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Article: Discrepancy Between Fingertip Glucose Levels and HbA1c in an Adolescent with Diabetes: A Fake Logbook or Pseudohypoglycemia?

Eviz, Elif / Adroviç Yıldız, Amra / Can, Ecem / Gökçe, Tuğba / Yeşiltepe Mutlu, Gül / Hatun, Şükrü

Turkish archives of pediatrics

2023 Volume 58, Issue 2, Page(s) 237–238

Language	English
Publishing date	2023-02-28
Publishing country	Turkey
Document type	Journal Article
ISSN	2757-6256
ISSN	2757-6256
DOI	10.5152/TurkArchPediatr.2023.22234
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Article ; Online: Current Management of Type 1 Diabetes in Children: Guideline-based Expert Opinions and Recommendations.

Hatun, Sukru / Gokce, Tugba / Can, Ecem / Eviz, Elif / Karakus, Kagan Ege / Smart, Carmel / Hanas, Ragnar / Yesiltepe Mutlu, Gul

Journal of clinical research in pediatric endocrinology

2024

Abstract: Successful management of type 1 diabetes (T1D) requires not only optimal glycemic outcomes, but also a holistic approach that encompasses all aspects of life and recommendations to address needs. Current goals include optimal glycaemic values, quality of ...

Abstract	Successful management of type 1 diabetes (T1D) requires not only optimal glycemic outcomes, but also a holistic approach that encompasses all aspects of life and recommendations to address needs. Current goals include optimal glycaemic values, quality of life and life expectancy similar to peers, prevention of long-term complications, prevention of severe hypoglycaemia as much as possible, facilitation of glucose management, etc. International Society for Pediatric and Adolescent Diabetes (ISPAD) has been updating its guidelines for diabetes care every 4 years since 1995, covering more and more topics. For optimal metabolic outcomes, diabetes teams need to follow these current recommendations, adapt them to their clinical practice and provide guidance to people with type 1 diabetes/families. In this review, in the light of ISPAD 2018-2022 guidelines and clinical experiences, "10 Key Recommendations", emphasizing the importance of teamwork and the use of technology, current type 1 diabetes treatment is described for practical applications.
Language	English
Publishing date	2024-03-15
Publishing country	Turkey
Document type	Journal Article
ZDB-ID	2641608-6
ISSN	1308-5735 ; 1308-5727
ISSN (online)	1308-5735
ISSN	1308-5727
DOI	10.4274/jcrpe.galenos.2024.2024-1-15
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Article ; Online: Assessing the feasibility of time in tight range (TITR) targets with advanced hybrid closed loop (AHCL) use in children and adolescents: A single-centre real-world study.

Eviz, Elif / Killi, Nesrin Ecem / Karakus, Kagan Ege / Can, Ecem / Gokce, Tugba / Yesiltepe Mutlu, Gul / Hatun, Sukru

Diabetic medicine : a journal of the British Diabetic Association

2024 , Page(s) e15333

Abstract: Aims: Time in Tight Range (TITR) is a novel glycaemic metric in monitoring type 1 diabetes (T1D) management. The aim of this study was to assess the attainability of the TITR target in children and adolescents using the advanced hybrid closed loop (AHCL) ...

Abstract	Aims: Time in Tight Range (TITR) is a novel glycaemic metric in monitoring type 1 diabetes (T1D) management. The aim of this study was to assess the attainability of the TITR target in children and adolescents using the advanced hybrid closed loop (AHCL). Methods: The 2128-day CGM data from 56 children and adolescents with T1D using AHCL (Minimed-780G) were analysed. Time in Range (TIR) (3.9-10 mmol/L), TITR (3.9-7.7 mmol/L), and other glycaemic parameters were separately analysed in terms of whole day, daytime (06.00-23:59), and nighttime (00.00-05.59) results. The participants were divided into two groups by autocorrection rate where Group 1 had a rate of <30% and Group 2 had a rate of ≥30. Results: All glycaemic parameters indicated a better glycaemic outcome in the nighttime with higher TIR and TITR values compared with daytime (for TIR 87.5 ± 9.5% vs. 78.8 ± 8%, p < 0.001, and TITR 68.2 ± 13.5% vs. 57.5 ± 8.8%, p < 0.001). The rates of TITR >50% and >60% were 87% and 52%, respectively. When those with TITR >60% (n: 29) and those without (n: 27) were evaluated in terms of hypoglycaemia, no statistically significant difference was found in time below range (TBR) 3-3.9 mmol/L (0.3% vs. 2.1%, p: 0.084) and TBR < 3 mmol/L (0.47% vs. 0.3%, p: 0.298). Group 1 had a significantly higher TIR and TITR compared to Group 2 (82.6 ± 6.1% vs. 75.6 ± 8.6%, p: 0.008 and 62.1 ± 7.5% vs. 53.8 ± 7.5%, p: 0.002, respectively). Conclusions: Most children and adolescents on AHCL achieved the 50% target for TITR whereas more than half achieved the >60% target. A target of >50% for TITR seems realistic in children with T1D using AHCL.
Language	English
Publishing date	2024-04-26
Publishing country	England
Document type	Journal Article
ZDB-ID	605769-x
ISSN	1464-5491 ; 0742-3071 ; 1466-5468
ISSN (online)	1464-5491
ISSN	0742-3071 ; 1466-5468
DOI	10.1111/dme.15333
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Article ; Online: The attitudes, experiences, and self-competencies of pediatric endocrinology fellows and attending physicians regarding diabetes technology: the Turkey experience.

Mutlu, Gul Yesiltepe / Eren, Erdal / Eviz, Elif / Gokce, Tugba / Sakarya, Sibel / Hatun, Sukru

Journal of pediatric endocrinology & metabolism : JPEM

2022 Volume 35, Issue 5, Page(s) 611–616

Abstract: Background: Unlike in Western countries, the use of diabetes technologies has been limited in Turkey, or at least until the last few years. This low adoption frequency may be attributed to the lack of experience of pediatric diabetes teams in working ... ...

Abstract	Background: Unlike in Western countries, the use of diabetes technologies has been limited in Turkey, or at least until the last few years. This low adoption frequency may be attributed to the lack of experience of pediatric diabetes teams in working with new technologies. The aim of this study is to evaluate the attitudes, experiences and self-efficacies of pediatric endocrinology fellows and attending physicians in terms of use of continuous subcutaneous insulin infusion (CSII) therapy and continuous glucose monitoring (CGM) systems. Methods: The questionnaire used in this study consisted of 63 questions including 10 questions evaluating the demographic characteristics and experience of the participants, 33 Likert-type questions related to self-competency, 17 yes/no questions and 3 open-ended questions which evaluated attitudes towards our study area. This questionnaire was e-mailed to pediatric endocrinology fellows and attending physicians working in Turkey. Results: A total of 24 fellows and 28 attending physicians working in the field of pediatric endocrinology participated in the survey. Of the respondents, 61% reported that there was no formal training curriculum regarding diabetes technology at their institutions. The mean scores obtained from the Likert scale questions measuring self-competency in using CSII and CGM were 3.8 and 3.3 out of 5, respectively. Of the respondents, 55% judged themselves to be under-skilled in interpreting pump reports while 39% of the respondents reported themselves as being under-skilled in interpreting CGM reports. Conclusions: While it is true that training programs for using diabetes technology have been established by the National Pediatric Endocrinology Association in Turkey, the development of a specific curriculum for institutions that provide pediatric endocrinology fellowship training in this framework will increase the self-confidence of pediatric endocrinologists in this matter and this will ultimately contribute to the improvement of the metabolic control of children with diabetes.
MeSH term(s)	Attitude ; Blood Glucose/metabolism ; Blood Glucose Self-Monitoring ; Child ; Diabetes Mellitus/therapy ; Humans ; Insulin ; Physicians ; Turkey
Chemical Substances	Blood Glucose ; Insulin
Language	English
Publishing date	2022-03-25
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1231070-0
ISSN	2191-0251 ; 0334-018X
ISSN (online)	2191-0251
ISSN	0334-018X
DOI	10.1515/jpem-2022-0024
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Article ; Online: The Advanced Hybrid Closed Loop Improves Glycemia Risk Index, Continuous Glucose Monitoring Index, and Time in Range in Children with Type 1 Diabetes: Real-World Data from a Single Center Study.

Eviz, Elif / Yesiltepe Mutlu, Gul / Karakus, Kagan Ege / Can, Ecem / Gokce, Tugba / Muradoglu, Serra / Hatun, Sukru

Diabetes technology & therapeutics

2023 Volume 25, Issue 10, Page(s) 689–696

Abstract: Introduction: ...

Abstract	Introduction:
Language	English
Publishing date	2023-09-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	1452816-2
ISSN	1557-8593 ; 1520-9156
ISSN (online)	1557-8593
ISSN	1520-9156
DOI	10.1089/dia.2023.0112
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Article ; Online: An Evaluation of Glucagon Injection Anxiety and Its Association with the Fear of Hypoglycemia among the Parents of Children with Type 1 Diabetes

Muradoğlu, Serra / Yeşiltepe Mutlu, Gül / Gökçe, Tuğba / Can, Ecem / Hatun, Şükrü

Journal of clinical research in pediatric endocrinology

2021 Volume 13, Issue 3, Page(s) 285–292

Abstract: Objective: Hypoglycemia is a common acute complication of type 1 diabetes (T1D), which may cause seizure, loss of consciousness, and temporary motor or sensory impairment. Glucagon administration is an effective way of treating severe hypoglycemia, ... ...

Abstract	Objective: Hypoglycemia is a common acute complication of type 1 diabetes (T1D), which may cause seizure, loss of consciousness, and temporary motor or sensory impairment. Glucagon administration is an effective way of treating severe hypoglycemia, especially in a free-living setting. Nonetheless, families have difficulties in managing severe hypoglycemia due to their anxiety and challenges with current glucagon administration techniques. The aim of the current study was to explore the associations between parental fear of hypoglycemia (FoH) and their general anxiety level, and in particular, their attitudes towards and thoughts on glucagon administration. Methods: Parents of children with T1D completed questionnaires assessing background and clinical information, FoH, generalized anxiety disorder (GAD) and parental anxiety for glucagon administration (PAGA). Results: Sixty-eight parents participated. Positive correlations were found between parental GAD-7 score and both FoH and the number of night-time blood glucose measurements and there was a negative correlation with the child’s age. Parents mean self-evaluation score of their competence in glucagon administration was 6 (standard deviation±2.9) on a scale of 0 to 10. Unsurprisingly, this score was negatively correlated with the PAGA scores. There was no significant difference between children using continuous glucose monitoring system and self-monitoring of blood glucose in terms of parental FoH, anxiety and misconceptions about glucagon administration. Conclusion: The results showed that parents of children with T1D had anxiety and fear connected with hypoglycemia and glucagon administration. Structured and practical training should be implemented to increase parents’ self-confidence including annual refresher training for home glucagon administration.
MeSH term(s)	Adolescent ; Anxiety/diagnosis ; Anxiety/etiology ; Anxiety/psychology ; Biomarkers/blood ; Blood Glucose/drug effects ; Blood Glucose/metabolism ; Caregivers/psychology ; Child ; Child, Preschool ; Diabetes Mellitus, Type 1/blood ; Diabetes Mellitus, Type 1/diagnosis ; Diabetes Mellitus, Type 1/drug therapy ; Fear ; Female ; Glucagon/administration & dosage ; Glucagon/adverse effects ; Health Knowledge, Attitudes, Practice ; Humans ; Hypoglycemia/blood ; Hypoglycemia/chemically induced ; Hypoglycemia/diagnosis ; Hypoglycemia/drug therapy ; Hypoglycemic Agents/adverse effects ; Injections, Intramuscular ; Male ; Parents/psychology ; Pilot Projects ; Surveys and Questionnaires
Chemical Substances	Biomarkers ; Blood Glucose ; Hypoglycemic Agents ; Glucagon (9007-92-5)
Language	English
Publishing date	2021-01-25
Publishing country	Turkey
Document type	Journal Article
ZDB-ID	2641608-6
ISSN	1308-5735 ; 1308-5727
ISSN (online)	1308-5735
ISSN	1308-5727
DOI	10.4274/jcrpe.galenos.2021.2020.0191
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Article ; Online: Insulin Requirements for Basal and Auto-Correction Insulin Delivery in Advanced Hybrid Closed-Loop System: 4193 Days' Real-World Data of Children in Two Different Age Groups.

Karakuş, Kağan Ege / Yeşiltepe Mutlu, Gül / Gökçe, Tuğba / Eviz, Elif / Can, Ecem / Muradoğlu, Serra / Hatun, Şükrü

Journal of diabetes science and technology

2022 Volume 18, Issue 2, Page(s) 445–453

Abstract: Background: The insulin requirements of people with type 1 diabetes (T1D) can vary throughout the day due to factors such as biorhythm, exercise, and food intake. The MiniMed 780G system delivers micro boluses to adjust basal insulin and delivers auto- ... ...

Abstract	Background: The insulin requirements of people with type 1 diabetes (T1D) can vary throughout the day due to factors such as biorhythm, exercise, and food intake. The MiniMed 780G system delivers micro boluses to adjust basal insulin and delivers auto-correction boluses to meet insulin needs when micro bolus increases are insufficient. Through analysis of MiniMed 780G data, this study investigates the variations in insulin requirements throughout the day. Methods: 4193 days' pump and continuous glucose monitoring (CGM) data of 34 children using MiniMed 780G were collected from Medtronic CareLink. Micro and auto-correction boluses were analyzed on an hourly basis for two age groups: below nine years old and above nine years old. Glycemic metrics were analyzed based on International CGM consensus. Results: The mean age was 12.3 years and mean duration of diabetes was 6.1 years. The mean time in range (TIR) and glucose management indicator (GMI) were 80.5% and 6.6%, respectively. The micro bolus (basal) ratio between 05.00 and 07.00 was significantly higher than the ratio between 10.00 and 03.00 ( Conclusion: The basal insulin need follows a diurnal pattern with two significantly different periods-high between 00.00 and 10.00 and low between 10.00 and 00.00. The auto-correction rates are low between 05.00 and 10.00 and show an increasing pattern peaking between 21.00 and 00.00. These findings are compatible with the dawn and reverse dawn phenomena.
MeSH term(s)	Child ; Humans ; Insulin ; Blood Glucose Self-Monitoring ; Blood Glucose ; Insulin, Regular, Human ; Diabetes Mellitus, Type 1/drug therapy
Chemical Substances	Insulin ; Blood Glucose ; Insulin, Regular, Human
Language	English
Publishing date	2022-06-30
Publishing country	United States
Document type	Journal Article
ISSN	1932-2968
ISSN (online)	1932-2968
DOI	10.1177/19322968221106194
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Article ; Online: The association of milk and multiple food avoidance with growth parameters in infants and children.

Sackesen, Cansin / Buyuktiryaki, Betul / Gokce, Tugba / Gogebakan, Emre / Gundogdu, Beliz Su / Eltan, Sevgi Bilgic / Karakoc-Aydiner, Elif / Yilmaz, Ebru Arik / Can, Ceren / Cengiz, Hilal / Unlugedik, Ozlem / Celik, Nevin / Incir, Said / Mutlu, Gul Yesiltepe / Yildirim, Damla / Ozel, Hulya Gokmen / Hatun, Sukru

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology

2024

Abstract: Background: Recent studies reported that strict avoidance of milk products in cow's milk allergy (CMA) affects growth and bone turnover, causing negative calcium balance and changes in bone metabolism.: Objective: To investigate biochemical ... ...

Abstract	Background: Recent studies reported that strict avoidance of milk products in cow's milk allergy (CMA) affects growth and bone turnover, causing negative calcium balance and changes in bone metabolism. Objective: To investigate biochemical parameters to predict bone turnover and its relations with height and weight measurements and nutritional intake. Methods: Height, weight, and body mass index z scores were plotted for age according to the World Health Organization. A 3-consecutive day food record was analyzed for nutritional values of foods. The blood levels of calcium, phosphorus, alkaline phosphatase, vitamin D, and parathyroid hormone (PTH) were determined. Results: The study included 69 controls, 66 children with isolated CMA, and 59 children with multiple food allergy (FA). The z scores for weight, height, and body mass index were lower in isolated CMA and multiple FA groups than controls (P < .001, P = .004, and P = .002, respectively). The nutritional intakes of protein, fat, carbohydrates, vitamins B2 and B12, niacin, calcium, and phosphorus were significantly lower in isolated CMA and multiple FA than controls. In infants (≤2 years of age), although blood calcium level was in normal range, it was significantly lower in isolated CMA and multiple FA than in controls (P < .001). In children older than 2 years, PTH level was significantly higher in isolated CMA and multiple FA groups than in controls (P = .003). Conclusion: Our study revealed that children with isolated CMA and multiple FA had a high nutrition gap, growth deceleration, and unbalanced bone metabolism, as illustrated by low blood calcium and elevated PTH levels.
Language	English
Publishing date	2024-03-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	1228189-x
ISSN	1534-4436 ; 0003-4738 ; 1081-1206
ISSN (online)	1534-4436
ISSN	0003-4738 ; 1081-1206
DOI	10.1016/j.anai.2024.02.023
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Article ; Online: Associations between sleep characteristics and glycemic variability in youth with type 1 diabetes.

İpar, Necla / Boran, Perran / Barış, Hatice Ezgi / Us, Mahmut Caner / Aygün, Burcu / Haliloğlu, Belma / Gökçe, Tuğba / Can, Ecem / Eviz, Elif / İnan, Neslihan Gökmen / Mutlu, Gül Yeşiltepe / Bereket, Abdullah / Hatun, Şükrü

Sleep medicine

2023 Volume 109, Page(s) 132–142

Abstract: Objective: This study aimed to determine sleep characteristics and their associations with glycemic variability in youth with type 1 diabetes (T1D).: Material and methods: This cross-sectional study conducted at two pediatric diabetes centers in ... ...

Abstract	Objective: This study aimed to determine sleep characteristics and their associations with glycemic variability in youth with type 1 diabetes (T1D). Material and methods: This cross-sectional study conducted at two pediatric diabetes centers in Istanbul, Turkey, included 84 children with T1D (mean age 10.5 years). Sleep characteristics and glycemic variability were determined by actigraphy, DSM-5 Level 2-Sleep Disturbance Scale Short Form and continuous glucose monitoring. Circadian preference was evaluated by the Children's Chronotype Questionnaire. Sleep disturbances were assessed by the. The sleep quality was determined by actigraphy-derived sleep measures. Results: Eighty-eight percent of participants had insufficient age-appropriate total sleep time (TST) (<9 h for 6-13-year-olds and <8 h for 14-17-year-olds). Chronotype was classified as intermediate in 50%, evening in 45.2%, and morning in 4.8%. A higher chronotype score indicating a stronger eveningness preference was associated with more time spent in hypoglycemia (β = 0.433, p = 0.002). On nights when participants had lower sleep efficiency and longer sleep onset latency, they had significantly higher overnight glycemic variability (β = -0.343, p = 0.016, β = 0.129, p = 0.017, respectively). Prolonged nocturnal wake duration was significantly associated with more time spent in daytime hypoglycemia (β = 0.037, p = 0.046) and higher overnight glycemic variability (J index, β = 0.300, p = 0.015). The associations between TST and glycemic variability indices were not significant. Conclusions: Sleep quality rather than TST was significantly associated with glycemic variability in children with T1D. Eveningness preference might contribute to an increased risk of hypoglycemia. Addressing sleep patterns and chronotypes can be crucial in management plans for youth with T1D.
MeSH term(s)	Child ; Humans ; Adolescent ; Diabetes Mellitus, Type 1/complications ; Circadian Rhythm ; Cross-Sectional Studies ; Blood Glucose Self-Monitoring ; Blood Glucose ; Sleep ; Hypoglycemia ; Surveys and Questionnaires
Chemical Substances	Blood Glucose
Language	English
Publishing date	2023-06-27
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2012041-2
ISSN	1878-5506 ; 1389-9457
ISSN (online)	1878-5506
ISSN	1389-9457
DOI	10.1016/j.sleep.2023.06.018
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Article ; Online: Corrigendum to "Associations between sleep characteristics and glycemic variability in youth with type 1 diabetes" [Sleep Med. 109 (2023) 132-142].

Sleep medicine

2023 Volume 113, Page(s) 422

Language	English
Publishing date	2023-09-20
Publishing country	Netherlands
Document type	Published Erratum
ZDB-ID	2012041-2
ISSN	1878-5506 ; 1389-9457
ISSN (online)	1878-5506
ISSN	1389-9457
DOI	10.1016/j.sleep.2023.09.016
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