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Purpose Recent studies indicate that dysbiosis of gut microbiota and low-grade infammation are important pathogenic determinants of type two diabetes mellitus (T2DM). The aim of this study is to investigate the efects of Lactobacillus GG on glycemic control, lipid profle, infammatory parameters, and some gene expression levels in individuals with T2DM. Methods In a randomized, placebo-controlled trial, 34 women, aged 30–60 years with T2DM consumed daily probiotics or placebo for 8 weeks. The probiotic group consumed 10× 109 Cfu/day Lactobacillus rhamnosus GG ATCC 53,103 (LGG), approved by the TR Ministry of Food, Agriculture, and Livestock. Anthropometric measurements, food diary, fasting blood, and fecal samples were taken at baseline and post-treatment. Results Fasting blood glucose was signifcantly decreased in probiotic (p=0.049) and placebo (p=0.028), but there was no diference between the groups. In the probiotic group, no signifcant diference was observed in HbA1c, fructosamine, lipid profle, and infammatory variables compared to baseline. In this group, with LGG supplementation, mucin 2 and 3A (MUC2 and MUC3A) gene expressions increased more than ninefolds (p=0.046 and p=0.008, respectively) at posttreatment. Meanwhile, there was no signifcant change in any of the gene expressions in the placebo group. There was no signifcant diference in energy, protein, dietary fber, and cholesterol intakes between placebo and probiotic groups during the study. However, daily fat intake (p=0.003), body weight (p=0.014), and body fat (p=0.015) in the probiotic group were signifcantly decreased. Conclusion In this study, the efects of a single probiotic strain were investigated for 8 weeks. At the end of the study, although there was no fnding that clearly refected on the glycemic parameters of T2DM, its benefcial efects on the expression of mucin genes, which are responsible for weight loss and protection of intestinal barrier functions, cannot be denied. Further studies are needed to reveal the importance of these fndings. Clinical trial registration ID: NCT05066152, October 4, 2021 retrospectively registered in ClinicalTrials.gov PRS web site.

Background It is well documented that patients with chronic metabolic diseases, such as diabetes and obesity, are adversely affected by the COVID-19 pandemic. However, when the subject is rare metabolic diseases, there are not enough data in the literature. Aim To investigate the course of COVID-19 among patients with Gaucher disease (GD), the most common lysosomal storage disease. Methods Based on the National Health System data, a retrospective cohort of patients with confirmed (polymerase chain reactionpositive) COVID-19 infection (n = 149 618) was investigated. The adverse outcomes between patients with GD (n = 39) and those without GD (n = 149 579) were compared with crude and propensity score-matched (PSM) groups. The outcomes were hospitalisation, the composite of intensive care unit (ICU) admission and/or mechanical ventilation and mortality. Results The patients with GD were significantly older and had a higher frequency of hypertension (HT), Type 2 diabetes mellitus (T2DM), dyslipidaemia, asthma or chronic obstructive pulmonary disease, chronic kidney disease, coronary artery disease, heart failure and cancer. Although hospitalisation rates in Gaucher patients were found to be higher in crude analyses, the PSM models (model 1, age and gender matched; model 2, matched for age, gender, HT, T2DM and cancer) revealed no difference for the outcomes between patients with GD and the general population. According to multivariate regression analyses, having a diagnosis of GD was not a significant predictor for hospitalisation (P = 0.241), ICU admission/mechanical ventilation (P = 0.403) or mortality (P = 0.231). Conclusion According to our national data, SARS-CoV-2 infection in patients with GD does not have a more severe course than the normal population.

Evde sağlık hizmetleri, yatağa bağımlı hastalar, çeşitli kronik hastalıklar ya da ameliyat sonrası ihtiyaçları nedeniyle sağlık kuruluşuna ulaşımda zorluklar yaşayan hastalara ev ortamında muayene, tetkik, tedavi ve rehabilitasyon hizmetlerinin profesyonel bir sağlık ekibi tarafından verilmesidir. Bilimsel ve teknolojik atılımlar, sosyal hakların gelişmesi ve yaygınlaşması, uzun süreli kurumsal bakım hizmetlerindeki yetersizlikler ve sağlık hizmetleri harcamalarında artan maliyetler evde sağlık hizmetlerini gündeme taşıyan faktörler arasında yer almaktadır. Son yıllarda teknolojide gelişmeler, tanı ve tedavi hizmetlerinin sunum şekline ve kalitesine etkileriyle evde sağlık hizmetlerinde önemli gelişmelere sebep olmuştur. Medikal cihazlar arasındaki iletişim, yapay zekâ uygulamaları, karar destek sistemleri, tele-sağlık, giyilebilir teknolojiler, güvenli ev teknolojileri, bakım robotları, büyük veri, nesnelerin interneti, sanal gerçeklik evde sağlık hizmetlerinin inovatif yaklaşımları arasında yer almaktadır. Bu yenilikçi yaklaşımlar sayesinde, kaynakların çok kısıtlı olduğu evde sağlık hizmetlerinde; ileri teknolojiler kullanılarak erişilebilir çözümlerin üretilmesi, hasta ve çalışan memnuniyetinin artırılması, bakım kalitesinin iyileştirilmesi ve maliyetlerin düşürülmesi sağlanabilir. Bu derlemede evde sağlık hizmetlerinde teknoloji kullanımının önemini vurgulamayı ve bu hizmetlerde kullanılan teknolojilerden bazı örnekler vermeyi amaçladık.

Diabetes is a common disorder with a heterogeneous clinical presentation and an enormous burden on health care worldwide. About 1-6% of patients with diabetes suffer from maturity-onset diabetes of the young (MODY), the most common form of monogenic diabetes with autosomal dominant inheritance. MODY is genetically and clinically heterogeneous and caused by genetic variations in pancreatic β-cell development and insulin secretion. We report here new findings from targeted next-generation sequencing (NGS) of 13 MODY-related genes. A sample of 22 unrelated pediatric patients with MODY and 13 unrelated healthy controls were recruited from a Turkish population. Targeted NGS was performed with Miseq 4000 (Illumina) to identify genetic variations in 13 MODY-related genes: HNF4A, GCK, HNF1A, PDX1, HNF1B, NEUROD1, KLF11, CEL, PAX4, INS, BLK, ABCC8, and KCNJ11. The NGS data were analyzed adhering to the Genome Analysis ToolKit (GATK) best practices pipeline, and variant filtering and annotation were performed. In the patient sample, we identified 43 MODY-specific genetic variations that were not present in the control group, including 11 missense mutations and 4 synonymous mutations. Importantly, and to the best of our knowledge, the missense mutations NEUROD1 p.D202E, KFL11 p.R461Q, BLK p.G248R, and KCNJ11 p.S385F were first associated with MODY in the present study. These findings contribute to the worldwide knowledge base on MODY and molecular correlates of clinical heterogeneity in monogenic childhood diabetes. Further comparative population genetics and functional genomics studies are called for, with an eye to discovery of novel diagnostics and personalized medicine in MODY. Because MODY is often misdiagnosed as type 1 or type 2 diabetes mellitus, advances in MODY diagnostics with NGS stand to benefit diabetes overall clinical care as well.

Purpose New coronavirus disease 2019 (COVID-19) has a worse prognosis in patients with diabetes. However, there are insufficient data about the effect of hyperglycemia on COVID-19 prognosis in non-diabetic patients. This study aimed to investigate the relationship between random blood glucose levels measured at the time of diagnosis and prognosis of COVID-19 disease in non-diabetic patients. Methods A nationwide retrospective cohort of non-diabetic patients with confirmed COVID-19 infection from 11 March to 30 May 2020 in the Turkish Ministry of Health database was investigated. The patients were stratified into three groups according to blood glucose levels which were Results A total of 12,817 non-diabetic patients (median age [IQR]: 44 [25] years, females: 50.9%) were included. Patients in group-2 (5%) and group-3 (14%) had higher mortality rates than patients in group-1 (2.1%). The rates of hospitalization, hospital stays longer than 8 days, intensive care unit (ICU) admission, ICU stay more than 6 days, and mechanical ventilation were also significantly higher in group-3 patients. Likewise, glucose levels in the range of 140-199 mg/dL were an independent associate of mortality and composite of ICU admission and/or mechanical ventilation. ConclusionHyperglycemia at the time of COVID-19 diagnosis is associated with poor prognosis in non-diabetic patients. Clinicians should be more careful in the treatment of non-diabetic COVID-19 patients with hyperglycemia.

Background/aim: high-sensitivity C-reactive protein (hs-CRP) is used in the differential diagnosis of maturity-onset diabetes of the young (MODY)-3, but other inflammatory markers have not been investigated in MODY patients. We aimed to compare the serum levels of anti-inflammatory and proinflammatory cytokines between MODY patients and healthy subjects and show the inflammatory features in MODY subtypes. Patients and methods: thirty patients with clinically suspected MODY and 34 healthy controls were included in this study. Next -generation sequencing (NGS) was used for the molecular diagnosis of MODY subtypes. Serum levels of cytokines were measured using a multiplexed cytokine assay and hs-CRP concentration was determined by the immunoturbidimetric assay. Results: the hs-CRP levels were higher in both NGS-confirmed (MODY, n=17) (p=0.009) and NGS-unconfirmed (non-MODY, n=13) patients (p, This study was supported by the Scientific Research Fund of Istanbul University within the scope of the project entitled “Investigation of Inflammatory Cytokine Profile in Maturity-Onset Diabetes of the Young (MODY)” (Project no. TSA-2017-25335). The Authors thank their patients and healthy control subjects who participated in the study

Maturity-onset diabetes of the young (MODY) is a highly heterogeneous group of monogenic and nonautoimmune diseases. Misdiagnosis of MODY is a widespread problem and about 5% of patients with type 2 diabetes mellitus and nearly 10% with type 1 diabetes mellitus may actually have MODY. Using next-generation DNA sequencing (NGS) to facilitate accurate diagnosis of MODY, this study investigated mutations in 13 MODY genes (

Aims Diabetes is a chronic disease that limits the quality and duration of life. We aimed to estimate the trends in prediabetes and diabetes between 2010-2020, and the projections to 2023 and 2045 in Turkey. Materials and methods Prediabetes and diabetes estimates were calculated by direct standardization using age/sex-specific data from the previous TURDEP-II survey as reference. The 2010-2020 population demographics were obtained from TurkStat. Comparative age-adjusted diabetes rates were estimated using standard population models of world and Europe. ResultsEstimates depicted that the population (20-84 years) of any degree of glucose intolerance in Turkey increased by approximately 5.3 million (diabetes: 2.2 million and prediabetes: 3.1 million) from 2010 to 2020. While the increase in prediabetes and diabetes rates was 22% and 31.6% in overall population, corresponding increase were 45.2% and 45.6% in the elderly. Notably, diabetes awareness was comparable (54% and 58%). Age-specific prediabetes and diabetes rates were significantly higher in women than in men (diabetes: 14.1% versus 17%; prediabetes: 38.6% versus 30.2%). The comparative age-adjusted prevalence of diabetes to the standard European but not the world population model, showed a higher rate of 19.4%. According to the projections the prevalence of diabetes will reach 15.9% in 2023 and 19.1% in 2045. Conclusion Diabetes has reached epidemic proportions in Turkey and will continue to grow in the coming decades. The fact suggests that there is an urgent need to developing and implementing the country-specific prevention program to halt this increase. Otherwise, the burden of diabetes on social, economic and health services will continue to increase.

Key summary points Aim To meet the current need in different European countries for improving prescribing in older adults, we aimed to create an update screening tool getting origin from the two user friendly criterion sets: the STOPP/STARTv2 criteria and CRIME criteria. Findings Based on thorough literature review, 55 criteria were added, 17 criteria were removed, and 60 criteria were modified. As a result, 153 TIME criteria composed of 112 TIME-to-STOP and 41 TIME-to-START criteria were introduced. Message TIME criterion set is an update screening tool reported from Eastern Europe that included experts from geriatrics and other specialties frequently giving care to older adults and some additional practical explanations for clinical use. Electronic supplementary material The online version of this article (10.1007/s41999-020-00297-z) contains supplementary material, which is available to authorized users., Purpose To improve prescribing in older adults, criterion sets have been introduced from different countries. While current criterion sets are useful to some extent, they do not meet the need in some European countries. Turkish inappropriate medication use in the elderly (TIME) criteria was planned to meet this need. Methods In phase 1, the user friendly sets: STOPP/START version2 and CRIME criteria were combined. National experts composed of geriatricians and non-geriatricians were invited to review and comment. In phase 2, thorough literature review was performed and reference-based revisions, omissions, and additions were made. Explanatory additions were added to some criteria to improve application in practice. In phase 3, all working group members reviewed the criteria/explanations and agreed on the final content. Results Phase 1 was performed by 49 expert academicians between May and October 2016. Phase 2 was performed by 23 working group academicians between October 2016 and November 2018 and included face-to-face interviews between at least two geriatrician members and one criterion-related specialist. Phase 3 was completed between November 2018–March 2019 with review and approval of all criteria by working group academicians. As a result, 55 criteria were added, 17 criteria were removed, and 60 criteria were modified from the first draft. A total of 153 TIME criteria composed of 112 TIME-to-STOP and 41 TIME-to-START criteria were introduced. Conclusion TIME criteria is an update screening tool that differs from the current useful tools by the interactive study of experts from geriatrics and non-geriatrics, inclusion of practical explanations for some criteria and by its eastern European origin. TIME study respectfully acknowledges its roots from STOPP/START and CRIME criteria. Studies are needed whether it would lead improvements in older adults’ health. Electronic supplementary material The online version of this article (10.1007/s41999-020-00297-z) contains supplementary material, which is available to authorized users.

Amaç: Kemoterapiye yeni başlayacak veya başlamış olan, geriatrik olan ve olmayan hastalarda sarkopeninin ve beslenme durumunun değerlendirilmesidir. Gereç ve Yöntem: Bu çalışmada, ilk kez kemoterapi alacak yetişkin kanser hastalar, kemoterapi tedavisinin 3.ayı ile 1.yılı arasında olan hastalarla sarkopeni yönünden ve beslenme durumları açısından değerlendirilmiştir. Hastaların geriatrik olup olmamasına göre karşılaştırılmış ve ayrıca sarkopenik olan hastalar kanser türlerine göre sınıflandırılarak da değerlendirilmiştir. Hastaların el kavrama kuvvetleri, biyoelektrik impedans ile apendiküler iskelet kas indeksi (boya göre düzeltilmiş), yürüme hızları ölçülmüş ve sarkopenik düzeyleri, malnütrisyon riskleri, üç günlük besin tüketim kayıtları ve laboratuvar parametreleri incelenmiştir. Bulgular: Toplamda 123 yetişkin hasta değerlendirilmiştir. Çalışmadaki hastaların 58’i (%47,2’si) geriatriktir (65 yaş ≥) ve %39’unun malnütrisyon riski yüksektir. Geriatrik olan grupta (%46,6) olmayanlara göre (%32,3) anlamlı derecede malnütrisyon riski yüksek bulunmuştur (p=0,029). Malnütrisyon riski kanserin tanı gruplarıyla da ilişkili bulunmuştur. Meme kanserine göre, malnütrisyon riskinin hepatobiliyer kanserlerde (pankreas dahil) 18,2 kat (p=0,002) ve diğer kanserlerde (baş-boyun, sarkom, beyin, mide, periton) 7,6 kat (p=0,018) daha yüksek olduğu görülmüştür. Sonuç: Özellikle geriatrik hastalarda, kanserin neden olduğu malnütrisyonun, tedavinin başlangıcında farkedilmesi ve değerledirilmesi önemlidir., Objective: The aim of this study is to evaluate patients who are just starting or have started chemotherapy and also who are geriatric and nongeriatric, of sarcopenia and nutritional status. Materials and Methods: In this study, adult cancer patients who will receive chemotherapy for the first time were evaluated in terms of sarcopenia and nutritional status with patients between the 3rd month and 1st year of chemotherapy treatment. Patients were compared according to whether they were geriatric or not, and sarcopenic patients were also evaluated by classifying them according to cancer sides. The patients’ hand grip strength, bioelectrical impedance, appendicular skeletal muscle index (corrected for height), walking speed were measured and evaluated for sarcopenia. In addition, malnutrition risks, three-day food consumption records and laboratory parameters were examined. Results: A total of 123 adult patients were evaluated and 58 (47.2%) of the patients in the study were geriatric (65 years ≥). The risk of malnutrition was high in 39% of the patients and was found to be significantly higher in the geriatric group (46.6%) than in the non-geriatric group (32.3%) (p=0.029). The risk of malnutrition was found to be associated with the diagnosis groups of cancer. Compared to breast cancer, the risk of malnutrition was 18.2 times (p=0.002) higher in hepatobiliary cancers (including pancreas) and 7.6 times (p=0.018) in other cancers (head and neck, sarcoma, brain, stomach, peritoneum). Conclusion: Especially in geriatric patients, it is important to recognize and evaluate malnutrition caused by cancer at the beginning of treatment.

Background There are scarce published data in differentiated thyroid cancer patients about new coronavirus disease 2019 (COVID‐19) disease outcomes and mortality. Here, we evaluated COVID‐19 infection outcomes and mortality in thyroid cancer patients with COVID‐19 infection. Design and methods We included a cohort of patients with thyroid cancer with PCR‐confirmed COVID‐19 disease from 11 March to 30 May 2020 from the Turkish Ministry of Health database in our nationwide, retrospective study. We compared the mortality and morbidity of COVID patients with or without thyroid cancer. Univariate and multivariate analyses were used to assess the independent factors for mortality, length of hospital stay and intensive care unit (ICU) admission and mechanical ventilation. We also analysed the effect of radioiodine treatment on severity and death rate of COVID‐19 disease. Results We evaluated 388 COVID‐19 patients with thyroid cancer [median age: 54 years, interquartile range (IQR) 18 years, males: 23%] and age and gender‐matched 388 COVID‐19 patients without thyroid cancer. Patients with thyroid cancer had a similar mortality ratio compared with the non‐cancer group. Among patients with thyroid cancer, age, presence of diabetes mellitus, asthma/COPD, heart failure, chronic kidney disease, prior coronary artery disease, RAS blocker usage and low lymphocyte count were associated with mortality. Radioactive iodine (RAI) treatment and cumulative radioactive iodine dosage did not negatively affect the severity and mortality of COVID‐19 disease in our patient group. Conclusions Our study indicated that history of thyroid cancer did not have an increased risk of mortality or morbidity in COVID‐19 disease. Besides, RAI therapy history and doses of radioactive iodine did not affect mortality or outcome.

PurposeCOVID-19 disease has a worse prognosis in patients with diabetes, but the comparative data about the course of COVID-19 in patients with type 1 (T1DM) and type 2 diabetes (T2DM) are lacking. The purpose of this study was to find out the relative clinical severity and mortality of COVID-19 patients with T1DM and T2DM.MethodsA nationwide retrospective cohort of patients with confirmed (PCR positive) COVID-19 infection (n=149,671) was investigated. After exclusion of individuals with unspecified diabetes status, the adverse outcomes between patients with T1DM (n=163), T2DM (n=33,478) and the non-diabetics (n=115,108) were compared by using the propensity score matching method. The outcomes were hospitalization, the composite of intensive care unit (ICU) admission and/or mechanical ventilation and mortality.ResultsThe patients with T1DM had higher mortality than the age and gender matched patients with T2DM (n=489) and the non-diabetics (n=489) (pConclusionAccording to the results, patients with T1DM had poorer COVID-19 prognosis than those with T2DM or the non-diabetics. These patients should be cared diligently until more data will be available about the causes of increased COVID-19 mortality in T1DM.

Amaç: Sağlık Meslek Yüksekokulu öğrencilerinin tütün ve tütün ürünleri kullanma davranışlarını incelemek ve bu davranış üzerinde belirleyicifaktörleri ortaya koymaktır.Yöntem: Bu araştırma, Medipol Üniversitesi Sağlık Hizmetleri Meslek Yüksekokulu’nda gerçekleştirilmiştir. Toplam 26 soruluk olarakhazırlanan, yapılandırılmış bir anket, 307 öğrenciye yüz yüze uygulanmıştır. Veriler, SPSS 23 programı kullanılarak Pearson ki-karekorelasyon testi ve binary lojistik regresyon modeli ile analiz edilmiştir. Çalışma öncesi İstanbul Medipol Üniversitesi Girişimsel OlmayanAraştırmalar Etik Kurulu’ndan onay alınmıştır.Bulgular: Anket verileri öğrencilerin %32.6’sının tütün ürünleri (sıklıkla sigara) kullandığını, erkek öğrencilerin sigara kullanma alışkanlığısıklığının daha yüksek olduğunu, daha erken yaşlarda sigara kullanmaya başladıklarını ve günlük tüketim miktarının (adedinin) daha fazlaolduğunu göstermiştir. Sigara kullanma davranışının gelişmesinde “sigara sağlığa zararlıdır” düşüncesine sahip olmanın azaltıcı, bunakarşılık sık görüşülen arkadaşların sigara kullanmasının artırıcı etkisi olduğu görülmüştür. Üniversite eğitiminin ilk ve son yıllarıkarşılaştırıldığında, sigara kullanan öğrenci sayısının zamanla arttığı saptanmıştır.Sonuç: Önceki yıllara göre, toplumumuzda Sağlık Meslek Yüksekokulu öğrencileri arasında sigara ve nargile kullanımı artmaktadır. Bu artıştacinsiyet, arkadaş etkisi, merak, özenti, stres ve kültürel özellikler ön plana çıkmaktadır. Bu nedenle tütün ürünleri ile mücadele politikalarındabu hususların dikkate alınması önem arz etmektedir. Aim: To examine tobacco and tobacco use behaviors of the students of Health Vocational School and to reveal the determining factors on this behavior. Methods: This research was carried out in Medipol University Health Services Vocational School. A structured questionnaire with a total of 26 questions was applied to 307 students face to face. The data were analyzed using the SPSS 23 program by Pearson chi-square test and binary logistic regression model. Before the study, approval was obtained from the Medipol University Non-Invasive Research Ethics Committee. Results: The survey data showed that 32.6% of the students used tobacco products (mainly cigarettes), the frequency of smoking habit of male students was higher, they started smoking at an earlier age and the amount of daily consumption was higher. In the development of smoking behavior, it has been observed that having the belief of “smoking is harmful for health” has a decreasing effect, whereas smoking of frequently seen friends has an increasing effect. When the first and last years of university education are compared, it is found that the number of students who smoke increases over time. Conclusion: Compared to previous studies, smoking and waterpipe use are increased among Health Vocational School students in our society. In this increase, gender, peer influence, curiosity, interest, stress, and cultural characteristics come to the front. For this reason, it is important to consider these issues in policies to combat tobacco products.

Background Coronavirus disease 2019 (COVID‐19) has been reported to be associated with a more severe course in patients with type 2 diabetes mellitus (T2DM). However, severe adverse outcomes are not recorded in all patients. In this study, we assessed disease outcomes in patients with and without T2DM hospitalized for COVID‐19. Methods A nationwide retrospective cohort of patients with T2DM hospitalized with confirmed COVID‐19 infection from 11 March to 30 May 2020 in the Turkish Ministry of Health database was investigated. Multivariate modeling was used to assess the independent predictors of demographic and clinical characteristics with mortality, length of hospital stay, and intensive care unit (ICU) admission and/or mechanical ventilation. Results A total of 18 426 inpatients (median age [interquartile range, IQR]: 61 [17] years; males: 43.3%) were investigated. Patients with T2DM (n = 9213) were compared with a group without diabetes (n = 9213) that were matched using the propensity scores for age and gender. Compared with the group without T2DM, 30‐day mortality following hospitalization was higher in patients with T2DM (13.6% vs 8.7%; hazard ratio 1.75; 95% CI, 1.58‐1.93; P, Highlights Coronavirus disease 2019 (COVID‐19) takes an unfavorable course in patients with type 2 diabetes mellitus (T2DM), and the risk increases in individuals with certain conditions, some of which are not modifiable.This study showed significantly higher mortality due to COVID‐19 in hospitalized patients with T2DM than without (13.6% vs 8.7%; hazard ratio 1.75; 95% CI, 1.58‐1.93).Older age, male gender, obesity, preexisting insulin treatment, low lymphocyte count, and pulmonary involvement on admission were the significant associates of COVID‐19 mortality.

Gençlerin Erişkin Başlangıçlı Diyabeti (MODY) otozomal dominant kalıtım ile karakterize monogenik bir hastalıktır. Şimdiye kadar 14 farklı gende çok sayıda heterozigot mutasyonlar tanımlanmış olup bu mutasyonların dağılımı her ülkede farklıdır. Çalışmamızda yaygın MODY alt tipleri, MODY1-3, için literatür araştırması yaparak HNF4A, GCK ve HNF1A genlerindeki yanlış anlamlı mutasyonları özetledik. Ancak Asya populasyonlarında bilinen MODY genleri bu diyabetik bireylere tanı koymak için yeterli olmayıp çoğu MODYX olarak tanımlanmaktadır. Dahası, Avrupa ülkeleri ile kıyaslandığında Çin, Japonya, Kore ve Hindistan populasyonlarında MODY prevalansında çelişkiler mevcut olup hastalığın genetik alt yapısının daha iyi anlaşılması için daha fazla genetik çalışmaya ihtiyaç duyulmaktadır.

Amaç: Çalışmamızın amacı tip 2 diyabet tanısı almış yaşlı erişkinlerde kırılganlıkla ilgili faktörleri belirlemektir. Gereç ve Yöntem: Çalışmaya 65 yaş ve üstü, tip 2 diyabet tanısı almış 108 kişi dahil edildi. Katılımcıların kırılganlığı FRAIL anketi ile değerlendirilmiş, beslenme durumu Mini Beslenme Değerlendirme Kısa Formu (MNA-SF) ile, depresyon durumu Hasta Sağlığı Anketi-2 (PHQ2) ve Geriatrik Depresyon Ölçeği Kısa Formu (GDS-SF) ile değerlendirilirken, yaşam kalitesi EuroQol-5 Boyut (EQ5D) ve EQ VAS puanlaması ile, kişisel bakım durumları ise Günlük Yaşamın Temel Aktiviteleri (BADL) ve Günlük Yaşamın Enstrümantal Aktiviteleri (IADL) formları ile değerlendirilmiştir. Bulgular: Kırılgan grupta, kırılgan olmayanlara göre uyku sorunları, düşme korkusu, idrar kaçırma, PHQ2, GDS-SF ve EQ5D skorları anlamlı olarak yüksek; MNASF skoru ise anlamlı olarak düşüktü (p, Objective: Our study aimed to determine the factors related to frailty in elderly adults having been diagnosed with type 2 diabetes mellitus. Material and Method: A total of 108 people aged 65 and over, diagnosed with type 2 diabetes, were included in the study. The frailty of the participants was evaluated with the FRAIL questionnaire, their nutritional status was evaluated with the Mini Nutrition Assessment Short Form (MNA-SF), the depression status with the Patient Health Questionnaire-2 (PHQ2) and the Geriatric Depression Scale Short Form (GDS-SF), while the quality of life was evaluated with the EuroQol-5 Dimension (EQ5D) and Scoring the EQ-VAS, and personal care status were evaluated with Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) forms. Results: Sleep problems, fear of falling, presence of urinary incontinence, PHQ2, GDS-SF, and EQ5D scores were significantly higher; the MNASF score was significantly lower in the frail group than the values in the non-frail group (p

Objective: The aim of this study is to investigate the relationships between the nutritional characteristics of pregnant women and the risk of gestational diabetes mellitus (GDM) and Gestational Glucose Intolerance (GGIT). Materials and Method: Women were investigated for GDM during the 24th to 28th weeks of pregnancy. According to the two-step diagnostic approach, women with normal glucose tolerance (normal), those with only 1 high glucose (GGIT) and those with at least 2 high values (GDM) in OGTT were included in the study. There was 60 pregnant women in each group (mean age 31.6±5.4; range 19-46 years). Demographic and clinical characteristics of the participants were questioned and a 3-day food consumptions record were evaluated with BEBIS program. Results: The mean weight, BMI and daily fiber intake in GDM group were significantly higher than the normal group. In the GDM and GGIT groups, the mean age, weight, daily carbohydrate (CHO) and protein intakes, and family history of diabetes were higher than those with normal group. Moreover, in the GDM group, daily fat intake was also significantly higher than the normal and GGIT groups. According to the separate models of logistic regression analysis; the age; daily protein, CHO and fat consumptions; having the first pregnancy and higher pre-pregnancy BMI (>25 kg/m2) were associated with increased likelihood of GDM. Similarly, the age, daily protein consumption, history of giving birth to a macrosomic baby and current smoking were positively linked with the risk of GGIT. Conclusion: Women’s nutritional habits (excessive CHO, fat and especially protein consumptions), phenotypic characteristics, family history of diabetes and poor obstetric history are similarly related to the risk of developing GDM and GGIT. Our results showed that in all women, particularly in those at high-risk for GDM who are planning pregnancy, a special attention should be given to general health and balanced diet, starting from pre-pregnancy. Disclosure M. Yabaci: None. I. Satman: None. C. Idiz: None. F. Turker: None. A. Yuksel: None. B. Omer: None. B. Demirel: None. E. Ozer: None. Funding Istanbul University

Background: The nuclear receptors Rev-erb alpha and Rev-erb beta are transcription factors that regulate the function of genes in glucose and lipid metabolism, and they also form a link between circadian rhythm and metabolism. We evaluated the variations in Rev-erb alpha and Rev-erb beta genes together with biochemical parameters as risk factors in type 2 diabetic (T2DM) patients. Methods: Molecular analyses of Rev-erb alpha and Rev-erb beta genes were performed on genomic DNA by using next-generation sequencing in 42 T2DM patients (21 obese and 21 non-obese) and 66 healthy controls. Results: We found 26 rare mutations in the study groups, including 13 missense mutations, 9 silent mutations, 3 5'UTR variations, and a 3'UTR variation, of which 9 were novel variations (5 missense and 3 silent and 1 5'UTR). Six common variations were also found in the Rev-erb genes; Rev-erb beta Chr3:24003765 A > G, Rev-erb beta rs924403442 (Chr3:24006717) G > T, Rev-erb alpha Chr17:38253751 T > C, Rev-erb alpha rs72836608 C > A, Rev-erb alpha rs2314339 C > T and Rev-erb alpha rs2102928 C > T. Of these, Rev-erb beta Chr3:24003765 A > G was a novel missense mutation (p.Q197R), while others were identified as intronic variants. T2DM patients with Rev-erb beta rs924403442 T allele had lower body surface area (BSA) than noncarriers (GG genotype) (p = 0.039). Rev-erb alpha rs72836608 A allele and Rev-erb alpha rs2314339 CC genotype were associated with decreased serum HDL-cholesterol levels in T2DM patients (p = 0.025 and p = 0.027, respectively). In our study, different effects of Rev-erbs polymorphisms were found according to gender and presence of obesity. Rev-erb alpha rs72836608 (C > A) and rs2314339 (C > T) and Rev-erb alpha rs2102928 (C > T) were associated with low HDL-C levels in male T2DM patients. In female patients, Rev-erb alpha rs2102928 (C > T) was associated with high microalbuminuria and Rev-erb beta rs9244403442 G > T was associated with low HDL and high BSA values. In addition, Rev-erb alpha Chr17: 38,253,751 (T > C), rs72836608 (C > A), and rs2314339 (C > T) and Rev-erb beta Chr3:24003765 (A > G) were associated with increased serum GGT levels in obese T2DM patients. In non-obese patients, Rev-erbs SNPs had no effect on serum GGT levels. Conclusion: Our findings indicate that variations in the Rev-erb alpha and Rev-erb beta genes can affect metabolic changes in T2DM and these effects may vary depending on gender and obesity. İstanbul Üniversitesi

Additional file 1.

Aim: This study aimed to determine the relationship between the frequency of measuring blood glucose levels and the complications and regulation of diabetes in patients under follow-up due to diabetes mellitus. Subjects and Method: This study was conducted via retrospective evaluation of patient files of 951 diabetics (90 with type 1 diabetes and 861 with type 2 diabetes). Patient information including age, gender, height, weight, type of diabetes, duration of diabetes, treatment of diabetes, hemoglobin A1c (HbA1c) value, presence of neuropathy, presence of nephropathy, presence of diabetic foot, presence of hypertension, and frequency of measuring blood glucose levels were recorded. Patients were divided into 3 groups by the frequency of measuring blood glucose levels, where those who measured blood glucose levels a total of 8 times for at least two days a week were assigned to group 1, those who measured blood glucose levels less than 8 times for less than two days a week were assigned to group 2, and those who measured blood glucose levels 8 times in the 2 days prior to the control visit, who had previously measured blood glucose levels in an irregular manner were assigned to group 3. Results: Of the patients, 548 were females and 403 were males, with a mean age of 58.12±13.17 years. There was a significant difference in the parameters of HbA1c (p

Purpose: This study aimed (1) to compare physical activity (PA) indicators, metabolic biomarkers, and comorbidity, (2) to investigate the relationship between PA indicators and metabolic biomarkers, comorbidity and (3) to identify barriers to PA in patients with type 2 diabetes (T2DM) who are using oral hypoglycaemic agent (OHA) or combined OHA and insulin (OHAiN). Methods: Sixty-one patients were classified as patients using only OHA or combined OHAiN. Metabolic biomarkers (waist-to-hip ratio, body mass index (BMI), lipid profile, glycosylated haemoglobin (HbA1c), fasting blood glucose, comorbidity and PA indicators (self-reported PA, number of steps (NOS), 6-minute walking distance (6MWD)) were assessed. PA perceptions and reasons for inactivity were questioned. Results: The comorbidity (p = .013), low-density lipoprotein-cholesterol (p = .026), total cholesterol (p = .008) and HbA1c (p = .020) were higher and PA level was lower (p = .007) in the OHAiN group. NOS was positively correlated with high-density lipoprotein-cholesterol (p = .037) and negatively correlated with BMI (p = .007). 6MWD was negatively correlated with BMI (p = .014) and comorbidity (p = .004) in the OHA group. BMI was a significant predictor of NOS (adjusted R2 = 0.242) and comorbidity for 6MWD (adjusted R2 = 0.250) in the OHA group. The majority of the patients (OHA = 34.3%, OHAiN = 42.3%) reported "lack of time" as the most common barrier to PA. Conclusions: This study showed that patients on OHAiN have lower PA levels, poorer metabolic profiles, and higher comorbidity rates than OHA users. PA indicators were related with some metabolic biomarkers and comorbidity in only OHA users. The most common reason for inactivity was "the lack of time" in both groups.

International audience; Branched chain amino acids (BCAA) are essential elements of the human diet, which display increased plasma levels in obesity and regained particular interest as potential biomarkers for development of diabetes. To define determinants of insulin resistance (IR) we investigated 73 genes involved in BCAA metabolism or regulation by fine-scale haplotype mapping in two European populations with metabolic syndrome. French and Romanians (n = 465) were genotyped for SNPs (Affymetrix) and enriched by imputation (BEAGLE 4.1) at 1000 genome project density. Initial association hits detected by sliding window were refined (HAPLOVIEW 3.1 and PHASE 2.1) and correlated to homeostasis model assessment (HOMAIR) index, in vivo insulin sensitivity (SI) and BCAA plasma levels (ANOVA). Four genomic regions were associated with IR located downstream of MUT, AACS, SLC6A15 and PRKCA genes (P between 9.3 and 3.7 x 10-5). Inferred haplotypes up to 13 SNPs length were associated with IR (e.g. MUT gene with P < 4.9 x 10-5; Bonferroni 1.3 x 10-3) and synergistic to HOMAIR. SNPs in the same regions were also associated with one order of magnitude lower P values (e.g. rs20167284 in the MUT gene with P < 1.27 x 10-4) and replicated in Mediterranean samples (n = 832). In French, influential haplotypes (OR > 2.0) were correlated with in vivo insulin sensitivity (1/SI) except for SLC6A15 gene. Association of these genes with BCAA levels was variable, but influential haplotypes confirmed implication of MUT from BCAA metabolism as well as a role of regulatory genes (AACS and PRKCA) and suggested potential changes in transcriptional activity. These data drive attention towards new regulatory regions involved in IR in relation with BCAA and show the ability of haplotypes in phased DNA to detect signals complimentary to SNPs, which may be useful in designing genetic markers for clinical applications in ethnic populations.

Background Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes.Methods We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18-85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR) 25-75 mL/min per 1.73 m(2) of body surface area, and a urine albumin-to-creatinine ratio (UACR) of 300-5000 mg/g who had received maximum labelled or tolerated renin-angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0.75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders) were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0.75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for >= 30 days) or end-stage kidney disease (eGFR = 90 days, chronic dialysis for >= 90 days, kidney transplantation, or death from kidney failure) in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials. gov, number NCT01858532.Findings Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325) or placebo group (n=1323). Median follow-up was 2.2 years (IQR 1.4-2.9). 79 (6.0%) of 1325 patients in the atrasentan group and 105 (7.9%) of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR] 0.65 [95% CI 0.49-0.88]; p=0.0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3.5%) of 1325 patients in the atrasentan group and 34 (2.6%) of 1323 patients in the placebo group (HR 1.33 [95% CI 0.85-2.07]; p=0.208). 58 (4.4%) patients in the atrasentan group and 52 (3.9%) in the placebo group died (HR 1.09 [95% CI 0.75-1.59]; p=0.65).Interpretation Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Copyright (C) 2019 Elsevier Ltd. All rights reserved.

Objective Diabetes mellitus (DM) is a serious public health problem. Despite various epidemiological studies reporting prevalence of DM in Turkey, there is no meta-analysis or systematic review evaluating these studies as a whole and assessing temporal changes in the prevalence of DM. In this meta-analysis, the studies that have been conducted in the last 15 years and which provide information on the prevalence of DM in our country are examined. Methods Epidemiological studies on cardiovascular risk factors in adult Turkish population that had been conducted within the last 15 years and having the capacity of either representating or potentially representing the country, were searched through Ovid, Medline and Web of Science Core Collection the Turkish Academic Network and Information Center (ULAKBIM) databases. Additionally, websites of Ministry of Health and related societies were investigated for additional studies. Random effects model was used in meta-analysis of low bias risk studies. Meta-regression was performed to evaluate the temporal change in DM prevalence. Results There were 8 studies which provided information with regard to DM prevalence (n=84656). Four of these studies (n=56853) had low bias risk and four had high bias risk (n=27803). When compared with low bias risk studies, those with high bias risk had very large variation of DM prevalence (between 4% to 15%). Meta-analysis of the low bias risk group yielded a crude DM prevalence of 13.5% (95% CI: 11.6-15.5%) in the whole group, 14.2% (95% CI: 12.3-16.2%) in females, 12.6% (95% CI: 10.5-14.9%) in males. In meta-regression analysis of low bias risk group, mean age difference among the studies and the time period in which the study was undertaken were partially able to explain the inter-study heterogeneity (R2 values were 52% and 78%). Conclusion This meta-analysis shows that DM is a highly prevalent public health problem in our country. Contrary to studies, which compare the recent studies with previous ones and report an increasing prevalence of DM, the present meta-analysis-despite its limitations-provides findings that the temporal increase of DM prevalence is at least paused over time. This situation underlines the need for new studies.

Aims: Type 2 diabetes mellitus (T2DM) is a risk factor for severe COVID-19. Our aim was to compare the clinical outcomes of patients with and without T2DM during the first hit of COVID-19 in Istanbul.& nbsp; Methods: A retrospective population-based study was conducted including all consecutive adult symptomatic COVID-19 cases. Patients were confirmed with rt-PCR; treated and monitored in accordance with standard protocols. The primary endpoints were hospitalization and 30-day mortality.& nbsp; Results: Of the 93,571 patients, 22.6% had T2DM, with older age and higher BMI. Propensity Score matched evaluation resulted in significantly higher rates of hospitalization (1.5-fold), 30-day mortality (1.6-fold), and pneumonia (1.4-fold). They revealed more severe laboratory deviations, comorbidities, and frequent drug usage than the Non-DM group. In T2DM age, pneumonia, hypertension, obesity, and insulin-based therapies were associated with an increased likelihood of hospitalization; whereas age, male gender, lymphopenia, obesity, and insulin treatment were considerably associated with higher odds of death.& nbsp; Conclusions: COVID-19 patients with T2DM had worse clinical outcomes with higher hospitalization and 30-day mortality rates than those without diabetes. Compared to most territories of the world, COVID-19 mortality was much lower in Istanbul, which may be associated with accessible healthcare provision and the younger structure of the population.& nbsp; (C)& nbsp;2021 Elsevier B.V. All rights reserved.

Study Group for Diabetic Foot Infections of the Turkish Society of Clinical Microbiology and Infectious Diseases has called for collaboration of the relevant specialist societies and the Ministry of Health to issue a national consensus report on the diagnosis, treatment and prevention of diabetic foot (DF) wounds and diabetic foot infections (DFIs) in Turkey. In the periodical meetings of the assigned representatives from all the parties, various questions as to pathogenesis, microbiology, assessment and grading, treatment, prevention and control of diabetic foot were identified. Upon reviewing related literature and international guidelines, these questions were provided with consensus answers. Several of the answers provided in the report are listed below: [1] Although there are many reasons for the development of DF wounds, the main reason is the combined effect of diabetes-related vascular disease and neuropathy. [2] Aerobic Gram- positive cocci are mostly responsible for superficial DFIs in patients with cellulitis and no history of antibiotic use. [3] Pseudomonas aeruginosa is one of the commonly encountered agents when between the toes of the patient are moist. [4] When the other potential reasons are eliminated, DFIs should be considered in presence of at least two of the classical signs of inflammation including redness, warmth, swelling, tenderness, and pain, or purulent discharge in the foot lesion. [5] Infections are classified into mild, moderate, or severe groups according to some criteria such as the depth and width of the wounds, and the presence of systemic findings of infection. [6] PEDIS system should be preferred as a classification system for its high predictive value in diabetes-related foot complications. [7] Culture samples from the DF wound should only be obtained when infection is clinically considered and, where possible, before starting antibiotic treatment. [8] Inflammatory biomarkers such as leukocyte count, C-reactive protein, erythrocyte sedimentation rate, and procalcitonin may be useful in distinguishing between colonization with infection. [9] Magnetic resonance imaging is a sensitive and specific method in patients unresponsive to treatment when osteomyelitis and deep soft tissue abscesses are considered. [10] The gold standard in the diagnosis of osteomyelitis is histopathological examination. [11] To provide wound healing and to save the limb, removal of dead and infected tissue with urgent and aggressive debridement, appropriate antibiotic therapy, metabolic control, and off-loading of pressure, the diagnosis and proper treatment of peripheral arterial disease, and restoration of the foot function are necessary. [12] A lot of different factors playing a role in etiopathogenesis complicate the approach to be developed in this type of lesions, and therefore it requires a team concept. [13] In the empirical treatment, the objective should be treating only the potential agents. Adequate tissue levels, low side effects and patient compliance must be observed; effective drugs should be used in specified doses and duration. [14] Debridement is an essential and integral part of wound treatment and is an important tool allowing the formation of healthy granulation tissue. [15] When the infected tissue cannot be completely cleared with the debridement and in cases when the patient could not cope with the remaining infection load, performing a limb amputation on a safe level of infection would be lifesaving.

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) have been used to diagnose new-onset diabetes mellitus (DM) in order to simplify the diagnostic tests compared with the 2-hour oral glucose tolerance test (OGTT; 2-hPG). We aimed to identify optimal cut-off points of high sensitive C-reactive protein (hs-CRP) in new-onset DM people based on FPG, 2-hPG, or HbA1c methods. Data derived from recent population-based survey in Turkey (TURDEP-II). The study included 26,499 adult people (63% women, response rate 85%). The mean serum concentration of hs-CRP in women was higher than in men (p<0.001). The people with new-onset DM based on HbA1c had higher mean hs-CRP level than FPG based and 2-hPG based DM cases. In HbA1c, 2-hPG, and FPG based new-onset DM people, cut-off levels of hs-CRP in women were 2.9, 2.1, and 2.5 mg/L [27.5, 19.7, and 23.5 nmol/L] and corresponding values in men were 2.0, 1.8, and 1.8 mg/L (19.0, 16.9, and 16.9 nmol/L), respectively (sensitivity 60–65% and specificity 54–64%). Our results revealed that hs-CRP may not further strengthen the diagnosis of new-onset DM. Nevertheless, the highest hs-CRP level observed in new-onset DM people diagnosed with HbA1c criterion supports the general assumption that this method might recognize people in more advanced diabetic stage compared with other diagnostic methods.