Researcher:
Gökçe, Tuğba

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Doctor

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Tuğba

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Gökçe

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Gökçe, Tuğba

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Now showing 1 - 10 of 23
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    Publication
    Discrepancy between fingertip glucose vevels and HBA1C in an adolescent with diabetes: a fake logbook or pseudohypoglycemia?
    (AVES, 2023) N/A; Eviz, Elif; Yıldız, Amra Adrovic; Can, Ecem; Gökçe, Tuğba; Yeşiltepe Mutlu, Rahime Gül; Hatun, Şükrü; School of Medicine; Koç University Hospital
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    Publication
    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
    (Sage Publications Inc., 2024) Karakuş, Kağan Ege; Yeşiltepe Mutlu, Rahime Gül; Gökçe, Tuğba; Eviz, Elif; Can, Ecem; Muradoğlu, Serra Küpçüoğlu; Hatun, Şükrü; School of Medicine; Koç University Hospital
    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 (P <.01), whereas micro bolus was significantly lower between 19.00 and 21.00 than those between 00.00 and 10.00 (P <.001). The auto-correction ratio between 21.00 and 00.00 was significantly higher than those between 03.00-17.00 (P <.001) and 19.00-21.00 (P =.008), whereas auto-correction was significantly lower between 07.00 and 10.00 than those between 10.00 and 03.00 (P <.001). The micro bolus ratio was significantly higher in children below nine years old than in children above nine years old between 21.00-00.00 (P =.026) and 00.00-03.00 (P =.003). 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.
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    Current management of Type 1 diabetes in children: guideline-based expert opinions and recommendations
    (Galenos Yayınevi, 2024) Smart, Carmel; Hanas, Ragnar; Hatun, Şükrü; Gökçe, Tuğba; Can, Ecem; Eviz, Elif; Karakuş, Kağan Ege; Yeşiltepe Mutlu, Rahime Gül; School of Medicine; Koç University Hospital
    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 glycemic values, quality of life and life expectancy similar to peers, prevention of long-term complications, prevention of severe hypoglycemia as far as possible and facilitation of glucose management. The International Society for Pediatric and Adolescent Diabetes (ISPAD) has been updating its guidelines for diabetes care every four 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 T1D and their 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 T1D treatment is described for practical applications.
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    PublicationOpen Access
    Inequalities in access to diabetes technologies in children with Type 1 diabetes: a multicenter, cross-sectional study from Türkiye
    (Galenos Yayınevi, 2024) Karakus K.E.; Yıldırım, R.; Özalkak, Ş.; Özbek, M.N.; Yıldırım, N.; Delibağ, G.; Eklioğlu, B.S.; Haliloğlu, B.; Aydın, M.; Kırmızıbekmez, H; Sakarya, Sibel; Gökçe, Tuğba; Can, Ecem; Eviz, Elif; Yeşiltepe Mutlu, Rahime Gül; Hatun, Şükrü; School of Medicine; Koç University Hospital
    Objective: To determine inequalities in access to diabetes technologies and the effect of socioeconomic factors on families with children with type 1 diabetes. Methods: In this multicenter cross-sectional study, parents of children with type 1 diabetes completed a questionnaire about household sociodemographic characteristics, latest HbA1c values, continuous glucose monitoring (CGM) and insulin pump use of children, the education and working status of parents. These characteristics were compared between technology use (only-CGM, only-pump, CGM+pump, no technology use). Results: Among 882 families, only-CGM users, only-pump users, and CGM+pump users compared with no technology users, adjusting for age, sex, region, education levels, number of working parents, and household income. Children living in the least developed region had lower odds of having only-CGM (OR=0.20, 95%CI 0.12-0.34) and having CGM+pump (OR=0.07, 95%CI 0.03-0.22) compared with those living in the most developed region. Children with parents who had not finished high school had lower odds of having only-CGM (Mothers: OR=0.36, 95%CI 0.19-0.66; fathers: OR=0.32, 95%CI 0.18-0.60) or both CGM+pump (OR=0.27, 95%CI 0.11-0.64; fathers: OR=0.34, 95%CI 0.15-0.79) rather than no-technology compared to children whose parents has a university degree. Every $840 increase in the household income increased the odds by 5% for having only-CGM (OR=1.05, 95%CI 1.02-1.09) and CGM+pump (OR=1.05, 95%CI 1.01-1.08). Conclusion: Socioeconomic factors such as education, regions, and income were associated with inequality in access to technologies. The inequalities are more prominent in access to CGM while CGM had a bigger contribution to glycemic control.
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    Inequalities in access to diabetes technologies in children by the socioeconomic levels of families: a multicenter, cross-sectional study
    (Mary Ann Liebert, Inc, 2023) Yildirim, R.; Özalkak, S.; Özbek, M.; Yildirim, N.; Delibag, G.; Eklioglu, B.; Haliloglu, B.; Aydin, M.; Kirmizibekmez, H.; Karakuş, Kağan Ege; Sakarya, Sibel; Gökçe, Tuğba; Can, Ecem; Muradoğlu, Serra Küpçüoğlu; Eviz, Elif; Yeşiltepe Mutlu, Rahime Gül; Hatun, Şükrü; School of Medicine; Koç University Hospital
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    The association of milk and multiple food avoidance with growth parameters in infants and children
    (American College of Allergy, Asthma and Immunology, 2024) Eltan, Sevgi Bilgiç; Karakoç-Aydıner, Elif; Yılmaz, Ebru Arık; Can, Ceren Özel, Hülya Gökmen; Saçkesen, Cansın; Büyüktiryaki, Ayşe Betül; Gökçe, Tuğba; Göğebakan, Emre; Gündoğdu, Beliz Su; Cengiz, Hilal; Çelik, Nevin; İncir, Said; Yeşiltepe Mutlu, Rahime Gül; Yıldırım, Damla; Hatun, Şükrü; School of Medicine
    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. © 2024 American College of Allergy, Asthma & Immunology
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    I'm not alone-my take-away message from the my friend diabetes camp
    (Springernature, 2020) N/A; N/A; Yeşiltepe Mutlu, Rahime Gül; Gökçe, Tuğba; Can, Ecem; Muradoğlu, Serra Küpçüoğlu; Hatun, Şükrü; Faculty Member; Doctor; Nurse; Doctor; Faculty Member; School of Medicine; N/A; N/A; N/A; School of Medicine; N/A; Koç University Hospital; Koç University Hospital; Koç University Hospital; N/A; 153511; N/A; N/A; N/A; 153504
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    A short-term evaluation of children with diabetes using medtronic 780g system- a single center experience from Turkey
    (Mary Ann Liebert, Inc, 2022) N/A; N/A; Yeşiltepe Mutlu, Rahime Gül; Eviz, Elif; Can, Ecem; Gökçe, Tuğba; Muradoğlu, Serra Küpçüoğlu; Hatun, Şükrü; Faculty Member; Researcher; Nurse; Doctor; Doctor; Faculty Member; School of Medicine; School of Medicine; N/A; N/A; N/A; School of Medicine; N/A; N/A; Koç University Hospital; Koç University Hospital; Koç University Hospital; N/A; 153511; 327618; N/A; N/A; N/A; 153504
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    The attitudes, experiences, and self-competencies of pediatric endocrinology fellows and attending physicians regarding diabetes technology: the Turkey experience
    (Walter De Gruyter Gmbh, 2022) Eren, Erdal; N/A; N/A; N/A; N/A; N/A; Yeşiltepe Mutlu, Rahime Gül; Eviz, Elif; Gökçe, Tuğba; Sakarya, Sibel; Hatun, Şükrü; Faculty Member; Researcher; Doctor; Faculty Member; Faculty Member; School of Medicine; School of Medicine; N/A; School of Medicine; School of Medicine; Koç University Hospital; 153511; 327618; N/A; 172028; 153504
    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.
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    The my friend diabetes carbohydrate bolus calculator: user experiences
    (Mary Ann Liebert, Inc, 2022) N/A; N/A; Karakuş, Kağan Ege; Gökçe, Tuğba; Can, Ecem; Muradoğlu, Serra Küpçüoğlu; Eviz, Elif; Yeşiltepe Mutlu, Rahime Gül; Hatun, Şükrü; Undergraduate Student; Doctor; Nurse; Doctor; N/A; Researcher; Faculty Member; Faculty Member; School of Medicine; N/A; N/A; N/A; School of Medicine; School of Medicine; School of Medicine; School of Medicine; N/A; N/A; N/A; N/A; N/A; 327618; 153511; 153504
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