| Abstract | Cilj istraživanja:
Utvrditi utječe li ŠBT1 i kvaliteta metaboličke kontrole ŠBT1 (izražena vrijednostima HbA1c) na rast i razvoj djece oboljele od ŠBT1, liječene na Klinici za dječje bolesti, KBC Split.
Materijal i metode:
U istraživanje su uključena djeca oboljela od ŠBT1 u razdoblju od siječnja 2007. godine do prosinca 2008 godine, koju smo pratili tijekom sedam godina i koji nisu bolovali od drugih popratnih bolesti koje bi mogle utjecati na rast i razvoj. Svakom bolesniku su analizirane sljedeće varijable: kronološka dob, spol, HSDS, ITM-SDS, a od laboratorijskih parametara HbA1c. Spolni razvoj ispitanika praćen je po Tanneru. Bolesnike smo podijelili na osnovu spolnog razvoja: na skupinu bolesnika koji su u vrijeme postavljanja dijagnoze bili u predpubertetu i skupinu bolesnika koji su u vrijeme postavljanja dijagnoze bili u pubertetu, na osnovu dobi: na skupinu bolesnika kojima je bolest dijagnosticirana prije 8 godine života i skupinu bolesnika kojima je bolest dijagnosticirana nakon 8 godine života, na osnovi metaboličke kontrole: na skupinu s lošijom metaboličkom kontrolom (HbA1c<8%) i skupinu s boljom metaboličkom kontrolom (HbA1c>8%) bolesti. Prikupljene podatke smo obradili deskriptivnim (standardnim) statističkim metodama, tablično i grafički, a dio podataka koristeći Mann-Whitney U-test (neparametrijska inačicu t-testa).
Rezultati:
U naše istraživanja uključeno je 32 djece oboljele od ŠBT1. Prosječne dob u vrijeme obolijevanja od ŠBT1 je bila 6.56 godina, a prosječnom vrijednosti HbA1c 7.97% tijekom sedam godina praćenja. Prosječna dob obolijevanja u skupinu bolje metabolički kontroliranih bolesnika bila je 6.74 godine, a u skupini lošije metabolički kontroliranih bolesnika 6.32 godine. Prosječna dob prelaska iz predpuberteta u pubertet u skupini bolje metabolički kontroliranih bolesnika bila je 10.53 godine, a u skupini lošije metabolički kontroliranih 10.74. Uzimajući u obzir spol bolesnika, bolesnici muškog spola s boljom metaboličkom kontrolom bolesti stupali su u pubertet u prosječnoj dobi od 11.02 godine, a bolesnici muškog spola s lošijom metaboličkom kontrolom bolesti u prosječnoj dobi od 11.27 godina. Bolesnice ženskog spola s boljom metaboličkom kontrolom bolesti u prosjeku su stupale u pubertet s 10.04 godine, a one s lošijom metaboličkom bolesti s 10.74 godine. Prosječna vrijednost HSDS-a za sve bolesnike tijekom sedam godina praćenja se smanjuju, ali razlika HSDS-a između skupine bolje i lošije metabolički kontroliranih bolesnika nije statistički značajna. Najniže vrijednosti ITM-SDS-a za sve bolesnike su u vrijeme postavljanja dijagnoze ŠBT1, a najviše vrijednosti doseže na kraju prve godine praćenja. Razlika ITM-SDS-a između skupine bolje i lošije metabolički kontroliranih bolesnika nije statistički značajna.
Zaključci:
Bolesnici koji su oboljeli u ranijoj dobi od ŠBT1 su postizali lošiju metaboličku kontrolu nego oni koji su oboljeli u kasnijoj dobi. Dob nastupa puberteta je u skladu s dobi nastupa puberteta osoba koje ne boluju od ŠBT1 iako su se pubertetske oznake kasnije razvijale u bolesnika s lošijom metaboličkom kontrolom nego u bolesnika koji su imali bolju metaboličku kontrolu bolesti. HSDS oboljelih se smanjivao s godinama praćenja, ali se nije statistički razlikovao između skupine bolje i lošije metabolički kontroliranih bolesnika. ITM-SDS oboljelih je rastao u prvoj godini praćenja. Razlika ITM-SDS-a između skupine bolje i lošije metabolički kontroliranih bolesnika nije bila statistički značajna. |
| Abstract (english) | Objectives:
To establish if diabetes mellitus type 1 and the quality of metabolic control of diabetes mellitus type 1 (expressed as HbA1c) influenced the growth and development of children diagnosed with diabetes mellitus type 1 during the period from January 2007 to December 2008 and treated at the Department of Pediatrics, University Hospital Split.
Material and Methods:
We included children who were diagnosed with diabetes mellitus type 1 during the period from January 2007 to December 2008, followed for 7 years and who did not suffer from other coexisting disorders that could affect growth and development. Each patient was analyzed using the following variables: age, gender, HSDS, BMI-SDS, and laboratory parameter HbA1c. Sexual development of patients was followed according to Tanner. The patients were divided based on sexual development: in a group of patients who were prepubertal at the time of diagnosis and in a group of patients who were pubertal at the time of diagnosis, based on age: in a group of patients who were diagnosed before 8 years of age and patients diagnosed after 8 years of age, and on the basis of metabolic control: in a group with worse metabolic control (HbA1c <8%) and in a group with better metabolic control (HbA1c> 8%) of disease. Variables were analyzed by descriptive (standard) statistical methods, tables and graphics, and part of the variables were analyzed using the Mann-Whitney U-test (non-parametric t-test).
Results:
Our study included 32 children diagnosed with diabetes mellitus type 1, with the average age of 6.56 years at the onset of disease and with an average HbA1c of 7.97% during the 7 years of follow up. The average age of onset of disease was 6.74 in the group of patients with better metabolic control and the average age in the group with poorer metabolic control was 6.32. The average age of transition from pre-puberty to puberty in the group with better metabolic control was 10.53 and the average age of transition in the group with poorer metabolic control was 10.74. When taking gender in consideration, our result show that male patients with better metabolic control of disease entered puberty at the age of 11.02 and male patients with poorer metabolic control entered puberty at the age of 11.27. Female patients with better metabolic control entered puberty at the age of 10.04 and females with poorer metabolic control entered puberty at the age of 10.74. In average, the value of HSDS decreased in all patients during the seven years of follow up, but the value of HSDS does not differ significantly between those with better and those with poorer metabolic control. In all patients, the lowest values of BMI-SDS were observed at the time of diagnosis of diabetes mellitus type 1, and BMI-SDS reached maximum value at the end of the first year of follow up. In comparison between patients with better and poorer metabolic control, there was no statistically significant differences in BMI-SDS.
Conclusion:
Patients diagnosed with type 1 diabetes mellitus at an earlier age, reached poorer metabolic control compared to those who were diagnosed at later age. The age of onset of puberty in our patients is in accordance with the age of onset of puberty of general population children who are not suffering from diabetes mellitus type 1. However, patients with poorer metabolic control entered puberty later than patients with better metabolic control. The value of HSDS decreased during the years of monitoring, but there was no statistically significant difference in the value of HSDS between patients with better and patients with poorer metabolic control. Furthermore, the value of BMI-SDS increased in the first year of monitoring. Finally, there was no statistically significant difference in the value of BMI-SDS between group with better and those with poorer metabolic control. |
