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

Reliability and validity of a Turkish version of the acceptance and action diabetes questionnaire

WOS: 000472919500002PubMed ID: 31247700Objective The aim of this study is to perform validity and reliability examination of the Turkish form of Acceptance and Action Diabetes Questionnaire, and to investigate whether this scale is a measurement tool for evaluation of psychological flexibility levels in a sample of patients with diabetes in Turkey. Methods This study was conducted with 105 patients. Turkish forms of the Beck Depression Inventory (BDI), Problem Areas in Diabetes Questionnaire (PAID), State-Trait Anxiety Inventory (STAI-I and STAI-I I), Audit of Diabetes-Dependent Quality of Life (ADDQoL) and Turkish form of Acceptance and Action Diabetes Questionnaire (TAADQ) were applied. SPSS 20.0 and AMOS was used in statistical analysis. Results 56.12% of the patients were female and the mean of age was 54 (SD=+/- 9.9) years. The mean duration of education was found 7.65 (SD=3.97) years. 74.8% of the patients most of whom (83.3%, n=85) had diabetes mellitus and the mean glycemic control calculated with HbAlc was 8.02 +/- 1.91. According to the final fit indices, we found that the revised and corrected 9-item model was superior over the previous model. Cronbach Alpha coefficient of TAADQ was found as 0.836. Conclusion TAAI)Q is a valid and reliable assessment tool in Turkish population. So TAADQ will be a powerfull tool in assessing psychological flexibility in diabetes patients

Vitamin D Does not Have Any Impact on Ovarian Reserve Markers in Infertile Women

Objective: To evaluate the potential role of vitamin D on ovarian reserve markers in infertile women with different reserve patterns. Study design: This prospective cross-sectional study included the infertile women attending the Hitit University Hospital. The initial examination included the measurements of waist circumference and hip circumference, body mass index, and waist/hip ratio. A total of 171 women were divided into three groups according to ovarian reserve patterns: (i) adequate ovarian reserve pattern (AOR, n=77), (ii) high ovarian reserve pattern (polycystic ovarian syndrome, n=62), and (iii) diminished ovarian reserve pattern (DOR, n=32). The serum estradiol (E2), follicle stimulating hormone, total testosterone, 17-hydroxy-progesterone (17(OH) P), dehydroepiandrosterone sulfate, anti-mullerian hormone, and hydroxycholecalciferol (25(OH) D) levels were analyzed. Results: No significant difference between three different groups was detected in terms of body mass index, waist circumference, hip circumference, waist/hip ratio, E2 and 17OHP levels (p>0.05, for all). One-hundred-sixty-nine (98.2%) women in all groups had vitamin D concentration below 30 ng/mL as a cut-off value. The circulating 25 (OH) D levels did not show a significant difference between all ovarian reserve groups (p=0.804). No correlation between 25(OH) D and anti-mullerian hormone levels was documented in women with AOR, polycystic ovarian syndrome and DOR patterns (r=-0.099 p=0.393, r=0.034 p=0.794 and r=0.157 p=0.390 respectively). 25 (OH) D levels were significantly correlated with body mass index, waist circumference and hip circumference parameters only in AOR group (r=-0.355 p=0.002, r=-0.305 p=0.007 and r=-0.322 p=0.004 respectively). Conclusions: There is no association between 25 (OH) D and ovarian reserve markers. 25 (OH) D levels were significantly correlated with body mass index, waist circumference and hip circumference parameters only in AOR group

Low level of Nesfatin-1 is associated with gestational diabetes mellitus

Introduction: Gestational diabetes mellitus (GDM) occurs in similar to 10-25% of pregnancies. Nesfatin-1, plays a role in carbohydrate metabolism by inhibiting glucagon secretion, besides has a glucose-dependent insulinotropic effect. Explanation of the GDM pathogenesis is important due to preventing gestational complications. We aimed to investigate relationship between GDM and Nesfatin-1. Material and methods: Seventy-nine pregnant subjects were randomly allocated to either GDM group (GDG, n = 38) or control group (CG, n = 41). For GDM diagnosis, 50 and 100 g oral glucose tolerance test (OGTT) were used. Nesfatin-1, insulin and other parameters were measured for all subjects. The homeostasis model assessment-insulin resistance (HOMA-IR) was calculated. Results: Nesfatin-1 was found lower and insulin was found higher in GDG than CG. Negative correlation has been founded between Nesfatin-1 with weight, BMI, fasting glucose, serum glucose level at first hour of the 50 g OGTT and HOMA-IR. Conclusion: In this study, patients with GDM had lower Nesfatin-1 levels than without GDM. Therefore, when the Nesfatin-1 effects on the GDM pathogenesis is clear, it may be contributed to diagnosis and treatment of the GDM.This work was supported by Hitit University [grant number: TIP 19003.14.001]

The frequency of malignancy and the relationship between malignancy and ultrasonographic features of thyroid nodules with indeterminate cytology (vol 45, pg 37, 2014)

WOS: 000331638200027Various approaches are available for the management of nodules that are evaluated to be indeterminate according to the results of thyroid fine needle aspiration biopsy. The present study aimed to determine the rate of malignancy and the ultrasonographic features that could be used as predictor of malignant pathologies at the nodules with indeterminate cytology. A total of 201 patients who underwent total thyroidectomy and whose fine needle aspiration biopsy results were evaluated to be Hurthle cell lesion (n = 99), follicular neoplasm (n = 61) or suspicious for malignancy (n = 41) were enrolled in this study. Of these patients, 178 were females (88.6 %) and 23 were males (11.4 %). The rates of malignancy were found to be 33.3 % in the Hurthle cell lesion group, 23.0 % in the follicular neoplasm group and 53.7 % in the suspicious for malignancy group (p = 0.006). The comparison of the ultrasonographic characteristics of the malignant and benign nodules revealed hypoechogenicity and microcalcification to be more common in malignant nodules (34.3 vs. 16.9 %, p = 0.005; 27.1 vs. 13.1 %, p = 0.014; respectively). While 92.3 % of the malignant nodules were =1 cm, 82.9 % of the benign nodules were =1 cm (p = 0.042). In the current study, malignancy was observed in 33.3 % of the Hurthle cell lesion group, 23 % of the follicular neoplasm group and 53.7 % of the suspicious for malignancy group. In addition, we detected that microcalcification and benign hypoechoic at patients with indeterminate cytology can be related with increased risk of malignancy. We believe that as the patients at Hurthle cell lesion group have higher risk of malignancy than the patients with Follicular Neoplasia, total thyroidectomy will be suitable for these patients

The influence of physical training modalities on basal metabolic rate and leptin on obese adolescent boys

Ozbar, Nurper/0000-0003-0931-5263; Gedikbasi, Asuman/0000-0001-7121-6077; OZBAR, NURPER/0000-0003-0931-5263WOS: 000432457500020PubMed: 30325913The aim of this study was to investigate the effects of physical training modalities on basal metabolic rate, cardiovascular fitness and serum leptin level in obese adolescent boys. Sixteen obese adolescent boys (age: 16.81 +/- 0.91 years) were randomly assigned to either resistance (RTG) (n=8) or endurance (ETG) (n=8) training and followed the respective training programmes for six months (3 days/wk, 60 min/day). Leptin, basal metabolism rate (BMR), and maximum oxygen consumption (VO2max) were evaluated at the beginning and end of the intervention. After the training period, Leptin was decreased and VO2max was increased in both groups (p<0.05), whereas BMR was statistically increased only in ETG (p<0.05). These results indicated that both types of exercises had positive effects on cardiovascular fitness and hormonal control of fat metabolism in obese male adolescents. Resistance exercises should be considered as an alternative or supplementation to endurance exercises in youth obesity management.Marmara University Scientific Research Projects CommitteeMarmara University [SAG-C-DRP-04609-0145]This study was financially supported by the Marmara University Scientific Research Projects Committee (project no: SAG-C-DRP-04609-0145)

The influence of physical training modalities on basal metabolic rate and leptin on obese adolescent boys

The aim of this study was to investigate the effects of physical training modalities on basal metabolic rate, cardiovascular fitness and serum leptin level in obese adolescent boys. Sixteen obese adolescent boys (age: 16.81 +/- 0.91 years) were randomly assigned to either resistance (RTG) (n=8) or endurance (ETG) (n=8) training and followed the respective training programmes for six months (3 days/wk, 60 min/day). Leptin, basal metabolism rate (BMR), and maximum oxygen consumption (VO2max) were evaluated at the beginning and end of the intervention. After the training period, Leptin was decreased and VO2max was increased in both groups (p<0.05), whereas BMR was statistically increased only in ETG (p<0.05). These results indicated that both types of exercises had positive effects on cardiovascular fitness and hormonal control of fat metabolism in obese male adolescents. Resistance exercises should be considered as an alternative or supplementation to endurance exercises in youth obesity management

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

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