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

The effect of telmisartan treatment on insulin resistance, metabolic parameters and serum adiponectin and tumor necrosis factor-A levels in hypertensive patients with metabolic syndrome

Çalışmamızda diyet ve egzersizden oluşan yaşam tarzı değişikliklerine ek olarak 8 haftalık 80 mg/gün dozunda telmisartan (Pritor / GlaxoSmithKline) kullanımının metabolik sendromlu hipertansif hastalarda vücut yağ oranı, arteryal kan basıncı, insülin direnci, glukoz ve lipid metabolizmaları, serum adiponektin ve TNF-a düzeyleri üzerine olan etkileri araştırıldı. Çalışmaya 18'i telmisartan, 18'i kontrol gurubu olmak üzere metabolik sendrom ve hipertansiyon tanısı bulunan toplam 36 hasta alındı. Çalışma sonunda bazal ölçümlere göre her iki gurubun beden kitle indekslerinde, vücut yağ oranlarında ve bel çevrelerinde anlamlı azalma olduğu saptandı. Her iki gurup karşılaştırıldığında telmisartan gurubunda, sistolik ve ortalama kan basıncındaki düşmenin sadece yaşam tarzı değişiklikleri uygulanan kontrol gurubuna göre daha fazla olduğu görüldü (sırasıyla p=0,0001 ve p=0,003). Telmisartan gurubunda kontrol gurubuna göre serum insülin düzeyinde ve HOMA ile belirlenen insülin direncinde anlamlı azalma saptanırken (sırasıyla p=0,040 ve p=0,034) her iki gurubun lipid profilinde istatistiksel anlamlı bir değişiklik gözlenmedi. Serum adiponektin düzeylerinde telmisartan gurubunda % 19,1 ± 41,7 bir artış gözlenmesine rağmen kontrol gurubuna göre istatistiksel anlamlı bir farklılık saptanmadı. Serum TNF-a düzeyleri açısından da her iki gurup arasında anlamlı farklılık yoktu. Sonuç olarak metabolik sendromlu hipertansif hastalarda telmisartan kullanımının yaşam tarzı değişikliğine göre insülin direnci ve glukoz metabolizması üzerine olumlu katkısı olduğu görüldü. Telmisartan kullanımı ile insülin direncinde anlamlı azalma sağlanmış olmasına rağmen adiponektin ve TNF-a düzeylerinde değişiklik gözlenmemiş olması, telmisartan tedavisinin insülin direnci üzerine erken dönemde saptanan etkilerinin PPAR- Y aktivasyonu dışında başka mekanizmalar üzerinden gerçekleştiğini düşündürmektedir. Telmisartan tedavisinin sekiz hafta gibi kısa bir sürede insülin direncinde azalma sağlamış olması metabolik sendromun bir parçası olarak karşımıza çıkan hipertansiyon tedavisinde telmisartan kullanımını iyi bir seçenek haline getirmektedirIn present study, we investigated the effect of 80 mg/day telmisartan usage (Pritor / GlaxoSmithKline) for 8 weeks in addition to life style changes such as diet and exercise on percentages of body fat, arterial blood pressure, insulin resistance, glucose and lipid metabolism, serum adiponectin and TNF-a levels in hypertensive patients with metabolic syndrome. A total of 36 hypertensive patients with metabolic syndrome were enrolled the study and randomized to telmisartan (n=18) and control (n=18) groups. There was significant decrease in body mass indexes, percentages of body fat and waist circumferences according to baseline measurements in both groups at the end of the study. There was a more pronounced decrease in systolic and diastolic blood pressure in telmisartan group compared with control group in which only life style changes were applied (p=0.0001 and p=0.003, respectively). In comparison to control group, serum insulin level and insulin resistance assessed by HOMA-IR were decreased significantly in telmisartan group (p=0,040 and p=0,034, respectively), while there was no statistically significant change in lipid profiles of groups. Serum adiponectin level was increased 19.1 ± 41.7% in telmisartan group but it was not statistically significant compared with control group. There was also no significant change in serum TNF-a level in both groups. In conclusion, it has been observed that telmisartan treatment had favorable effects on insulin resistance and glucose metabolism compared with life style changes. Amelioration of insulin resistance with telmisartan treatment, while there was no change in serum adiponectin and TNF-a levels, indicates that the early effect of telmisartan therapy on insulin resistance is caused by mechanisms other than PPAR-gamma activation. The fundamental effect of short term telmisartan treatment such as 8 weeks on insulin resistance makes telmisartan a good therapeutic option for hypertensive patients with metabolic syndrome

The association between olfaction and taste functions with serum ghrelin and leptin levels in obese women

Purpose: To investigate the olfaction and taste functions in obese female patients and the association between serum ghrelin and leptin levels compared with healthy controls. Methods: Fifty-two obese women, who have a body mass index >30 kg/m(2), and 15 healthy women were included in the study. After 8 hrs fasting, blood samples were taken for serum biochemical parameters, ghrelin, and leptin level measurement. For the quantitative assessment of olfactory function, all participants underwent an N-butanol threshold test and odor identification test using 12 Sniffin' Sticks (R) fragrance sticks. The gustatory function was tested by administering a whole-mouth above threshold test using sucrose solutions. Results: The sucrose taste threshold score in obese women was significantly higher than the controls (P = 0.004). We found positively significant correlation between serum ghrelin levels and n-butanol threshold scores in obese women (r = 0.300, P = 0.031). N-butanol smell threshold was not significantly different between the two groups (P = 0.149), while the Sniffin' Sticks smell test scores were significantly lower in obese women compared with the controls (P = 0.007). Serum leptin levels were also significantly higher in obese women (P < 0.001) although there was no significant difference in serum ghrelin levels between the two groups (P = 0.768). There was no correlation between serum leptin levels and Sniffin' Sticks scores, n-butanol, and sucrose taste threshold scores in obese women. Conclusions: These results might suggest that leptin, which is an anorexigenic peptide, may have a negative effect on taste and smell functions. More studies are warranted to elucidate the exact role of ghrelin secretion on olfaction and taste functions

Clinical impact of Glucagon like peptide-1 receptor analogs on the complications of obesity

Background: Obesity is a chronic disease associated with increased morbidity and mortality due to its complications. The aims of obesity treatment are primarily to accomplish weight loss, and prevention or treatment of its complications. Lifestyle changes along with behavioral therapy constitute the first line treatment of obesity followed by pharmacotherapy. Glucagon-like peptide receptor analogs (GLP-1 RA’s) are among the approved pharmacotherapy options. Their central effect on suppressing appetite results in considerable weight loss. However their effect on the complications of obesity have not been very well recognized. This review aims to analyze the effects of GLP-RA’s on the complications of obesity, as diabetes mellitus, hypertension, nonalcoholic steatohepatitis (NASH), cardiovascular diseases, polycystic ovary syndrome, infertility, obstructive sleep apnea (OSA) and central nervous system problems. Summary: Data from preclinical studies and clinical trials have been thoroughly evaluated. Effects regarding the complications as far as the scope of this review has covered can be summarized as blood glucose lowering, blood pressure lowering, resolution of NASH, improving major cardiovascular events, improving fertility and sex hormone levels, improvement in OSA symptoms and in cognitive scores. Although the mechanisms are not fully elucidated, it is clear that the effects are not solely due to weight loss, but some pleiotropic effects like decreased inflammation, oxidative stress and fibrosis also play role in some of the complications. Key messages: Treating obesity is not only enabling weight loss but ameliorating complications related with obesity. Thus any anti-obesity medication has to have some favorable effects on the complications. As far as the GLP-RA’s analogs are concerned, there seem to be improvement in many of the complications regardless of the weight loss effect of these medications