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    Impact of obesity on the metabolic control of type 2 diabetes: results of the Turkish nationwide survey of glycemic and other metabolic parameters of patients with diabetes mellitus (Temd Obesity Study)
    (S. Karger AG, 2019) Sönmez, Alper; Yumuk, Volkan; Haymana, Cem; Demirci, İbrahim; Barçın, Cem; Kıyıcı, Sinem; Güldiken, Sibel; Örük, Gonca; Saydam, Başak Özgen; Baldane, Süleyman; Kutlutürk, Faruk; Küçükler, Ferit Kerim; Deyneli, Oğuzhan; Çetinarslan, Berrin; Sabuncu, Tevfik; Bayram, Fahri; Satman, İlhan
    Background: Obesity is the main obstacle for metabolic control in patients with type 2 diabetes. Turkey has the highest prevalence of obesity and type 2 diabetes in Europe. The effect of obesity on the metabolic control, and the macro- A nd microvascular complications of patients are not apparent. Objectives: This nationwide survey aimed to investigate the prevalence of overweight and obesity among patients with type 2 diabetes and to search for the impact of obesity on the metabolic control of these patients. We also investigated the independent associates of obesity in patients with type 2 diabetes. Methods: We consecutively enrolled patients who were under follow-up for at least 1 year in 69 tertiary healthcare units in 37 cities. The demographic, anthropometric, and clinical data including medications were recorded. Patients were excluded if they were pregnant, younger than 18 years, had decompensated liver disease, psychiatric disorders interfering with cognition or compliance, had bariatric surgery, or were undergoing renal replacement therapy. Results: Only 10% of patients with type 2 diabetes (n = 4,648) had normal body mass indexes (BMI), while the others were affected by overweight (31%) or obesity (59%). Women had a significantly higher prevalence of obesity (53.4 vs. 40%) and severe obesity (16.6 vs. 3.3%). Significant associations were present between high BMI levels and lower education levels, intake of insulin, antihypertensives and statins, poor metabolic control, or the presence of microvascular complications. Age, gender, level of education, smoking, and physical inactivity were the independent associates of obesity in patients with type 2 diabetes. Conclusion: The TEMD Obesity Study shows that obesity is a major determinant of the poor metabolic control in patients with type 2 diabetes. These results underline the importance of prevention and management of obesity to improve health care in patients with type 2 diabetes. Also, the results point out the independent sociodemographic and clinical associates of obesity, which should be the prior targets to overcome, in the national fight with obesity. © 2019 The Author(s) Published by S. Karger AG, Basel.
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    Treatment Patterns and Associated Clinical Outcomes in Type 2 Diabetes Patients Initiating Second-Line Glucose-Lowering Therapy: Interim Analysis of Baseline Data from Turkey Arm of the Global DISCOVER Study
    (Turkiye Klinikleri, 2021) Bayram, Fahri; Sari, Ramazan; Kucukler, Ferit Kerim; Araz, Mustafa; Colak, Ramis; Baspinar, Osman; Tetiker, Tamer
    Objective: To evaluate the treatment patterns and associated clinical outcomes in Type 2 diabetes (T2D) patients initiating a second-line glucose-lowering therapy. Material and Methods: This paper presents a preliminary subgroup analysis of the baseline data collected from 536 patients [mean (standard deviation) age: 55.1 (10.0) years, 50.2% were males] in the Turkey arm of global observational DISCOVER study among T2D patients initiating second-line glucose-lowering therapy. Patient demographics, disease (duration, complications) and treatment (type of regimens, modifications) characteristics, hemoglobin A1c (HbA1c), low-density lipoprotein-cholesterol (LDL-C), and systolic blood pressure (BP) target achievement rates and the patient-reported outcomes were recorded at the initiation of second-line therapy. Results: Overall, 11.7% of patients were HbA1c target of <7% at baseline, 62.5% were systolic BP target of <140 mmHg and 21.2% were LDL-C target of <100 mg/dL. Major and minor hypoglycemic events were noted in 5.5% and 10.7% of patients, while macro and microvascular complications in 17.2% and 20.1% of patients, respectively. Metformin monot- herapy (47.9%) and metformin+sulfonylurea combination (22.6%) were the two most common first-line therapies. However, insulin (32.3%) was the most commonly prescribed second-line agent. Lifestyle assessment revealed a healthy lifestyle in 50.7% of patients. Conclusion: Our finding revealed a failure to achieve HbA1c, LDL-C, and systolic BP targets and a high rate of diabetes-related complications before initiation of second-line therapy in a significant proportion of Turkish T20 patients. Thus, emphasizing a need for more aggressive risk factor screening and modification at early disease stages and earlier treatment intensification among T2D patients.
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    Turkish nationwide survEy of glycemic and other Metabolic parameters of patients with Diabetes mellitus (TEMD study)
    (Elsevier Ireland Ltd, 2018) Sönmez, Alper; Haymana, Cem; Bayram, Fahri; Salman, Serpil; Dizdar, Oğuzhan Sıtkı; Gürkan, Eren; Kargılı Çarlıoğlu, Ayşe; Küçükler, Ferit Kerim
    Aims: Turkey has the highest prevalence of diabetes in Europe. It is therefore essential to know the overall cardiovascular risk and reveal the predictors of metabolic control in Turkish adults with diabetes mellitus. Methods: A nationwide, multicenter survey consecutively enrolled patients who were under follow up for at least a year. Optimal control was defined as HbA1c < 7%, home arterial blood pressure (ABP) < 135/85 mmHg, or LDL-C < 100 mg/dL. Achieving all parameters indicated triple metabolic control. Results: HbA1c levels of patients (n = 5211) were 8.6 ± 1.9% (71 ± 22 mmol/mol) and 7.7 ± 1.7% (61 ± 19 mmol/mol), in Type 1 and Type 2 diabetes, respectively. Glycemic control was achieved in 15.3% and 40.2%, and triple metabolic control was achieved in 5.5% and 10.1%, respectively. Only 1.5% of patients met all the criteria of being non-obese, non-smoker, exercising, and under triple metabolic control. Low education level was a significant predictor of poor glycemic control in both groups. Conclusions: Few patients with Type 2, and even fewer with Type 1 diabetes have optimal metabolic control in Turkey. TEMD study will provide evidence-based information to policy makers to focus more on the quality and sustainability of diabetes care in order to reduce the national burden of the disease. © 2018 Elsevier B.V.