title: Evaluation of therapeutics management patterns and glycemic control of pediatric type 1 diabetes mellitus patients in Turkey: A nationwide cross-sectional study.
abstract: OBJECTIVE
  To evaluate the management strategies, glycemic control and complications of pediatric type 1 diabetes mellitus (T1DM) patients in Turkey.
  
  
  METHODS
  Study included 498 patients with T1DM between the ages 1-18. Data provided from patients' hospital files were recorded on standard case report forms by applicant clinicians within the 3months of data collection period between October 2012 and July 2013.
  
  
  RESULTS
  Mean age of patients was 11.3±3.8years. Mean duration of DM was determined as 3.7±3.1years. Majority of patients (85.5%) used basal/bolus injection (BBI), and 6.5% used continuous subcutaneous insulin infusion pump. Assessment of glycemic control based on HbA1c levels showed that 29.1% of patients had an HbA1c value <7.5% (58mmol/mol), 16.1% had a value between 7.5% (58mmol/mol) and 8% (64mmol/mol), 19.1% had a value between 8.1% (64mmol/mol) and 9%(75mmol/mol) and 35.7% a value >9%(75mmol/mol). Hypoglycemia was reported in 145 (29.1%) patients and the number of severe hypoglycemic attacks in the last 3months was 1.0±2.4. Taking into consideration the carbohydrate count and insulin correction dose and parents with high socioeconomic status was related to have better glycemic control. The most common comorbidities were Hashimoto's thyroiditis/hypothyroidism (6.2%) followed by celiac disease (3.8%), epilepsy(1.2%), and asthma(1.0%).
  
  
  CONCLUSIONS
  BBI insulin therapy is widely used among pediatric T1DM patients in Turkey. However, despite improvements in treatment facilities and diabetic care, glycemic control is not at a satisfactory level. Therefore, new and comprehensive initiatives require for pediatric T1DM patients with poor glycemic control. Promoting use of carbohydrate count and insulin correction doses may improve the glycemic control of pediatric T1DM in Turkey.
authors.affiliation: Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology, 41100 Kocaeli, Turkey.
authors.forename: Şükrü
authors.initials: Ş
authors.lastname: Hatun
authors.affiliation: Diyarbakır Children State Hospital, Clinic of Pediatric Endocrinology, 21100 Diyarbakır, Turkey.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Demirbilek
authors.affiliation: Ege University Faculty of Medicine, Department of Pediatric Endocrinology, 35100 İzmir, Turkey.
authors.forename: Şükran
authors.initials: Ş
authors.lastname: Darcan
authors.affiliation: Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology, 41100 Kocaeli, Turkey.
authors.forename: Ayşegül
authors.initials: A
authors.lastname: Yüksel
authors.affiliation: Osmangazi University Faculty of Medicine, Department of Pediatric Endocrinology, 26100 Eskişehir, Turkey.
authors.forename: Cigdem
authors.initials: C
authors.lastname: Binay
authors.affiliation: Ege University Faculty of Medicine, Department of Pediatric Endocrinology, 35100 İzmir, Turkey.
authors.forename: Damla Gökşen
authors.initials: DG
authors.lastname: Şimşek
authors.affiliation: Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Endocrinology, 55100 Samsun, Turkey.
authors.forename: Cengiz
authors.initials: C
authors.lastname: Kara
authors.affiliation: ENDOMER Pediatric Endocrine Center, 06100 Ankara, Turkey.
authors.forename: Ergun
authors.initials: E
authors.lastname: Çetinkaya
authors.affiliation: Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology, 34100 Istanbul, Turkey.
authors.forename: Tolga
authors.initials: T
authors.lastname: Ünüvar
authors.affiliation: Maternity and Children's Hospital, Clinic of Pediatric Endocrinology, 33100 Mersin, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Uçaktürk
authors.affiliation: Trakya University Faculty of Medicine, Department of Pediatric Endocrinology, 22000 Edirne, Turkey.
authors.forename: Filiz
authors.initials: F
authors.lastname: Tütüncüler
authors.affiliation: Bezmialem University Faculty of Medicine, Department of Pediatric Endocrinology, 34100 Istanbul, Turkey.
authors.forename: Yaşar
authors.initials: Y
authors.lastname: Cesur
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, 34110 Istanbul, Turkey.
authors.forename: Ruveyde
authors.initials: R
authors.lastname: Bundak
authors.affiliation: Uludag University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey.
authors.forename: Halil
authors.initials: H
authors.lastname: Sağlam
authors.affiliation: Osmangazi University Faculty of Medicine, Department of Pediatric Endocrinology, 26100 Eskişehir, Turkey.
authors.forename: Enver
authors.initials: E
authors.lastname: Şimşek
authors.affiliation: Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, 34100 İstanbul, Turkey.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Bereket
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D019468:Disease Management; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007223:Infant; D008297:Male; D014421:Turkey
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Children; Glycemic control; HbA1c; Treatment; Type 1 diabetes