Anjiyotensin dönüştürücü enzim ve anjiyotensin II tip 1 reseptörü gen polimorfizmlerinin Trakya bölgesindeki Türk hastalarda görülen iskemik inme ile ilişkisi

Amaç: Bu çalışmanın amacı, Trakya bölgesinde yaşayan iskemik inme geçirmiş hastalarda ACE insersiyon/delesyon (I/D) ve AT1R (A1166C) gen polimorfizmlerinin sıklığını, vasküler risk faktörleri ve inme alt-grupları ile ilişkisini araştırmaktır. Hastalar ve Yöntemler: Çalışmaya 162 iskemik inme geçirmiş hasta ile 146 sağlıklı olgu alındı. İskemik inme hastaları, ORG 10172 Akut İnme Tedavisi (TOAST) kriterlerine göre büyük ve küçük damar hastalığı olarak inme alt gruplarına ayrıldı. ACE I/D polimorfizmi polimeraz zincir reaksiyonu (PZR), AT1R (A1166C) gen polimorfizmi ise PZR ve restriksiyon fragment uzunluk polimorfizmi (RFLP) yöntemleri kullanılarak yapıldı. Bulgular: Hasta grubundaki ACE I/D genotip dağılımı (DD=34.0%, ID=50.0%, II=16.0%), kontrol grubu ile karşılaştırıldığında (DD=34.3%, ID=49.7%, II=16.1%) fark bulunmadı. Ayrıca hasta grubundaki AT1R (A1166C) genotip dağılımları ile (AA=58.0%, CA=34.6% ve CC=7.4%) kontrol grubu ile karşılaştırıldığında (AA=60.1%, CA=35.7% ve CC=4.2%) anlamlı fark saptanmadı. Her iki inme alt grubu arasında ACE I/D ve AT1R (A1166C) polimorfizmlerinin dağılımı açısından farklılık bulunmadı. Sonuç: Çalışmamızda Trakya bölgesinde yaşayan insanlarda ACE I/D ve AT1R (A1166C) gen polimorfizmlerinin iskemik inme gelişmesinde genetik risk faktörleri olmadıkları belirlendi.Objectives: The aim of this study was to investigate the frequency of ACE insertion/deletion (I/D) and AT1R (A1166C) gene polymorphisms in ischemic stroke patients in Trakya region and the relation between these gene polymorphisms and stroke subtypes and vascular risk factors. Patients and Methods: The study involved 162 patients with ischemic stroke and 146 control subjects. Ischemic stroke patients were divided into large and small vessel disease subgroups according to ORG 10172 in Acute Stroke Treatment TOAST criteria. The ACE I/D polymorphism was investigated using polymerase chain reaction (PCR), and the AT1R (A1166C) polymorphism was identified using PCR and restriction fragment length polymorphism (RFLP) assay. Results: The ACE I/D genotype distribution in patients (DD=34.0%, ID=50.0%, II=16.0%) did not differ from those in controls (DD=34.3%, ID=49.7%, II=16.1%). The AT1R A1166C genotype distribution in patients (AA=58.0%, CA=34.6%, CC=7.4%) did not significantly differ from those in controls (AA=60.1%, CA=35.7%, CC=4.2%). There was also no difference among the stroke subgroups regarding the distribution of ACE I/D and AT1R (A1166C) polymorphisms. Conclusion: Our results show that ACE I/D and AT1R (A1166C) gene polymorphisms were not genetic risk factors for ischemic stroke in subjects in Trakya region

Tip 2 diyabetik hastaların birinci derece yakınlarında total homosistein ve asimetrik dimetilargininin plazma düzeyleri

Amaç: Tip 2 diyabetik hastaların birinci derece yakınlarında, ailesinde diyabet öyküsü olmayan sağlıklı olgulara göre kardiyovasküler hastalıklar daha sık görülmektedir. Asimetrik dimetilarginin (ADMA) ve homosistein (Hcy) plazma düzeyleri kardiyovasküler hastalıklar ve endotel disfonksiyonuyla ilişkili göstergelerdir. Bu çalışmada, tip 2 diyabetik hastaların birinci derece yakınlarında ADMA ve Hcy plazma düzeyleri ile bu göstergelerle kardiyovasküler risk faktörleri arasındaki ilişkilerin incelenmesi amaçlandı. Hastalar ve Yöntemler: Dolaşımdaki ADMA ve Hcy düzeyleri 15 tip 2 diyabet hastasının birinci derece yakınında ve ailesinde diyabet öyküsü olmayan 15 kontrol olgusunda ölçüldü. Bulgular: Her iki grup arasında ADMA ve Hcy plazma düzeyleri açısından anlamlı farklılık saptanmadı (p>0.05). Asimetrik dimetilarginin plazma düzeyi tip 2 diyabetik olguların birinci derece yakınlarında, bel çevresi (p=0.02), açlık insülin düzeyi (p=0.03), insülin direnci (p=0.01), total kolesterol (p=0.04) ve HDL kolesterol (p=0.03) ile ilişkiliydi. Sonuç: Bu sonuçlara göre, kardiyovasküler risk faktörlerine sahip olan tip 2 diyabetik olguların birinci derece yakınlarında, ADMA plazma düzeylerinin doğrudan endotel disfonksiyonunun gelişimine katkıda bulunmadığını düşünmekteyiz.Objectives: Cardiovascular diseases are more common among first degree relatives of type 2 diabetic patients than healthy subjects without a family history of diabetes. Plasma asymmetric dimethylarginine (ADMA) and homocysteine (Hcy) levels are markers of endothelial dysfunction and cardiovascular disease. The objective of this study was to evaluate levels of ADMA, Hcy and their association with cardiovascular risk factors in first degree relatives of type 2 diabetic patients. Patients and Methods: The circulating ADMA and Hcy levels were measured in 15 first degree relatives of type 2 diabetic patients and 15 control subjects without a known family history of diabetes. Results: No statistically significant differences were found in plasma levels of ADMA and Hcy between the two groups (p>0.05). Plasma ADMA levels correlated significantly with waist circumference (p=0.02), fasting insulin levels (p=0.03), insulin resistance (p=0.01), total cholesterol (p=0.04) and HDL-cholesterol (p=0.03) levels in the first degree relatives of type 2 diabetic patients. Conclusion: These results suggest that plasma ADMA levels do not directly contribute to the development of endothelial dysfunction in first degree relatives of type 2 diabetic patients with cardiovascular risk factors

Obez hastalarda proinflamatuvar sitokinler ile fibrinolitik sistem arasındaki ilişki

Amaç: Obez kişilerde proinflamatuar sitokinlerden TNF-? ve IL-6, fibrinolitik sistem parametrelerinden t-PA ve PAI-1 ve insülin direnci arasındaki ilişki araştırıldı. Hastalar ve Yöntemler: Çalışmaya obez (VKİ ?30 kg/m2) olarak değerlendirilen 54 kişi (41 kadın, 13 erkek; ort. yaş 33.5) ve obezite sorunu olmayan (VKİ <25 kg/m2) 30 kişi (19 kadın, 11 erkek; ort. yaş 22.3) alındı. Fibrinojen düzeyleri koagülometrik olarak ve TNF-?, IL-6, t-PA, PAI-1 düzeyleri ELISA yöntemiyle ölçüldü. Bulgular: Kontrol grubuyla karşılaştırıldığında, obez kişilerde fibrinojen (p<0.01), PAI-1 (p<0.001), TNF-? (p<0.01) ve IL-6 düzeyleri (p<0.001) anlamlı derecede yüksek, t-PA düzeyi (p<0.001) ve t-PA/PAI-1 oranı (p<0.001) anlamlı derecede düşük bulundu. Obezlerde TNF-? ile t-PA (p=0.007) ve t-PA/PAI-1 oranı (p=0.016) arasında ters ilişki saptandı. İnsülin direnci olan ve olmayan obez kişilerde parametreler arasında fark yoktu. Sonuç: Obezitede adipoz dokudan salgılanan özellikle TNF-? gibi inflamatuar sitokinlerin artması fibrinolizde azalmaya yol açar. Obez kişilerde görülen bu değişiklikler, insülin direncinden bağımsız olarak ateroskleroza neden olabilir.Objectives: The aim of this study was to investigate the relationship between proinflammatory cytokines (TNF-&amp;#945; and IL-6), and fibrinolytic system parameters (t-PA, and PAI-1) and insulin resistance in obese individuals. Patients and Methods: The study included 54 obese subjects (BMI &amp;#8805;30 kg/m2; 41 females, 13 males; mean age 33.5 years) and 30 non-obese healthy individuals (BMI &lt;25 kg/m2; 19 females, 11 males; mean age 22.3 years). Fibrinogen levels were measured by the coagulometric method and the measurements of TNF-&amp;#945;, IL-6, t-PA and PAI-1 were carried out by the ELISA method. Results: Compared with non-obese subjects, obese individuals had significantly higher fibrinogen (p&lt;0.01), PAI-1 (p&lt;0.001), TNF-&amp;#945; (p&lt;0.01), and IL-6 (p&lt;0.001) levels, and significantly lower t-PA level (p&lt;0.001) and t-PA/PAI-1 ratio (p&lt;0.001). We also found an inverse relationship between TNF-&amp;#945; and t-PA levels (p=0.007) and t-PA/PAI-1 ratio (p=0.016) in obese individuals. The presence or absence of insulin resistance did not affect proinflammatory cytokines and fibrinolytic system parameters in obese individuals. Conclusion: Our findings indicate increased inflammatory cytokine levels especially in TNF-&amp;#945; level, and decreased fibrinolysis in obese individuals. These changes may contribute to atherosclerotic process independent from insulin resistance in obesity

Management of endocrine surgical disorders during COVID-19 pandemic: expert opinion for non-surgical options

Purpose The COVID-19 pandemic brought unprecedented conditions for overall health care systems by restricting resources for non-COVID-19 patients. As the burden of the disease escalates, routine elective surgeries are being cancelled. The aim of this paper was to provide a guideline for management of endocrine surgical disorders during a pandemic. Methods We used Delphi method with a nine-scale Likert scale on two rounds of voting involving 64 experienced eminent surgeons and endocrinologists who had the necessary experience to provide insight on endocrine disorder management. All voting was done by email using a standard questionnaire. Results Overall, 37 recommendations were voted on. In two rounds, all recommendations reached an agreement and were either endorsed or rejected. Endorsed statements include dietary change in primary hyperparathyroidism, Cinacalcet treatment in secondary hyperparathyroidism, alpha-blocker administration for pheochromocytoma, methimazole +/- beta-blocker combination for Graves' disease, and follow-up for fine-needle aspiration results of thyroid nodules indicated as Bethesda 3-4 cytological results and papillary microcarcinoma. Conclusion This survey summarizes expert opinion for the management of endocrine surgical conditions during unprecedented times when access to surgical treatment is severely disrupted. The statements are not applicable in circumstances in which surgical treatment is possible

Wpływ dystrybucji tkanki tłuszczowej oraz wybranych adipokin na insulinooporność w stanie przedcukrzycowym

  Introduction: The risk of developing insulin resistance and metabolic syndrome is particularly high in central obesity. In this study we evaluated the effects of fat distribution and some adipokines on insulin resistance in prediabetic patients. Material and methods: Eighty-seven age- and sex-matched patients were divided into three groups according to their 75-gram oral glucose tolerance test results as follows: impaired fasting glucose group, impaired glucose tolerance group, and normal glucose tolerance group. Fasting insulin levels were measured. Homeostatic model assessment of insulin resistance was calculated. Body fat mass measurements were assessed by bioelectric impedance analyser and abdominal fat thicknesses (subcutaneous, visceral, and preperitoneal) by ultrasonography. The fasting serum levels of several adipokines [adiponectin, leptin, resistin, vaspin, visfatin, retinol-binding protein-4 (RBP-4), tumour necrosis factor-alpha (TNF-alpha)] were measured by ELISA method. Results: The mean body mass index, fat mass measurements, and abdominal fat thicknesses of the groups were similar. There were no differences between groups in terms of the mean fasting insulin, vaspin, RBP-4, leptin, resistin, and TNF-alpha. In comparison of the prediabetic and normal groups, the levels of adiponectin (p &lt; 0.001) and visfatin (p &lt; 0.001) were lower in the prediabetic group. Furthermore, we found that high body mass index (p &lt; 0.01) and fat mass (p &lt; 0.01) and low adiponectin (p &lt; 0.05) levels have roles in the development of insulin resistance in the prediabetic group. Conclusions: We suggested that in the prediabetic period not only obesity but also decreased adiponectin levels play some role in the pathogenesis of insulin resistance. (Endokrynol Pol 2016; 67 (3): 277–282)    Wstęp: Ryzyko rozwoju insulinooporności i zespołu metabolicznego zwiększa się zwłaszcza u osób z otyłością centralną. W niniejszym badaniu oceniono wpływ dystrybucji tkanki tłuszczowej i wybranych adipokin na insulinooporność u osób ze stanem przedcukrzycowym. Materiał i metody: Osiemdziesięciu siedmiu chorych dobranych pod względem wieku I płci podzielono na 3 grupy w zależności od wyniku testu doustnego obciążenia 75 g glukozy: osoby z nieprawidłową glikemią na czczo, osoby z nieprawidłową tolerancją glukozy i osoby z prawidłową tolerancją glukozy. Zmierzono stężenie insulin na czczo. Do oszacowania insulinooporności zastosowano model homeostazy. Masę tkanki tłuszczowej oceniono za pomocą analizatora bioimpedancji elektrycznej, a grubość brzusznej tkanki tłuszczowej (podskórnej, trzewnej i przedotrzewnowej) zmierzono metodą ultrasonograficzną. Stężenie na czczo w surowicy kilku adipokin (adiponektyna, leptyna, rezystyna, waspina, wisfatyna, białko wiążące retinol-4 [RBP-4], czynnik martwicy nowotworów alfa [TNF-alfa]) zmierzono, stosując metodę ELISA. Wyniki: Średni wskaźnik masy ciała, masa tkanki tłuszczowej I grubość brzusznej tkanki tłuszczowej były podobne we wszystkich grupach. Nie stwierdzono różnic między grupami pod względem średniego stężenia insuliny na czczo ani stężeń waspiny, RBP-4, leptyny, rezystyny i TNF-alfa. W porównaniu grup ze stanem cukrzycowym i grupy z prawidłową tolerancją glukozy wykazano, że stężenia adiponektyny (p &lt; 0,001) i wisfatyny (p &lt; 0,001) były niższe u osób ze stanem przedcukrzycowym. Ponadto stwierdzono, że wysoki wskaźnik masy ciała (p &lt; 0,01) i duża masa tkanki tłuszczowej (p &lt; 0,01) oraz niskie stężenie adiponektyny (p &lt; 0,05) przyczyniają się do rozwoju insulinooporności u osób ze stanem przedcukrzycowym. Wnioski: Autorzy sugerują, że nie tylko otyłość, ale również obniżenie stężenia adiponektyny odgrywają pewną rolę w patogenezie insulinooporności w okresie przedcukrzycowym. (Endokrynol Pol 2016; 67 (3): 277–282)

The effects of pulsed electromagnetic field treatment in pain due to diabetic polyneuropathy

Amaç: Diyabetik periferik nöropati, diyabetin en sık görülen ve özürlülüğe neden olan komplikasyonudur. Nöropatik ağrı sıklıkla çoklu farmakolojik tedaviye dirençlidir ve bu ajanların yan etkileri kullanımlarını sınırlar. Nöropatik ağrı tedavisinde farklı alternatif tedaviler araştırılmaktadır. Nonfarmakolojik tedavilerin sistemik yan etkileri düşüktür. Bu rasgele seçilmiş, plasebo kontrollü çalışmada, dirençli diyabetik nöropatik ağrıda puls elektromanyetik alan tedavisinin etkinliği araştırıldı. Hastalar ve Yöntemler: Çalışma, rasgele ayrılan, 25 puls elektromanyetik alan tedavisi (PEMF) ve 25 plasebo grubunda olmak üzere 50 hastayla tamamlandı. Tedavi grubundaki hastaların her iki ayağına on ardışık gün ve günde 1 saat PEMF uygulandı. Olguların tedaviden önce, sonra ve 6. haftadaki kontrollerinde vizüel analog skala ve nöropatik ağrı skala değerlendirmeleri yapıldı. Elektronöromiyografi tetkikleri, tedaviden önce ve 6. hafta kontrollerinde değerlendirildi. Bulgular: Çalışmanın sonucunda, vizüel analog skala ile yapılan ağrı değerlendirmesinde tedavi sonunda %53, kontrol değerlendirmesinde %67 iyileşme saptandı. Nöropatik ağrı skalası farklı verilerinde saptanan düzelme, tedavi grubunda plasebo grubuna göre istatistiksel olarak anlamlıydı. Sinir ileti hızı çalışmalarında iki grup verileri arasında anlamlı istatistiksel fark saptanmadı. Sonuç: Puls elektromanyetik alan tedavisi, ağrı skorları ve polinöropati semptomları üzerindeki olumlu etkileri ile diyabetik nöropatik ağrı tedavisinde alternatif bir seçenek olarak düşünülebilir.Objectives: Diabetic polyneuropathy is the most common and disabled complication of diabetes mellitus. Pharmacological treatment of diabetic neuropathy is limited because of the side efects of the drugs, used in the treatment of diabetic neuropthy. Alternative treatments are also used in diabetic neuropathy. Systemic side effects of non-pharmacological treatment modalities are rare. We evaluated the value of pulsed electromagnetic field treatment in patients with pain due to diabetic polyneuropathy. Patients and Methods: Symptomatic 95 patients were included in the study, and from these patients, 25 patients were randomized in pulsed electromagnetic field treatment group and 25 patients were randomized in placebo group. Pulsed electromagnetic field device was applied over both feet of the patients for one hour a day (during 10 days). Visual analog scale and neuropathic pain scale of all patients were performed before and after treatment and 6th week. Electroneuromyography was also performed before treatment and 6th week. Results: Improvement of pain determined by visual analog scale was 53% after treatment and 67% six weeks later. The improvement of visual analog scale scores were statistically significant in study group when compared with control subjects. Conclusion: The pulsed electromagnetic field may be an alternative treatment modality in diabetic patients with neuropathic pain

Frequency of thyroid diseases in type 2 diabetic patients

Amaç: Tiroid hastalıkları ve tip 2 diabetes mellitus (DM) toplumda sık görülen iki hastalıktır. Bu çalışmada, tip 2 diyabetik olgularda tiroid hastalıklarının sıklığını inceledik. Hastalar ve Yöntemler: Trakya Üniversitesi Endokrinoloji Bilim Dalında takip edilen tip 2 DM hastalarından tiroid fonksiyon testleri, anti-tiroglobulin antikoru, anti-tiroid peroksidaz antikoru ve tiroid ultrasonografi ve/veya sintigrafi sonuçları bulunan 306'sı retrospektif olarak incelendi. Bulgular: Yirmi dokuz (%9.5) olguda Hashimoto tiroiditi, beşinde (%1.7) multinodüler guatr, üçünde (Graves hastalığı (%1) ve bir olguda (%0.3) toksik soliter adenom olmak üzere toplam 38 (%12.4) olguda tiroid hastalığı belirlendi. Sonuç: Yapılan inceleme sonucunda tip 2 DM olgularında tiroid hastalıklarına genel popülasyondakine benzer sıklıkla rastlandığını tespit ettik. Tip 2 DM'li hastaların, kardiyovasküler hastalık eğilimi yaratan başta hipotiroidi olmak üzere tiroid hastalıkları açısından genel popülasyon için geçerli olan öneriler dışında ayrıca taranmasına gerek olmadığı sonucuna vardık.Objectives: Thyroid diseases and type 2 diabetes mellitus are two abundant diseases in general population. In this study, we evaluated the frequency of thyroid diseases in type 2 diabetic patients. Patients and Methods: The study included 306 type 2 diabetic patients, who were followed up in Trakya University Department of Endocrinology and Metabolism Disorders. All patients had thyroid function tests, antithyroglobulin antibody values, antithyroid peroxidase values, and thyroid imaging (scintigraphy and/or ultrasonography). Results: A total of 38 (12.4%) patients had thyroid diseases with the following distribution: 29 (9.5%) Hashimoto thyroiditis, five (1.7%) multinodular goitre, three (%1) Graves' disease, and one toxic solitary adenoma (0.3%). Conclusion: We found that thyroid diseases in type 2 diabetics were seen as frequent as in general population. We suggest that there is no need to screen type 2 diabetics for thyroid diseases, hypothyroid in particular, that increase the risk for cardiovascular diseases, in addition to the recommended screening of the general population in guidelines

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)

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- and 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

Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria

BackgroundMigraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert.MethodsIn this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis.ResultsLonger headache duration (&lt;4 h) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, nausea/vomiting, and photophobia and/or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in patients with I/GE, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had the distinguishing capability of being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone.ConclusionLonger headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs

The Evaluation of autonomic cardiac neuropathy in type II Diabetes Mellitus with several tests

Çalışmamızda Tip II Diabetes Mellitus'lu vakalarda otonom nöropatinin yarattığı kardiyak etkileri incelemeyi planladık. Bu amaçla hastalara ve kontrol grubuna kardiyovasküler refleks testlerini uyguladık, QT dağılımlarını inceledik. Çalışmamız Ekim-1998, Ekim-1999 tarihleri arasında Trakya Üniversitesi Tıp Fakültesi İç Hastalıkları Anabilim Dalı Endokrinoloji Bölümü Diabetes Mellitus Polikliniğinde takip edilen 25 NIDDM hastası ve 15 sağlıklı kontrol grubundan oluşturuldu. NIDDM grubunu, otonom nöropatinin daha çok tespit edildiği beş yıl üzerinde diabet süresi olan ve polinöropatisi klinik veya laboratuvar olarak tespit edilmiş vakalar oluşturdu. Diabetik ve kontrol grubuna iskemik kalp hastalığını dışlamak amacıyla efor testi, hipertansiyonun olmadığını göstermek için 24 saatlik ambulatuar kan basıncı takibi uygulandı. Daha sonra her iki gruba da kardiyovasküler refleks testleri uygulandı. Test sonuçlarına göre 19 otonom nöropatili diabetik, 6 otonom nöropatisiz diabetik elde edildi. Kardiyovasküler refleks testi sonuçlarına göre gruplar ile diabet süresi, HbA1c, vücut kitle indeksi, yaş ortalaması arasında ilişki bulunmadı. Uygulanan beş kardiyovasküler refleks testinden en erken derin solunuma kalp hızı testinin bozulduğu tespit edildi. Valsalva manevrasına kalp hızı yanıtı testi de anlamlı derecede otonom nöropatili grupta düşük bulundu. Diğer üç testin sonucu gruplar arasında istatistiksel olarak anlamlı fark göstermedi. Otonom nöropatili diabetiklerde QT dağılımının en yüksek, kontrol grubunda en düşük değerde olduğu görüldü. Üç grup arasında istatistiksel olarak anlamlı farklılık vardı. Otonom skor ile QT dağılımı arasında lineer bir korelasyon saptandı. QT dağılımı ile diabet süresi arasında ise anlamlı ilişki bulunmadı. Sonuç olarak QT dağılımının diabetik hastalarda otonom nöropatinin teşhisinde kullanılabileceği kararına vardık. QT dağılımı kardiyovasküler refleks testlerine göre diabetik otonom nöropatinin erken teşhisinde, izlenmesinde, terapatik etkinin değerlendirilmesinde uygulanması kolay, noninvazif, hasta ile kooperasyon gerektirmeyen güvenirliği yüksek olan bir metodtur.In our study we investigated cardiac effects of autonomic neuropathy in patients with type II diabetes mellitus. Cardiovascular reflex tests were performed with patient and control group, QT dispersions were assessed. Our study included 25 NIDDM patients and 15 healthy control cases that are followed at the Diabetes Policlinic of Trakya University Medical Faculty Hospital between the dates of October 1998- October 1999. The patient group consisted off cases suffering NIDDM more than 5 years long and having polineuropathy on clinical or laboratory grounds. In order to show that patient and control group do not have ischeamic cardiac disease and hypertension we did effort test and 24 hours ambulatory blood pressure monitorization. Both groups underwent cardiovascular tests. According to the results of the tests 1 9 of the diabetic patients had autonomic neuropathy. There was no correlation between cardiovascular tests and diabetic age, HbA1c, body mass index. The heart rate response to deep ventilation was the cardiovascular test that first became abnormal. Heart rate was found significantly low in response to Valsalva manoeuvre. The other three tests showed no statistically significant difference between two groups. QT dispersion was significantly high in patients with autonomic neuropathy and low in control group. A linear correlation was found between autonomic score and QT dispersion. There was no significant correlation between QT dispersion and diabetic age. We conclude that QT dispersion can be used to detect autonomic neuropathy in diabetic patients. QT dispersion is a simple, non-invasive, reliable test that needs no patient cooperation in following diabetics' autonomic neuropathy and assesing therapeutic effects