive to treatment? Lancet Diabetes Endocrinol. Oct 2018;6(10):809-820. doi:10.1016/S2213-8587(18)30035-4
- 29. Noras K, Rusak E, Jarosz-Chobot P. The Problem of Abnormal Body Weight and Dyslipidemia as Risk Factors for Cardiovascular Diseases in Children and Adolescents with Type 1 Diabetes. J Diabetes Res. 2021;2021:5555149. doi:10.1155/2021/5555149
Prevalence of Dyslipidemia at Onset and During Follow-Up in Pediatric Patients with Type 1 Diabetes Mellitus
Öz
Objectives: This study assessed the prevalence of dyslipidemia in pediatric patients with type 1 diabetes mellitus (T1DM) at diagnosis and after one year, examining the effects of glycemic control on lipid levels.
Material and methods: A retrospective analysis was conducted on 56 T1DM patients (30 males, 26 females) aged 10-18 years. These patients were monitored every three months for at least one year. Data on lipid profiles and glycemic control were collected at baseline and after one year.
Results: Dyslipidemia prevalence significantly decreased from 60.7% at baseline to 26.8% after one year (p < 0.001). At follow-up, hemoglobin A1c (HbA1c), low-density lipoprotein (LDL), and triglyceride (TG) levels were significantly lower compared to baseline (7.95 ± 1.73% vs. 13.45 ± 2.45%, 84.07 ± 27.55 mg/dl vs. 94.84 ± 27.87 mg/dl, and 78.75 ± 29.93 mg/dl vs. 105.98 ± 58.95 mg/dl, respectively) (p < 0.001, p = 0.007, p = 0.001). Total cholesterol (TC) also decreased, though the difference was near significance (151.20 ± 25.55 mg/dl vs. 159.79 ± 29.78 mg/dl, p = 0.05). High-density lipoprotein (HDL) levels increased significantly (55.60 ± 11.10 mg/dl vs. 49.63 ± 13.46 mg/dl, p < 0.001). Females had higher HDL levels than males (60.08 ± 12.37 mg/dl vs. 51.71 ± 8.24 mg/dl, p = 0.004). HbA1c levels showed a positive correlation with TC, LDL, and TG, and a negative correlation with HDL.
Conclusion: This study highlights a significant reduction in dyslipidemia in pediatric T1DM patients after one year, linked to improved glycemic control. Effective HbA1c management is crucial for better lipid profiles and reduced cardiovascular risk.
Anahtar Kelimeler
Kaynakça
- 1. Svoren BM, Nicholas J. Diabetes Mellitus in Children. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, Behrman RE, eds. Nelson Textbook of Pediatrics. 20 ed. Elsevier Saunders; 2016:2760-83:chap 589.
- 2. Morales AE, She JX, Schatz DA. Genetics of type 1 diabetes. In: Pescovitz OH, Eugster EA (Eds). Pediatric Endocrinology. 1st ed. Philadelphia: Lippincott Williams & Wilkins; 2004:402-26.
- 3. Buse JB, Ginsberg HN, Bakris GL, et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care. Jan 2007;30(1):162-72. doi:10.2337/dc07-9917
- 4. McGill HC, Jr., McMahan CA, Malcom GT, Oalmann MC, Strong JP. Relation of glycohemoglobin and adiposity to atherosclerosis in youth. Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Arterioscler Thromb Vasc Biol. Apr 1995;15(4):431-40.
- 5. McGill HC, Jr., McMahan CA, Malcom GT, Oalmann MC, Strong JP. Effects of serum lipoproteins and smoking on atherosclerosis in young men and women. The PDAY Research Group. Pathobiological Determinants of Atherosclerosis in Youth. Arterioscler Thromb Vasc Biol. Jan 1997;17(1):95-106.
- 6. Hamad A, Qureshi JH. Dyslipidaemia in recently diagnosed young subjects of type 1 diabetes mellitus with normal/favourable BMI: a risk factor of macrovascular disease. Biomedica. 2008;24:130-133.
- 7. Neal WA, John CC. Disorders of lipoprotein metabolism and transport. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, Behrman RE (Eds.). Nelson Textbook of Pediatrics. 20th ed. Philadelphia: Elsevier Saunders; 2016:691-705.
- 8. Berenson GS, Srinivasan SR, Bao W, Newman WP, 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med. Jun 4 1998;338(23):1650-6. doi:10.1056/NEJM19980604 3382302
- 9. Maahs DM, Maniatis AK, Nadeau K, Wadwa RP, McFann K, Klingensmith GJ. Total cholesterol and high-density lipoprotein levels in pediatric subjects with type 1 diabetes mellitus. J Pediatr. Oct 2005;147(4):544-6. doi:10.1016/ j.jpeds.2005.04.068
- 10. Vergès B. Lipid disorders in type 1 diabetes. In: Liu PC-P (Ed.). Type 1 diabetes - Complications, Pathogenesis and Alternative Treatments. Rijeka: InTech; 2011:45-60.
- 11. Edge JA, James T, Shine B. Longitudinal screening of serum lipids in children and adolescents with Type 1 diabetes in a UK clinic population. Diabet Med. Aug 2008;25(8):942-8. doi:10.1111/j.1464-5491.2008.02518.x
- 12. Dobrovolskiene R, Mockeviciene G, Urbonaite B, Jurgeviciene N, Preiksa RT, Ostrauskas R. The risk of early cardiovascular disease in Lithuanian diabetic children and adolescents: a type 1 diabetes register database based study. Diabetes Res Clin Pract. Apr 2013;100(1):119-25. doi:10.1016/j.diabres.2013.01.022
- 13. Craig ME, Jefferies C, Dabelea D, et al. ISPAD Clinical Practice Consensus Guidelines 2014. Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes. Sep 2014;15 Suppl 20:4-17. doi:10.1111/pedi. 12186
- 14. American Diabetes A. Standards of medical care in diabetes 2016. Diabetes Care. Jan 2016;39 Suppl 1(1):1-102. doi:10.2337/dc16-S001
- 15. Donaghue KC, Wadwa RP, Dimeglio LA, et al. Microvascular and macrovascular complications in children and adolescents. Pediatr Diabetes. 2014:15 (Suppl. 20): 257–269. doi:10.1111/pedi.12180
- 16. Neyzi O, Günöz H, Furman A, et al. Türk çocuklarında vücut ağırlığı, boy uzunluğu, baş çevresi ve vücut kitle indeksi referans değerleri. Çocuk Sağlığı Hast Derg. 2008;51(1):1- 14.
- 17. Tumer N, Yalcinkaya F, Ince E, et al. Blood pressure nomograms for children and adolescents in Turkey. Pediatr Nephrol. Jun 1999;13(5):438-43. doi:10.1007/s004670050 636
- 18. Schwab KO, Doerfer J, Hecker W, et al. Spectrum and prevalence of atherogenic risk factors in 27,358 children, adolescents, and young adults with type 1 diabetes: cross-sectional data from the German diabetes documentation and quality management system (DPV). Diabetes Care. Feb 2006;29(2):218-25.
- 19. Redondo MJ, Foster NC, Libman IM, et al. Prevalence of cardiovascular risk factors in youth with type 1 diabetes and elevated body mass index. Acta Diabetol. Apr 2016;53(2):271-7. doi:10.1007/s00592-015-0785-1
- 20. Homma TK, Endo CM, Saruhashi T, et al. Dyslipidemia in young patients with type 1 diabetes mellitus. Arch Endocrinol Metab. Jun 2015;59(3):215-9. doi:10.1590/2359-3997000000040
- 21. Krantz JS, Mack WJ, Hodis HN, Liu CR, Liu CH, Kaufman FR. Early onset of subclinical atherosclerosis in young persons with type 1 diabetes. J Pediatr. Oct 2004;145(4):452-7. doi:10.1016/ j.jpeds.2004.06.042
- 22. Silva L, Silva S, Oliveira AMS, et al. Hypertriglyceridemic Waist and Associated Factors in Children and Adolescents with Type 1 Diabetes Mellitus. Rev Paul Pediatr. 2020;38:e2019073. doi:10.1590/1984-0462/2020/38/20190 73
- 23. Maahs DM, Wadwa RP, McFann K, et al. Longitudinal lipid screening and use of lipid-lowering medications in pediatric type 1 diabetes. J Pediatr. Feb 2007;150(2):146-50, 150 e1-2. doi:10.1016/j.jpeds.2006.10.054
- 24. Bulut T, Demirel F, Metin A. The prevalence of dyslipidemia and associated factors in children and adolescents with type 1 diabetes. J Pediatr Endocrinol Metab. Feb 1 2017;30(2):181-187. doi:10.1515/jpem-2016-0111
- 25. Guy J, Ogden L, Wadwa RP, et al. Lipid and lipoprotein profiles in youth with and without type 1 diabetes: the SEARCH for Diabetes in Youth case-control study. Diabetes Care. Mar 2009;32(3):416-20. doi:10.2337/dc08-1775
- 26. Reh CM, Mittelman SD, Wee CP, Shah AC, Kaufman FR, Wood JR. A longitudinal assessment of lipids in youth with type 1 diabetes. Pediatr Diabetes. Jun 2011;12(4 Pt 2):365-71. doi:10.1111/j.1399-5448.2010.00733.x
- 27. Shah N, Khadilkar A, Gondhalekar K, Khadilkar V. Prevalence of dyslipidemia in Indian children with poorly controlled type 1 diabetes mellitus. Pediatr Diabetes. Sep 2020;21(6):987-994. doi:10.1111/pedi.13063
- 28. Bjornstad P, Donaghue KC, Maahs DM. Macrovascular disease and risk factors in youth with type 1 diabetes: time to be more attentive to treatment? Lancet Diabetes Endocrinol. Oct 2018;6(10):809-820. doi:10.1016/S2213-8587(18)30035-4
- 29. Noras K, Rusak E, Jarosz-Chobot P. The Problem of Abnormal Body Weight and Dyslipidemia as Risk Factors for Cardiovascular Diseases in Children and Adolescents with Type 1 Diabetes. J Diabetes Res. 2021;2021:5555149. doi:10.1155/2021/5555149
Toplam 29 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Hizmetleri ve Sistemleri (Diğer) |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Erken Görünüm Tarihi | 29 Mart 2025 |
| Yayımlanma Tarihi | 29 Mart 2025 |
| Gönderilme Tarihi | 11 Şubat 2025 |
| Kabul Tarihi | 13 Mart 2025 |
| Yayımlandığı Sayı | Yıl 2025Cilt: 47 Sayı: 1 |
