Tip 1 Diyabette Gece Hipoglisemisi “Ebeveynler Önlemeyi Biliyor mu?”: Tanımlayıcı Bir Çalışma
Year 2023,
, 72 - 80, 28.04.2023
Çağrı Çövener Özçelik
,
Eda Aktaş
Abstract
Amaç: Araştırma 6-18 yaş grubu tip 1 diyabetli çocuk ve ergenlerin ebeveynlerinin gece hipoglisemisinin önlenmesiyle ilgili bilgi
durumunun değerlendirmek amacıyla gerçekleştirilmiştir.
Gereç ve Yöntemler: Tanımlayıcı tasarımdaki araştırma, Ocak-Mayıs 2018 tarihleri arasında İstanbul ilindeki dört hastanenin pediatrik
endokrinoloji polikliniklerinde takipli 150 tip 1 diyabetli çocuk ve ergenin ebeveynleri ile gerçekleştirilmiştir. Araştırmanın verileri
Ebeveyn Tanıtıcı Bilgi Formu ve Ebeveyn Hipoglisemi Bilgi Düzeyi Formu’ndan yararlanılarak toplanmıştır. Verilerin analizinde
tanımlayıcı istatistikler ve Mann Whitney U testi kullanılmıştır.
Bulgular: Katılımcıların yaş ortalaması 39,23±7,205 olup, çocuklarının diyabet yaşı 5,17±3,75’tir. Katılımcıların %78,7(n=118)’si gece
hipoglisemilerine yönelik eğitim almıştır. Gece hipoglisemisine yönelik bilginin büyük oranda (%65,3; n=98) hemşireden alındığı
saptanmıştır. Gece hipoglisemisi durumunda yapılan ilk uygulamanın sıklıkla (%45,3; n=68) kilosuna göre hızlı etkili karbonhidrat
vermek ve hemen kan glikozu ölçümü yapmak (%43,3; n=65) olduğu görülmüştür. Katılımcıların gece hipoglisemisi ile ilgili bilgi
düzeylerinin değerlendirildiği forma verdikleri doğru yanıt oranı %60 olarak saptanmıştır. Ebeveyn hipoglisemi bilgi durumu formu
toplam puanı ile gece hipoglisemisi ile ilgili eğitim alanlar arasında istatistiksel olarak anlamlı fark saptanmıştır (U=1101, p<0.001).
Sonuç: Araştırma sonucunda tip 1 diyabetli çocuk/ergen ebeveynlerinin gece hipoglisemisinin önlenmesi ve gece hipoglisemisine müdahale
ilgili bilgi düzeylerinin yetersiz olduğu saptanmıştır.
Supporting Institution
yok
Thanks
Araştırmanın veri toplama aşamasındaki katkılarından ötürü Ayşe BOSTANCIKLIOĞLU, Berfin TUNÇ, Muzbah ÖZDEMİR, Özgür POYRAZ, Özlem YILMAZ, Zeynep KAYA’ya ve tüm katılımcılara teşekkür ederiz.
References
- 1. Türkiye Diyabet Vakfı. Diabetes Mellitus Tanı, Sınıflama ve
İzlem İlkeleri. TÜRKDİAB Diyabet Tanı ve Tedavi Rehberi
2020. İstanbul: Pasifik, 2020:16.
- 2. American Diabetes Association. Diagnosis and Classification
of Diabetes Mellitus. Journal of Clinical and Applied Research
and Education Diabetes Care. 2018;39(1):13-26.
- 3. Mobasseri M, Shirmohammadi M, Amiri T, Vahed N, Fard
HH, Ghojazadeh M. Prevalence and incidence of type 1
diabetes in the world: A systematic review and meta-analysis.
Health Promotion Perspectives. 2020;10(2):98-115.
- 4. International Diabetes Federation: IDF Diabetes Atlas,
Brüssels, Belgium 2021, 10. Baskı, IDF Diyabet Atlası 2021,
IDF Diyabet Atlası (diabetesatlas.org) Erişim tarihi: 02.04.2022
- 5. Bachmann S, Auderset A, Burckhardt MA, Szinnai G, Hess M,
Zumsteg U, Donner B. Autonomic cardiac regulation during
spontaneous nocturnal hypoglycemia in children with type 1
diabetes. Pediatric Diabetes. 2021;22(7):1023-1030.
- 6. Kahsay H, Fantahun B, Nedi T, Demoz GT. Evaluation of
hypoglycemia and associated factors among patients with type
1 diabetes on follow-up care at St. Paul’s Hospital Millennium
Medical College, Addis Ababa, Ethiopia. J Diabetes Res. 2019;
2019:9037374.
- 7. Çocukluk Çağı Diyabet Eğitimci Rehberi. T.C. Halk Sağlığı
Genel Müdürlüğü, 2020.
- 8. Mosquera-Lopez C, Dodier R, Tyler NS, Wilson LM, El
Youssef J, Castle JR, Jacobs PG. Predicting and preventing
nocturnal hypoglycemia in type 1 diabetes using big data
analytics and decision theoretic analysis. Diabetes Technol
Ther. 2020;22(11):801-811.
- 9. Buckingham B, Chase HP, Dassau E, Cobry E, Clinton P, Gage
V, Caswell K, Wilkinson J, Cameron F, Lee H, Bequette W,
Doyle III FJ. Prevention of nocturnal hypoglycemia using
predictive alarm algorithms and insulin pump suspension.
Diabetes Care. 2010;33(5):1013-1017.
- 10. Abraham MB, Karges B, Dovc K, Naranjo D, Arbelaez
AM. ISPAD Clinical Practice Consensus Guidelines
2022: Assessment and management of hypoglycemia in
children and adolescents with diabetes. Pediatr Diabetes.
2022;23(8):1322‐1340.
- 11. Lainetti KR, Pimenta J, Vendramini MF. Can hypoglycemic
episodes in type 1 diabetics trigger cardiac arrhythmias?.
Diabetes Res Clin Pract. 2019;158:107878.
- 12. Jensen MH, Dethlefsen C, Vestergaard P, Hejlesen O.
Prediction of nocturnal hypoglycemia from continuous glucose
monitoring data in people with type 1 diabetes: A proof-ofconcept
study. J Diabetes Sci Technol. 2020;14(2):250-256.
- 13. Dehghankar L, Namdar P, Yekefallah L, Hosseini N, Moradi
M. The effect of peers support on fear of hypoglycemia in
iranian patients with type 1 diabetes: A clinical trial study. Iran
J Nurs Midwifery Res. 2021;26(2):162-167.
- 14. Wang H, Donnan PT, Leese CJ, Duncan E, Fitzpatrick D,
Frier BM, Leese GP. Temporal changes in frequency of severe
hypoglycemia treated by emergency medical services in types
1 and 2 diabetes: A population-based data-linkage cohort
study. Clin Diabetes Endocrinol. 2017;3:7.
- 15. Pinsker JE, Dassau E. Predictive low-glucose suspend to
prevent hypoglycemia. Diabetes Technol Ther. 2017;19(5):271-
276.
- 16. Graveling AJ, Frier BM. The risks of nocturnal hypoglycaemia
in insulin-treated diabetes. Diabetes Res Clin Pract.
2017;133:30-39.
- 17. Musolino G, Dovc K, Boughton CK, Tauschmann M, Allen
JM, Nagl K, Fritsch M, Yong J, Metcalfe E, Schaeffer D,
Fichelle M, Schierloh U, Thiele AG, Abt D, Kojzar H, Mader
JK, Slegtenhorst S, Ashcroft N, Wilinska ME, Sibayan J, Cohen
N, Kollman C, Hofer SE, Fröhlich-Reiterer E, Kapellen TM,
Acerini CL, de Beaufort C, Campbell F, Rami-Merhar B,
Hovorka R, Consortium K. Reduced burden of diabetes and
improved quality of life: Experiences from unrestricted dayand‐
night hybrid closed‐loop use in very young children with
type 1 diabetes. Pediatric Diabetes. 2019; 20(6):794-799.
- 18. Patton SR, Clements MA, Marker AM, Nelson EL. Intervention
to reduce hypoglycemia fear in parents of young kids using
video‐based telehealth (REDCHiP). Pediatric Diabetes.
2019;21(1):112-119.
- 19. Karaca Sivrikaya S, Ergün S. Diyabet eğitimi ve hemşirenin
rolü. Kırşehir Ahi Evran Üniversitesi Sağlık Bilimleri Dergisi.
2018;2(2):25-36.
- 20. McGill DE, Levitsky LL. Management of hypoglycemia in
children and adolescents with type 1 diabetes mellitus. Curr
Diab Rep. 2016;16(9):88.
- 21. LaManna J, Litchman ML, Dickinson JK, Todd A, Julius MM,
Whitehouse CR, Hyer S, Kavookjian J. Diabetes Education
Impact on Hypoglycemia Outcomes: A Systematic Review
of Evidence and Gaps in the Literature. Diabetes Educ.
2019;45(4):349-369.
- 22. Üstün S. Tip-I diyabet tanısı almış çocuklar ile ailelerinin,
hastalığa uyum süreci ve hastalığı kabul düzeylerinin
karşılaştırılması. Yüksek Lisans Tezi. Dokuz Eylül Üniversitesi,
Sağlık Bilimleri Enstitüsü, İzmir, 2011. (https://tez.yok.gov.tr/
Ulusal Tez Merkezi Erişim Tarihi: 05.11.2019).
- 23. Altundağ S. Tip 1 diyabetli çocukların hastalığa uyumunda
eğitimin ve sosyal desteğin etkisi. Pamukkale Tıp Dergisi.
2018;11(2):137-144.
- 24. Malone HE, Nicholl H, Coyne I. Fundamentals of estimating
size. Nurse Res. 2016;23(5):21-25.
- 25. Çövener Özçelik Ç, Ocakçı AF. Tip 1 Diyabet Yönetimi,
İstanbul Tıp Kitabevi, İstanbul; 2014.
- 26. Zhu B, Abu Irsheed GM, Martyn-Nemeth P, Reutrakul S.
Type 1 diabetes, sleep, and hypoglycemia. Curr Diab Rep.
2021;21(12):1-19.
- 27. Lindholm Olinder A, DeAbreu M, Greene S, Haugstvedt A,
Lange K, Majaliwa ES, Pais V, Pelicand J, Town M, Mahmud
FH. ISPAD Clinical Practice Consensus Guidelines 2022:
Diabetes education in children and adolescents. Pediatr
Diabetes. 2022;23(8):1229‐1242.
- 28. Feyzioğlu G. Tip 1 diyabet hastalarının bilgi arayışında internet
tutumlarının değerlendirilmesi. Yüksek Lisans Tezi. Haliç
üniversitesi, Sağlık Bilimleri Enstitüsü, İstanbul, 2015. (https://
tez.yok.gov.tr/UlusalTezMerkezi Erişim tarihi: 06.10.2020).
- 29. Urakami T. The Advanced Diabetes Technologies for
Reduction of the Frequency of Hypoglycemia and Minimizing
the Occurrence of Severe Hypoglycemia in Children and
Adolescents with Type 1 Diabetes. J Clin Med. 2023;12(3):
781.
- 30. Alotaibi A, Khalifah RA, McAssey K. The efficacy and safety
of insulin pump therapy with predictivelow glucose suspend
feature in decreasing hypoglycemia inchildren with type 1
diabetes mellitus: A systematic review andmeta-analysis.
Pediatr Diabetes. 2020;21:1256-1267.
- 31. Perez KM, Hamburger ER, Lyttle M, Williams R, Bergner
E, Kahanda S, Cobry E, Jaser SS. Sleep in type 1 diabetes:
Implications for glycemic control and diabetes management.
Curr Diab Rep. 2018;18(2):5.
- 32. American Diabetes Association. 2. Classification and Diagnosis
of Diabetes: Standards of Medical Care in Diabetes-2020.
Diabetes Care. 2020;43(Suppl 1):S14-S31.
- 33. Dağdelen S. Diyabet Tedavi ve Klinik İzlem Protokolleri. T. C.
Sağlık Bakanlığı Sağlık Hizmetleri genel Müdürlüğü, Ankara,
2019
- 34. Cengiz E, Danne T, Ahmad T, Ayyavoo A, Beran D, Ehtisham
S, Fairchild J, Jarosz-Chobot P, May Ng S, Paterson M, Codner
E. ISPAD Clinical Practice Consensus Guidelines 2022: Insulin
treatment in children and adolescents with diabetes. Pediatr
Diabetes. 2022;23(8):1277‐1296.
Nocturnal Hypoglycemia in Type 1 Diabetes “Do Parents Know How to Prevent?”:A Descriptive Study
Year 2023,
, 72 - 80, 28.04.2023
Çağrı Çövener Özçelik
,
Eda Aktaş
Abstract
Aim: The study was carried out to evaluate the knowledge of parents of children and adolescents aged 6-18 years with type 1 diabetes
about the prevention of nocturnal hypoglycemia.
Material and Methods: This descriptive study was conducted with the parents of 150 children and adolescents with type 1 diabetes who
were followed up in the pediatric endocrinology outpatient clinics of four hospitals in Istanbul between January and May 2018. The
data of the study were collected by using the Parent Information Information Form and the Parent Hypoglycemia Information Form.
Descriptive statistics and Mann Whitney U test were used in the analysis of the data.
Results: The mean age of the participants was 39.23±7.205, and the diabetes age of their children was 5.17±3.75. 78.7% (n=18) of the
participants received training on nocturnal hypoglycemia. It was determined that information on nocturnal hypoglycemia was obtained
from nurses (65.3%; n=98) to a large extent. It has been observed that the first application in case of nocturnal hypoglycemia is often
(45.3%; n=68) to give fast-acting carbohydrates according to their weight and to measure blood glucose immediately (43.3%; n=65). The
correct response rate of the participants to the form in which their knowledge level about nocturnal hypoglycemia was evaluated was
60%. A statistically significant difference was found between the total score of the parent hypoglycemia information form and those who
received training on nocturnal hypoglycemia (U=1101, p<0.001).
Conclusion: It was determined that the level of knowledge of the parents of children/adolescents with type 1 diabetes regarding
prevention of nocturnal hypoglycemia and intervention to nocturnal hypoglycemia was insufficient
References
- 1. Türkiye Diyabet Vakfı. Diabetes Mellitus Tanı, Sınıflama ve
İzlem İlkeleri. TÜRKDİAB Diyabet Tanı ve Tedavi Rehberi
2020. İstanbul: Pasifik, 2020:16.
- 2. American Diabetes Association. Diagnosis and Classification
of Diabetes Mellitus. Journal of Clinical and Applied Research
and Education Diabetes Care. 2018;39(1):13-26.
- 3. Mobasseri M, Shirmohammadi M, Amiri T, Vahed N, Fard
HH, Ghojazadeh M. Prevalence and incidence of type 1
diabetes in the world: A systematic review and meta-analysis.
Health Promotion Perspectives. 2020;10(2):98-115.
- 4. International Diabetes Federation: IDF Diabetes Atlas,
Brüssels, Belgium 2021, 10. Baskı, IDF Diyabet Atlası 2021,
IDF Diyabet Atlası (diabetesatlas.org) Erişim tarihi: 02.04.2022
- 5. Bachmann S, Auderset A, Burckhardt MA, Szinnai G, Hess M,
Zumsteg U, Donner B. Autonomic cardiac regulation during
spontaneous nocturnal hypoglycemia in children with type 1
diabetes. Pediatric Diabetes. 2021;22(7):1023-1030.
- 6. Kahsay H, Fantahun B, Nedi T, Demoz GT. Evaluation of
hypoglycemia and associated factors among patients with type
1 diabetes on follow-up care at St. Paul’s Hospital Millennium
Medical College, Addis Ababa, Ethiopia. J Diabetes Res. 2019;
2019:9037374.
- 7. Çocukluk Çağı Diyabet Eğitimci Rehberi. T.C. Halk Sağlığı
Genel Müdürlüğü, 2020.
- 8. Mosquera-Lopez C, Dodier R, Tyler NS, Wilson LM, El
Youssef J, Castle JR, Jacobs PG. Predicting and preventing
nocturnal hypoglycemia in type 1 diabetes using big data
analytics and decision theoretic analysis. Diabetes Technol
Ther. 2020;22(11):801-811.
- 9. Buckingham B, Chase HP, Dassau E, Cobry E, Clinton P, Gage
V, Caswell K, Wilkinson J, Cameron F, Lee H, Bequette W,
Doyle III FJ. Prevention of nocturnal hypoglycemia using
predictive alarm algorithms and insulin pump suspension.
Diabetes Care. 2010;33(5):1013-1017.
- 10. Abraham MB, Karges B, Dovc K, Naranjo D, Arbelaez
AM. ISPAD Clinical Practice Consensus Guidelines
2022: Assessment and management of hypoglycemia in
children and adolescents with diabetes. Pediatr Diabetes.
2022;23(8):1322‐1340.
- 11. Lainetti KR, Pimenta J, Vendramini MF. Can hypoglycemic
episodes in type 1 diabetics trigger cardiac arrhythmias?.
Diabetes Res Clin Pract. 2019;158:107878.
- 12. Jensen MH, Dethlefsen C, Vestergaard P, Hejlesen O.
Prediction of nocturnal hypoglycemia from continuous glucose
monitoring data in people with type 1 diabetes: A proof-ofconcept
study. J Diabetes Sci Technol. 2020;14(2):250-256.
- 13. Dehghankar L, Namdar P, Yekefallah L, Hosseini N, Moradi
M. The effect of peers support on fear of hypoglycemia in
iranian patients with type 1 diabetes: A clinical trial study. Iran
J Nurs Midwifery Res. 2021;26(2):162-167.
- 14. Wang H, Donnan PT, Leese CJ, Duncan E, Fitzpatrick D,
Frier BM, Leese GP. Temporal changes in frequency of severe
hypoglycemia treated by emergency medical services in types
1 and 2 diabetes: A population-based data-linkage cohort
study. Clin Diabetes Endocrinol. 2017;3:7.
- 15. Pinsker JE, Dassau E. Predictive low-glucose suspend to
prevent hypoglycemia. Diabetes Technol Ther. 2017;19(5):271-
276.
- 16. Graveling AJ, Frier BM. The risks of nocturnal hypoglycaemia
in insulin-treated diabetes. Diabetes Res Clin Pract.
2017;133:30-39.
- 17. Musolino G, Dovc K, Boughton CK, Tauschmann M, Allen
JM, Nagl K, Fritsch M, Yong J, Metcalfe E, Schaeffer D,
Fichelle M, Schierloh U, Thiele AG, Abt D, Kojzar H, Mader
JK, Slegtenhorst S, Ashcroft N, Wilinska ME, Sibayan J, Cohen
N, Kollman C, Hofer SE, Fröhlich-Reiterer E, Kapellen TM,
Acerini CL, de Beaufort C, Campbell F, Rami-Merhar B,
Hovorka R, Consortium K. Reduced burden of diabetes and
improved quality of life: Experiences from unrestricted dayand‐
night hybrid closed‐loop use in very young children with
type 1 diabetes. Pediatric Diabetes. 2019; 20(6):794-799.
- 18. Patton SR, Clements MA, Marker AM, Nelson EL. Intervention
to reduce hypoglycemia fear in parents of young kids using
video‐based telehealth (REDCHiP). Pediatric Diabetes.
2019;21(1):112-119.
- 19. Karaca Sivrikaya S, Ergün S. Diyabet eğitimi ve hemşirenin
rolü. Kırşehir Ahi Evran Üniversitesi Sağlık Bilimleri Dergisi.
2018;2(2):25-36.
- 20. McGill DE, Levitsky LL. Management of hypoglycemia in
children and adolescents with type 1 diabetes mellitus. Curr
Diab Rep. 2016;16(9):88.
- 21. LaManna J, Litchman ML, Dickinson JK, Todd A, Julius MM,
Whitehouse CR, Hyer S, Kavookjian J. Diabetes Education
Impact on Hypoglycemia Outcomes: A Systematic Review
of Evidence and Gaps in the Literature. Diabetes Educ.
2019;45(4):349-369.
- 22. Üstün S. Tip-I diyabet tanısı almış çocuklar ile ailelerinin,
hastalığa uyum süreci ve hastalığı kabul düzeylerinin
karşılaştırılması. Yüksek Lisans Tezi. Dokuz Eylül Üniversitesi,
Sağlık Bilimleri Enstitüsü, İzmir, 2011. (https://tez.yok.gov.tr/
Ulusal Tez Merkezi Erişim Tarihi: 05.11.2019).
- 23. Altundağ S. Tip 1 diyabetli çocukların hastalığa uyumunda
eğitimin ve sosyal desteğin etkisi. Pamukkale Tıp Dergisi.
2018;11(2):137-144.
- 24. Malone HE, Nicholl H, Coyne I. Fundamentals of estimating
size. Nurse Res. 2016;23(5):21-25.
- 25. Çövener Özçelik Ç, Ocakçı AF. Tip 1 Diyabet Yönetimi,
İstanbul Tıp Kitabevi, İstanbul; 2014.
- 26. Zhu B, Abu Irsheed GM, Martyn-Nemeth P, Reutrakul S.
Type 1 diabetes, sleep, and hypoglycemia. Curr Diab Rep.
2021;21(12):1-19.
- 27. Lindholm Olinder A, DeAbreu M, Greene S, Haugstvedt A,
Lange K, Majaliwa ES, Pais V, Pelicand J, Town M, Mahmud
FH. ISPAD Clinical Practice Consensus Guidelines 2022:
Diabetes education in children and adolescents. Pediatr
Diabetes. 2022;23(8):1229‐1242.
- 28. Feyzioğlu G. Tip 1 diyabet hastalarının bilgi arayışında internet
tutumlarının değerlendirilmesi. Yüksek Lisans Tezi. Haliç
üniversitesi, Sağlık Bilimleri Enstitüsü, İstanbul, 2015. (https://
tez.yok.gov.tr/UlusalTezMerkezi Erişim tarihi: 06.10.2020).
- 29. Urakami T. The Advanced Diabetes Technologies for
Reduction of the Frequency of Hypoglycemia and Minimizing
the Occurrence of Severe Hypoglycemia in Children and
Adolescents with Type 1 Diabetes. J Clin Med. 2023;12(3):
781.
- 30. Alotaibi A, Khalifah RA, McAssey K. The efficacy and safety
of insulin pump therapy with predictivelow glucose suspend
feature in decreasing hypoglycemia inchildren with type 1
diabetes mellitus: A systematic review andmeta-analysis.
Pediatr Diabetes. 2020;21:1256-1267.
- 31. Perez KM, Hamburger ER, Lyttle M, Williams R, Bergner
E, Kahanda S, Cobry E, Jaser SS. Sleep in type 1 diabetes:
Implications for glycemic control and diabetes management.
Curr Diab Rep. 2018;18(2):5.
- 32. American Diabetes Association. 2. Classification and Diagnosis
of Diabetes: Standards of Medical Care in Diabetes-2020.
Diabetes Care. 2020;43(Suppl 1):S14-S31.
- 33. Dağdelen S. Diyabet Tedavi ve Klinik İzlem Protokolleri. T. C.
Sağlık Bakanlığı Sağlık Hizmetleri genel Müdürlüğü, Ankara,
2019
- 34. Cengiz E, Danne T, Ahmad T, Ayyavoo A, Beran D, Ehtisham
S, Fairchild J, Jarosz-Chobot P, May Ng S, Paterson M, Codner
E. ISPAD Clinical Practice Consensus Guidelines 2022: Insulin
treatment in children and adolescents with diabetes. Pediatr
Diabetes. 2022;23(8):1277‐1296.