Physician Adherence to the SEMT Guidelines for the Management of Type 2 Diabetes in Turkey: ADMIRE Study

Objective: To evaluate the impact of physicians' adherence to the guidelines developed by the Diabetes Study Group of The Society of Endocrinology and Metabolism of Turkey (SEMT) on glycemic control in diabetes mellitus

A patient-based study on the adherence of physicians to guidelines for the management of type 2 diabetes in Turkey

WOS: 000311026100015PubMed ID: 22652276Aims: To evaluate physicians' adherence to guidelines by Diabetes Study Group of The Society of Endocrinology and Metabolism of Turkey (SEMT). Methods: The medical records of 1790 patients with type 2 diabetes (mean age, 58.7 +/- 10.9 years; diabetes duration, 7.7 perpendicular to 7.5 years) followed by 180 physicians during last 12 months were reviewed. Adherence to SEMT guidelines was analysed under medical history, physical examination and laboratory evaluations subheadings, each scored on a 10-point scale. Effects of patients' age, gender, diabetes duration, body mass index, chronic complications, physicians' specialty and institution on guideline adherence were evaluated. Results: Follow-up procedures were >75% compliant for 52% of patients. Full adherence to medical history, physical examination and laboratory aspects of SEMT guidelines were met in 68.6%, 8.3% and 19.2% of patients, respectively. Older patients and males fared better for laboratory evaluations. All aspects of guideline adherence were poor in patients with short duration of diabetes and in the absence of chronic complications. State institutions and family practitioners had lower adherence scores for physical examination and laboratory evaluation. Conclusions: Overall guideline adherence of physicians was suboptimal. Educational programs emphasizing the preventive aspect of diabetes management, targeted towards family practitioners and state institutions, may improve guideline adherence and patient outcome. (C) 2012 Elsevier Ireland Ltd. All rights reserved.sanofi TurkeySanofi-AventisWe thank to the members of the ADMIRE Study Group for their valuable contribution (see Appendix). We thank to Oktay Ozdemir and Murat Kirtis for their assistance with statistical analysis and drafting the manuscript. We also thank to sanofi Turkey for providing unrestricted and unconditioned grant for the study

Macro-TSH Can Be a Rare Cause of Elevated Serum Thyroid Stimulating Hormone Concentration: A Case Report

In this case report, an 18 years old female subject with incidentally detected thyroid stimulating hormon (TSH) elevation due to macro-TSH without clinical findings of thyroid disorder was defined. Initially, the laboratory investigations revealed high TSH [11.45 µIU/mL; normal reference interval (NRI: 0.50-5.50 µIU/mL)] with electrochemiluminescence immunoassay (ECLIA) method. When L-thyroxine and L-triodothyronine treatments were found to be ineffective for lowering TSH, polyethylene glycol (PEG) method for TSH measurement was planned to rule out the posibility of macro-TSH. TSH level upon using the PEG method was found to be within normal ranges as 1.96 µIU/mL. In conclusion, normal free thyroxine level accompanied by elevated TSH is mostly encountered in cases of subclinical hypothyroidism. Such a laboratory finding can also be caused by macro-TSH which is a rare condition. To avoid unnecessary investigations and treatment, macro-TSH should be kept in mind in patients with high TSH levels without symptoms of hypothyroidism in the differential diagnosis. [Med-Science 2014; 3(4.000): 1691-6

A patient-based study on the adherence of physicians to guidelines for the management of type 2 diabetes in Turkey

Conclusions: Overall guideline adherence of physicians was suboptimal. Educational programs emphasizing the preventive aspect of diabetes management, targeted towards family practitioners and state institutions, may improve guideline adherence and patient outcome. (C) 2012 Elsevier Ireland Ltd. All rights reserved

PHYSICAL ACTIVITY ALTERS URINARY ALBUMIN/ CREATININE RATIO IN TYPE 1 DIABETIC PATIENT

While the best way to identify microalbuminuria is to determine albumin excretion rate (AER) in a 24 h urine sample. Published data have shown that calculation of an albumin/creatinine ratio (ACR) in a spot urine sample has reasonable rate of sensitivity and specificity. We aimed to evaluate the effect of daily exercise on ACR and estimate the best time for the examination of the ACR in a spot urine sample. Sixteen eligible patients with Type 1 diabetes mellitus were asked to perform varying degree of exercise periods. Urinary albumin and creatinine excretion rates during each period were determined. ACR and AER of timed urinary samples were compared with the 24 hour urinary AER. We found significant correlations between timed and 24 hour urinary AER. According to diagnostic performance tests, ACR and AER of timed urine samples were both found to be significantly more sensitive during resting period when compared with mild or moderate active periods. It is concluded that ACR and AER of a timed urine sample are sensitive and specific methods for determining microalbuminuria, while overnight resting samples give the impression of being more diagnostic