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    Assessment of two different insulin regimens in children with type 1 diabetes: A longitudinal study
    (2022) Turan, Hande; Tarcin, Gurkan; Dagdeviren Cakir, Aydilek; Gunes Kaya, Didem; Ozer, Yavuz; Ercan, Oya; Olcay Evliyaoglu, Saadet
    Aim: In type 1 diabetes, insulin therapy can be applied by either daily multiple dose injections with an insulin pen or subcutaneous continuous insulin infusion with an insulin pump. Numerous studies have investigated the superiority of both regimens over each other, and conflicting results have been reported. In this study, the periods when patients with type 1 diabetes were receiving subcutaneous continuous insulin infusion and multiple dose injections were compared in terms of clinical and metabolic outcomes. Materials and Methods: Children with type 1 diabetes who were receiving multiple dose injections and later switched to subcutaneous continuous insulin infusion were included. Follow-up period was evaluated in two periods: during multiple dose injections and subcutaneous continuous insulin infusion. Physical and laboratory findings, blood sugar monitoring and food chart records were compared between these two periods. Results: A total of 44 cases with a mean age of 10.6± 4.4 years were included. While a significant decrease was found in HbA1C values in the first year after the insertion of insulin pump, the values in the second year were similar to that in the pre-pump period. Mean body mass index was increased after switching to subcutaneous continuous insulin infusion. In the second year of the subcutaneous continuous insulin infusion, a significant decrease in hypoglycemic events was observed. Conclusion: In terms of glycemic control, no difference was found between subcutaneous continuous insulin infusion and multiple dose injections in the long term suggesting that similar clinical results can be obtained with multiple dose injections therapy in cases who cannot afford an insulin pump. Considering that HbA1c levels tend to increase in the second year of subcutaneous continuous insulin infusion and similarly body mass index after switching to subcutaneous continuous insulin infusion, clinicians should be aware of the misuse of insulin pump, and patients’ education should be revised regularly.
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    Clinical features, diagnosis and treatment outcomes of Cushing's disease in children: A multicenter study
    (Wiley, 2024) Tarcin, Gurkan; Catli, Gonul; Cetinkaya, Semra; Eren, Erdal; Kardelen, Asli Derya; Akinci, Aysehan; Bober, Ece
    Objective: Since Cushing's disease (CD) is less common in the paediatric age group than in adults, data on this subject are relatively limited in children. Herein, we aim to share the clinical, diagnostic and therapeutic features of paediatric CD cases.Design: National, multicenter and retrospective study.Patients: All centres were asked to complete a form including questions regarding initial complaints, physical examination findings, diagnostic tests, treatment modalities and follow-up data of the children with CD between December 2015 and March 2017.Measurements: Diagnostic tests of CD and tumour size.Results: Thirty-four patients (M:F = 16:18) from 15 tertiary centres were enroled. The most frequent complaint and physical examination finding were rapid weight gain, and round face with plethora, respectively. Late-night serum cortisol level was the most sensitive test for the diagnosis of hypercortisolism and morning adrenocorticotropic hormone (ACTH) level to demonstrate the pituitary origin (100% and 96.8%, respectively). Adenoma was detected on magnetic resonance imaging (MRI) in 70.5% of the patients. Transsphenoidal adenomectomy (TSA) was the most preferred treatment (78.1%). At follow-up, 6 (24%) of the patients who underwent TSA were reoperated due to recurrence or surgical failure.Conclusions: Herein, national data of the clinical experience on paediatric CD have been presented. Our findings highlight that presenting complaints may be subtle in children, the sensitivities of the diagnostic tests are very variable and require a careful interpretation, and MRI fails to detect adenoma in approximately one-third of cases. Finally, clinicians should be aware of the recurrence of the disease during the follow-up after surgery.