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Purpose While obesity is related to more severe outcomes of coronavirus disease 2019 (COVID-19), factors leading to poor prognosis still remain unclear. The present study evaluated the outcomes of COVID-19 patients who were overweight or obese and variables associated with severe disease in a large group of consecutive cases. Methods A nationwide retrospective cohort study was performed using the Turkish National Healthcare Database. Demographic characteristics, laboratory tests, comorbidities, and medications of patients registered between March 11 and May 30, 2020, were recorded. Results A total of 14, 625 patients (median age:42, IQR:26 years; female 57.4%) with normal weight (34.7%), overweight (35.6%), and obesity (29.7%) were included. Hospitalization, ICU admission, intubation/mechanical ventilation, pulmonary involvement, and mortality were significantly higher in patients who were overweight or obese. In adjusted analyses, both overweight (OR, 95% CI: 1.82, 1.04–3.21; p=0.037) and obesity (OR, 95% CI: 2.69, 1.02–1.05; p Conclusions COVID-19 patients who were overweight or obese were more likely to have adverse outcomes but only obesity was a predictor of mortality. Such patients should receive urgent medical attention and active management, especially the elderly, men, and people with chronic kidney disease.

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.

Introduction Targeting better glycated hemoglobin (HbA1c) and blood pressure (BP) goals may endanger older adults with type 2 diabetes mellitus (T2DM). Overtreatment of T2DM and hypertension is a trending issue, although undertreatment is still common. We investigated the rates and predictors of overtreatment and undertreatment of glycemia and BP in older adults with T2DM and physicians' attitudes to deintensify or intensify treatment. Methods Data from older adults (>= 65 years) enrolled in a large nationwide T2DM survey in 2017 across Turkey were analyzed. Overtreatment of glycemia was defined as HbA1c < 6.5% plus the use of >= 2 oral antihyperglycemics or insulin, and BP overtreatment was defined as systolic BP (SBP) < 120 mmHg or diastolic BP (DBP) < 65 mmHg plus the use of >= 2 drugs. Undertreatment of glycemia was defined as HbA1c > 9%, and BP undertreatment was defined as SBP > 150 mmHg or DBP > 90 mmHg. Deintensification or intensification rates were calculated according to treatment modification initiated by the treating physician(s). Results the rate of overtreatment in the glycemia group (n = 1264) was 9.8% (n = 124) and that in the BP group (n = 1052) was 7.3% (n = 77), whereas the rate of undertreatment was 14.2% (n = 180) and 15.2% (n = 160), respectively. in the adjusted model, use of oral secretagogues (sulfonylureas or glinides) (odds ratio [OR] 1.94, 95% confidence interval [CI] 1.2-3.1) and follow-up at a private clinic (OR 1.81, 95% CI 1.0-3.3) were predictors of glycemia overtreatment. BP overtreatment was independently associated with the use insulin-based diabetes therapies (OR 1.86, 95% CI 1.14-3.04). There was no independent association of BP undertreatment to the study confounders. the deintensification and intensification rates were 25 and 75.6%, respectively, for glycemia and 10.9 and 9.2%, respectively, for BP. Conclusions the results show that one in ten older adults with T2DM are overtreated while one in four require modification of their current antihyperglycemic and antihypertensive treatments. Physicians are eager to intensify medications while they largely ignore deintensification in diabetes management. These results warrant enforced measures to improve the care of older adults with T2DM. Plain Language Summary Plain language summary is available for this article., Turkish Society of Endocrinology and Metabolism (TEMD) [04/10/2016-01], The TEMD study was funded by the Turkish Society of Endocrinology and Metabolism (TEMD) (Grant no. 04/10/2016-01). Automated blood pressure monitors were provided by Sanovel A/S. the funding agencies had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; or the preparation, review, or approval of the manuscript. No Rapid Service Fee was received by the journal for the publication of this article.

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.

The present survey aimed to find out the demographical and clinical characteristics of patients with hypertension in a population with type 2 diabetes mellitus (T2DM) in Turkey.Patients with T2DM who were followed-up in tertiary endocrine units for at least last one year were recruited. Demographic, clinical and biochemical data of the patients were collected. Hypertension was defined as taking anti-hypertensive medications or having office arterial blood pressure (ABP) ≥140/90 mmHg or home ABP ≥ 130/80 mmHg.A total of 4756 (58.9% women) diabetic patients were evaluated. The percentage of patients with hypertension was 67.5% (n = 3212). Although 87.4% (n = 2808) of hypertensive patients were under treatment, blood pressure was on target in 52.7% (n = 1479) of patients. Hypertension proportions were higher in woman (p = 0.001), older, more obese, and those who had longer diabetes duration, lower education levels, higher frequency of hypoglycemic events (all p0.001) and higher triglyceride levels (p = 0.003). LDL cholesterol level and the percentage of smokers were lower in hypertensive group than in non-hypertensive group (both p0.001). The percentage of macro and microvascular complications was higher in the hypertensive group than in the normotensive one (both p0.001). In multivariate logistic regression analysis, being a woman (OR: 1.26, 95% CI: 1.04-1.51, p = 0.016), smoking (OR: 1.38, 95% CI: 1.05-1.80, p = 0.020), regular physical activity (OR: 1.24, 95% CI: 1.01-1.53, p = 0.039) and the presence of macrovascular complications (OR: 1.38 95% CI: 1.15-1.65, p = 0.001) were the significant predictors of good ABP regulation. The ratios of masked and white coat hypertension were 41.2% and 5.7%, respectively.Our findings indicate that two-thirds (67.5%) of adult patients with T2DM have hypertension. Co-existence of hypertension increases the frequency of macro and microvascular diabetic complications in these patients. Despite the critical role of hypertension in morbidity and mortality, only half of the patients have favorable ABP levels. Masked hypertension seems to be another important issue in this population.

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.

Background: Attaining acceptable levels of LDL Cholesterol (LDL-C) significantly improves cardiovascular (CV) outcomes in patients with type 2 diabetes mellitus (T2DM). The LDL-C target attainment and the characteristics of patients attaining these targets were investigated in this study. Furthermore, the reasons for not choosing statins and the physicians’ attitudes on the treatment of diabetic dyslipidemia were also examined. Methods: A nationwide, cross-sectional survey was conducted in tertiary centers for diabetes management. Adult patients with T2DM, who were under follow-up for at least a year in outpatient clinics, were consecutively enrolled for the study. LDL-C goals were defined as below 70 mg/dL for patients with macrovascular complications or diabetic nephropathy, and below 100 mg/dL for other patients. Data about lipid-lowering medications were self-reported. Results: A total of 4504 patients (female: 58.6%) were enrolled for the study. The mean HbA1c and diabetes duration was 7.73 ± 1.74% and 10.9 ± 7.5 years, respectively. The need for statin treatment was 94.9% (n = 4262); however, only 42.4% (n = 1807) of these patients were under treatment, and only 24.8% (n = 448) of these patients achieved LDL-C targets. The main reason for statin discontinuation was negative media coverage (87.5%), while only a minority of patients (12.5%) mentioned side effects. Physicians initiated lipid-lowering therapy in only 20.3% of patients with high LDL-C levels. It was observed that the female gender was a significant independent predictor of not attaining LDL-C goals (OR: 0.70, 95% CI: 0.59–0.83). Conclusions: Less than 50 % of patients with T2DM who need statins were under treatment, and only a quarter of them attained their LDL-C targets. There exists a significant gap between the guideline recommendations and the real-world evidence in the treatment of dyslipidemia in T2DM. © 2020, The Author(s)., Ankara Universitesi; University of Health Sciences Lahore, UHS, The physicians and nurses in every TEMD study center who took role in recruitment of patients are acknowledged as the collaborators of TEMD Dyslipidemia Study (see supplementary data). The authors also appreciatively acknowledge the critical reviews and contributions of Professor Meral Kayikcioglu and Professor Ilker Tasci during the preparation of the manuscript. Consortium members and affiliations TEMD Study Group: Sibel Guldiken19, Semra Ayturk19, Murat Yilmaz20, Mehmet Asik21, Nevin Dinccag18, Ramazan Cakmak18, Fulya Turker18, Cemile Idiz18, Hulya Hacisahinogullari18, Elif Bagdemir18, Busra Yildiz18, Ozlem Haliloglu16, Seda Sancak22, Levent Ozsari23, Eylem Cagiltay23, Oguzhan Deyneli24, Eren Imre24, Sait Gonen25, S Nur Boysan19, Yuksel Altuntas26, Feyza Yener Ozturk26, Meral Mert27, Hamide Piskinpasa27, Hasan Aydin28, Sazi Imamoglu29, Ozen Oz Gul25, Sinem Kucuksarac Kiyici30, Berrin Cetinarslan31, Alev Selek31, Teoman Dogru32, Ali Kirik32, Belgin Efe14, Ahmet Kaya33, Ilker Cordan33, Suleyman Baldane34, Cem Onur Kirac34, Zehra Capa3, Mustafa Cesur35, Ilhan Yetkin36, Demet Corapcioglu37, Sule Canlar37, Okan Bulent Yildiz38, Suleyman Nahit Sendur38, Bekir Cakir9, Ahmet Corakci39, Mustafa Kutlu40, Neslihan Bascil Tutuncu41, Yusuf Bozkus41, Erman Cakal42, Berrin Demirbas43, Sibel Ertek44, Mustafa Altay45, Murat Dagdeviren45, Amir Hossein Abedi1, Sevki Cetinkalp46, Hatice Ozisik46, Guzide Gonca Oruk47, Serkan Yener48, Basak Ozgen Saydam48, Engin Guney49, Mustafa Unubol49, Guzin Fidan Yaylali50, Senay Topsakal50, Zeliha Hekimsoy51, Gulhan Akbaba52, Ibrahim Aslan53, Sefika Dalkiran13, Esen Akbay54, Kamile Gul55, Muge Ozsan Yilmaz6, Emre Bozkirli56, Seher Cetinkaya Altuntas12, Aysegul Atmaca57, Elif Tutku Durmuş57, Turkan Mete58, Faruk Kutluturk59, Ferit Kerim Kucukler60, Oguz Dikbas61, Safak Akin62, Irfan Nuhoglu63, Halil Onder Ersoz63, Taner Bayraktaroglu64, Pınar Sisman65, Ibrahim Sahin66, Sedat Cetin66, Ilyas Capoglu67, Emin Murat Akbas67, Rıfkı Ucler68, Mehmet Ali Eren4, Alpaslan Kemal Tuzcu69, Zafer Pekkolay69, Mesut Ozkaya70, Mustafa Araz71.19Trakya University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.20Corlu REYAP Private Hospital, Department of Endocrinology and Metabolism, Turkey.21Canakkale 18 March University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.22University of Health Sciences, School of Medicine, Fatih Sultan Mehmet Training and Research Hospital, Department of Endocrinology and Metabolism, Turkey.23University of Health Sciences, School of Medicine, Sultanabdulhamit Training and Research Hospital, Department of Endocrinology and Metabolism, Turkey.24Marmara University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.25Istanbul Science University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.26University of Health Sciences, School of Medicine, Sisli Hamidiye Etfal Training and Research Hospital, Department of Endocrinology and Metabolism, Turkey.27University of Health Sciences, School of Medicine, İstanbul Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Department of Endocrinology and Metabolism, Turkey.28Yeditepe University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.29Private Office.30University of Health Sciences, School of Medicine, Bursa Sevket Yılmaz Training and Research Hospital, Department of Endocrinology and Metabolism, Turkey.31Kocaeli University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.32Balikesir University, School of Medicine, Department of Internal Medicine, Turkey.33Necmettin Erbakan University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.34Selcuk University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.35Private Guven Hospital, Department of Endocrinology and Metabolism, Turkey.36Gazi University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.37Ankara University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.38Hacettepe University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.39Ufuk University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.40Private Bayındır Hospital, Department of Endocrinology and Metabolism, Turkey.41Baskent University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.42University of Health Sciences, School of Medicine, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Endocrinology and Metabolism, Turkey.43TOBB University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.44Private Memorial Hospital, Department of Endocrinology and Metabolism, Turkey.45University of Health Sciences, School of Medicine, Kecioren Training and Research Hospital, Department of Endocrinology and Metabolism, Turkey.46Ege University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.47University of Health Sciences, School of Medicine, Izmir Ataturk Training and Research Hospital, Department of Endocrinology and Metabolism, Turkey.48Dokuz Eylul University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.49Adnan Menderes University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.50Pamukkale University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.51Celal Bayar University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.52Mugla University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.53University of Health Sciences, School of Medicine, Antalya Training and Research Hospital, Department of Endocrinology and Metabolism, Turkey.54Mersin University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.55Kahramanmaras Sutcu Imam University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.56Baskent University, Adana Training Hospital, Department of Endocrinology and Metabolism, Turkey.5719 Mayıs University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.58University of Health Sciences, School of Medicine, Samsun Training and Research Hospital, Department of Endocrinology and Metabolism, Turkey.59Gaziosmanpasa University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.60Hitit University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.61Giresun University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.62Recep Tayyip Erdogan University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.63Karadeniz Technical University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.64Bulent Ecevit University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.65Kars Harakani State Hospital, Department of Endocrinology and Metabolism, Turkey.66Inonu University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.67Erzincan University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.68Yuzuncu Yil University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.69Dicle University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.70University of Health Sciences, School of Medicine, Gaziantep Ersin Arslan Research and Training Hospital, Turkey.71Gaziantep University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.

Laparoscopic sleeve gastrectomy (LSG) is gaining popularity worldwide. This retrospective cohort study evaluated the outcomes of a large cohort of patients with obesity who underwent LSG in a Bariatric Center of Excellence. All consecutive patients who underwent LSG between July 2013 and April 2016 were identified retrospectively. Preoperative and postoperative variables and comorbidities were recorded. The study consisted of 750 patients. Their mean age was 37.4 years; 72% were women, and the mean body mass index was 42.8 kg/m. The most common preoperative comorbidities were diabetes (23.3%), hyperlipidemia (21.9%), hypertension (21.1%), and obstructive sleep apnea (21.1%). The rates of comorbidity resolution during follow-up were 80.6%, 74.4%, 82.9%, and 94.3%, respectively. The percentage average excess weight loss 1, 3, and 6 months and 1 and 2 years after surgery was 29.4%±11.3%, 54.4%±17.7%, 76.9%±20.9%, 85.5%±23.6%, and 89.7%±27.6%, respectively. There was no mortality. LSG effectively and safely induced weight loss and comorbidity resolution.

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.

An old male who presented with atypical symptoms was diagnosed with thyrotoxicosis. He had multinodular goiter and was taking amiodarone (probably intermittently for a long time) for atrioventricular arrhythmias. The findings were interpreted in favor of amiodarone thyroiditis, but it was difficult to distinguish the type of amiodarone-induced thyrotoxicosis (AIT) because findings of both type 1 and 2 AIT were observed. Combined antithyroid drug (methimazole 20 mg/day) and corticosteroid (prednisolone 40 mg/day) were administered to treat both types of AIT. Normal thyroid hormone levels were found in the second week of treatment. Hepatotoxicity and decreasing platelet count developed as side effects of methimazole; therefore, the drug was stopped. Prednisolone was continued at the same dosage for 4 weeks and tapered to 6–10 mg every 4 weeks. Meanwhile, liver enzyme levels and platelet count returned to acceptable levels, but there was a risk of exacerbation. The patient was operated during the fourth month of follow-up when his cardiac problems were stable.

Tutuncu, Neslihan Bascil/0000-0002-1816-3903; Gonen, Mustafa Sait/0000-0002-1089-623X; CORAPCIOGLU, DEMET/0000-0003-0940-9147; Satman, Ilhan/0000-0001-8613-1797; nuhoglu, irfan/0000-0003-0650-3242; Sahin, Ibrahim/0000-0002-6231-0034; Demirci, Ibrahim/0000-0003-0498-3115; Altuntas, Seher Cetinkaya/0000-0002-9733-9443; Yildiz, Bulent O./0000-0003-1797-7662; BALCI, Mustafa Kemal/0000-0002-6494-3249; Araz, Mustafa/0000-0001-6741-7474; Saydam, Basak Ozgen/0000-0001-9457-8919; Bozkus, Yusuf/0000-0002-6976-6659; Sabuncu, Tevfik/0000-0001-6504-5355; SELEK, ALEV/0000-0002-0646-8697; Ozturk, Feyza Yener/0000-0001-5584-4954; Salman, Serpil/0000-0003-4867-3725; AKBAS, EMIN MURAT/0000-0002-3033-0073; KIRIK, Ali Murat/0000-0002-5771-4843; Sonmez, Alper/0000-0002-9309-7715; Cesur, Fazil Mustafa/0000-0002-1029-2604, WOS:000452704800016, PubMed: 30244051, Aims: Turkey has the highest prevalence of diabetes in Europe. It is therefore essential to know the overall cardiovascular risk and reveal the predictors of metabolic control in Turkish adults with diabetes mellitus. Methods: A nationwide, multicenter survey consecutively enrolled patients who were under follow up for at least a year. Optimal control was defined as HbA1c, Turkish Society of Endocrinology and Metabolism, The TEMD study has been funded by the Turkish Society of Endocrinology and Metabolism. Automated blood pressure monitors were provided by Sanovel A/S. The funding agencies had no role in the design and conduct of the study; the collection, management, analysis and interpretation of the data; or the preparation, review or approval of the manuscript.

Objective: The objective of this study was to assess the effects of Ramadan fasting on daily life routines and metabolic conditions in diabetic patients. Material and Methods: The study sample consisted of 26 patients with Type 2 diabetes who fasted during Ramadan. Data on changes daily life routine and metabolic variables were gathered before and after Ramadan, within a 10 days period. Results: Almost all patients fasted during Ramadan although they had known that fasting had some negative effects on their health, and Islamic rules allow sick people not to fast. Most of the patients declared that they rearranged morning and evening medications according to fasting hours and skipped doses between dawn and sunset, changed diet routine and eating habits including food preference. In addition, some of them changed their sleep schedule and decreased daily physical activity level because of lack of energy caused by fasting. More than half of the patients experienced at least one episode of hypoglycemia during fasting period; all hypoglycemia experiences were mild episodes. However, there was no emergency admission due to fasting-related health problems. We found neither negative nor positive effects of Ramadan on metabolic control variables including weight, HbA1c, fructosamine, C-peptide, insulin, and lipid profile. Conclusion: Ramadan fasting has no negative effects on metabolic parameters in patients with Type 2 diabetes. © 2013 by Türkiye Klinikleri.

The aim was to evaluate the concentrations of lipid subfractions in relation to adipokines and metabolic parameters in adult growth hormone (GH)-deficient hypopituitary patients on conventional replacement therapy. The study included 21 GH deficient-hypopituitary patients (age: 36.0 ± 15.1 years, male/female: 7/14) on conventional replacement therapy other than GH and 20 comparable controls (age: 37.3 ± 14.0 years, male/female: 6/14). Lipid subfractions (Lipoprint system), serum adipokine (leptin, adiponectin, resistin) concentrations, body composition, a surrogate marker for insulin resistance (HOMA) and conventional lipid profile were evaluated. No statistically significant difference was found with respect to HOMA, adipokine concentrations and anthropometric parameters between patients and controls except for significantly increased waist-to-hip ratio in hypopituitary group. Total and LDL cholesterol concentrations were significantly higher in the patients. LDL particle size (268.88 ± 3.16 vs. 271.31 ± 3.11 A, P = 0.151) and small-dense LDL subfraction did not differ significantly. According to logistic regression analysis, triglyceride concentrations ≥1.69 mmol/L was the sole parameter significantly and independently predicted small (

The study aimed to investigate the effect of high dose radioactive iodine (RAI) on parathyroid function in patients with differentiated thyroid cancer. Nineteen patients (8 men/11 women, age 46.5 ± 13.2 years) undergoing RAI for thyroid remnant ablation were enrolled in the study. The biochemical parameters related to parathyroid function [serum calcium (Ca), phosphate (P), creatinine (Cr), alkaline phosphatase (ALP), intact parathyroid hormone (iPTH), urinary Ca, cAMP concentrations and the maximum tubular capacity for phosphate per unit volume of glomerular filtrate (TmP/GFR)] were evaluated at baseline and at the 1st, 3rd, 6th and 12th months of RAI administration. SPSS 15.0 was used for statistical analysis. For all patients, thyroid-stimulating hormone levels were >30 U/ml at baseline and

Background: We sought to determine the similarity of pathogens isolated from soft tissue and bone in patients with diabetic foot infections. It is widely believed that soft-tissue cultures are adequate in the determination of causative bacteria in patients with diabetic foot osteomyelitis. The culture results of specimens taken concurrently from soft-tissue and bone infections show that the former does not predict the latter with sufficient reliability. We sought to determine the similarity of pathogens isolated from soft tissue and bone in patients with diabetic foot infections. Methods: Forty-five patients with diabetic foot infections were enrolled in the study. Patients had to have clinically suspected foot lesions of grade 3 or higher on the Wagner classification system. In patients with clinically suspected osteomyelitis, magnetic resonance imaging, scintigraphy, or histopathologic examination were performed. Bone and deep soft tissue specimens were obtained from all patients by open surgical procedures under aseptic conditions during debridement or amputation. The specimens were compared only with the other specimens taken from the same patients. Results: The results of bone and soft-tissue cultures were identical in 49% (n = 22) of cases. In 11% (n = 5) of cases there were no common pathogens. In 29% (n = 13) of cases there were more pathogens in the soft-tissue specimens; these microorganisms included microbes isolated from bone cultures. In four patients (9%) with culture-positive soft-tissue specimens, bone culture specimens remained sterile. In one patient (2%) with culture-positive bone specimen, soft-tissue specimen remained sterile. Conclusion: Culture specimens should be obtained from both the bone and the overlying deep soft tissue in patients with suspected osteomyelitis whose clinical conditions are suitable. The decision to administer antibiotic therapy should depend on these results. (J Am Podiatr Med Assoc 98(4): 290–295, 2008)

Background Diabetes mellitus is a chronic, progressive disease with complex therapy protocols requiring major coping efforts from patients to achieve and maintain glycaemic control in order to reduce risk of diabetic complications. Disease coping strategies including good knowledge of diabetes and high ability of self-care have been reported to be impaired by alexithymic features. Alexithymia is a psychological construct characterised by inability to express emotions verbally, poor imagination and operational thinking, leading to failure in psychological self-regulation. Objective To compare prevalence of alexithymia and mean Toronto Alexithymia Scale-26 (TAS-26) scores in diabetic patients with non-diabetic controls; to investigate the association of alexithymia with glycemic control in diabetes. Method In this cross- sectional study, TAS-26 scores of 193 diabetic patients and 49 non-diabetic controls were compared. Disease related factors were obtained from patient records. Alexithymia was used as a continuous (mean TAS-26 scores) and semi-quantitative (dichotomised into non-alexithymic 11>TAS-26 scores>11 and alexithymic individuals) variable. Descriptive data are presented as mean±SD, median (range) or %. Differences in means were compared via Independent-Samples T Test and One-Way ANOVA. Proportions were analysed with chi-square test and odds ratios (OR) were calculated via cross tabulation with a confidence interval (CI) of 95%. PResults The control group was similar with respect to age, gender and education with the diabetic group. In the diabetic study population (n=193, male/female: 42/58%, age 54.2±14.0 years, median diabetes duration 7 years (1-32 years), postprandial blood glucose (PBG) 243±110 mg/dl, HbA1c 7.3±3.6%) prevalence of alexithymia was significantly higher than in the control group (65 % in diabetics vs. 45 % in controls, p=0.011; mean TAS-26 score 12.3±3.7 vs. 10.6±3.6, p=0.004, respectively). Poor postprandial glycaemic control (p=0.002), female gender (p=0.026), combination therapy (p=0.037) and poor educational level (p=0.005) were positively associated with TAS-26 scores in diabetic individuals. Alexithymic diabetic patients were less educated (OR=1.2, p=0.046) and under worse glycaemic control (OR=2.4, p=0.005) compared to their non-alexithymic counterparts.

Aims Foot infections and their sequelae are among the most common and severe complications of diabetes mellitus. As diabetic patients with foot infections develop osteomyelitis and may progress to amputation, early diagnosis of osteomyelitis is critical. Methods We compared the diagnostic values of labelled leucocyte scanning with Tc99m, magnetic resonance imaging (MRI) and microbiological examination of bone tissue specimens with histopathology, the definitive diagnostic procedure. Thirty-one diabetic patients with foot lesions were enrolled in the study and histopathological examination was performed in all. Patients had clinically suspected foot lesions of ≥ grade 3 according to the classification of Wagner. Results Bone specimens were obtained for histopathological examination. Microbiology had a sensitivity of 92% and specificity of 60%. Labelled leucocyte scanning had a sensitivity of 91%, specificity of 67%, and MRI a sensitivity of 78%, specificity of 60%. Conclusions Microbiological examination may be as useful as and less costly than other diagnostic procedures and is the only method which can guide the choice of antibiotic therapy.

WOS: 000227425700004, PubMed ID: 15713353, To assess the prevalence of subclinical neuropathy within the first year of type I diabetes mellitus, 30 patients and 14 healthy subjects have been studied prospectively. The patients whose diabetes duration was longer than 1 year have been excluded from the study. Control group consisted of healthy volunteers. Subjective neuropathy symptoms, neurological examination, and electrophysiological findings were evaluated. All patients were clinically asymptomatic. At least two abnormal independent neurophysiological nerve parameters, which were required as the criterion of the peripheral nervous system subclinical involvement, were found as in 96.6% of diabetic patients in the first years. The percentages of abnormal electrophysiological parameters in different motor and sensory nerves were 86.7% in sural nerve, 83.3% in peroneal motor nerve, 73.3% in posterior tibial motor nerve, 66.7% in median motor nerve, 63.3% in ulnar motor nerve, 60% in median sensory nerve, and 46.7% in ulnar sensory nerve. While distal motor latency, F conduction time, and minimum F latency were the most frequent abnormal parameters in the upper extremity electrophysiological study; conduction velocity, minimum and mean F latencies, F conduction time were the most frequent abnormal parameters in the lower extremity. In all sensory nerve conduction studies, the most frequent abnormal parameter was the onset latency. In the autonomic sympathetic nerve clectrophysiological study, plantar SSR latency was found significantly longer than the control group. In the lower extremity generally somatic motor fibres, sensory large fibres and sympathetic autonomic nerve fibres were found to be more affected. There is a correlation between HbAlc levels and nerve conduction velocity in posterior fibial and peroneal nerves. However, upper extremity nerve conduction dysfunction was not correlated with HbAlc value. Neither the duration of disease nor the age of the subject correlated with the nerve dysfunction. (C) 2004 Elsevier Ireland Ltd. All rights reserved.

Aims/hypothesis Diabetes is a rapidly rising independent risk factor for atherosclerosis and serious illness. This risk can be reduced by lifestyle changes and/or various drugs. Novel therapies to prevent diabetes, as well as new risk factors for diabetes, atherosclerosis and obesity require testing and identification. Methods People with impaired fasting glucose or impaired glucose tolerance were randomised to ramipril (15 mg/day) or placebo and rosiglitazone (8 mg/day) or placebo with a 2x2 factorial design. They are assessed semi-annually for the primary outcome (diabetes or death). Diabetes is diagnosed if two consecutive plasma glucose levels exceed diagnostic thresholds (i.e. fasting >/=7.0 mmol/l or 2-h >/=11.1 mmol/l) within a 3-month period. Assuming an annual primary outcome incidence of 5%, there is more than 90% power to detect a 22% reduction. Approximately 20% of participants are having annual carotid ultrasounds to assess the effects on atherosclerosis. Patients screened but not randomised are being followed prospectively to identify determinants of obesity, diabetes and related disorders. Results A total of 24,872 individuals in 21 countries were screened over 2 years and are eligible for follow-up. Of these, 5269 were randomised: 1835 (35%) had isolated impaired glucose tolerance, 739 (14%) had isolated impaired fasting glucose, and 2692 (51%) had both disorders. Annual carotid ultrasounds are currently being performed in 1406 randomised individuals. Conclusions/interpretation The DREAM trial and related studies will determine if ramipril or rosiglitazone reduces the number of cases of diabetes and atherosclerosis, and will identify novel risk factors for diabetes.

Forty-eight patients with type II diabetes mellitus were recruited for the study. Fifty-one shoulder joints with adhesive capsulitis were treated in this population. A physical therapy protocol including Transcutaneous Electrical Nerve Stimulation, pulsed ultrasound and exercises was applied to each patient. The patients were assessed on entry and termination of treatment and at 3 months post-treatment by Visual Analogue Scale for rest and activity pain intensity, active and passive range of motion of shoulder and Constant scores. The scores were compared between 18 patients with good glycemic control and no neuropathy and 30 patients with insufficient glycemic control and neuropathy. The results indicate that glycemia levels and neuropathy have no effect on response to physical therapy.

To examine the short- and long-term influences of the Marmara earthquake, which occurred on August 17, 1999 in Turkey, on glycemic control and quality of life (QOL), HbA1c, insulin requirement and QOL of 88 people with type 1 diabetes living in the quake zone were evaluated one year before (PreE), 3 months after (PostE) and one year after (FE) the earthquake. HbA1c levels and daily insulin requirements increased significantly at PostE (HbA1c from 7.4 +/- 1.3% to 8.5 +/- 1.8%, p

To examine the influence of diabetes education on well-being, 255 patients with type 2 diabetes were recruited according to whether they attended a diabetes education program ( n =126) or not ( n =129). In patients who had participated in the program, the mean anxiety score was significantly lower, whereas positive well-being and general well-being scores were significantly higher than for patients who had not participated. Factors related to lower well-being included: being female, taking insulin, not attending a diabetes education program and having HbA 1c level greater than 8%. The odds of having better well-being were two-fold higher in patients participating the diabetes education program compared with those who had not. Diabetes education has a crucial role in improving the well-being of patients with type 2 diabetes. All patients with diabetes should be encouraged to attend a diabetes education program.

OBJECTIVES—To investigate for the first time the prevalence of diabetes and impaired glucose tolerance (IGT) nationwide in Turkey; to assess regional variations and relationships between glucose intolerance and lifestyle and physical risk factors. RESEARCH DESIGN AND METHODS—The Turkish Diabetes Epidemiology Study (TURDEP) is a cross-sectional, population-based survey that included 24,788 subjects (age ≥20 years, women 55%, response 85%). Glucose tolerance was classified according to World Health Organization recommendations on the basis of 2-h blood glucose values. RESULTS—Crude prevalence of diabetes was 7.2% (previously undiagnosed, 2.3%) and of IGT, 6.7% (age-standardized to world and European populations, 7.9 and 7.0%). Both were more frequent in women than men (P < 0.0001) and in those living in urban rather than rural communities (P < 0.001). Prevalence rates of hypertension and obesity were 29 and 22%, respectively. Both were more common among women than men (P < 0.0001). Prevalence of diabetes and IGT increased with rising BMI, waist-to-hip ratio (WHR), and waist girth (P < 0.0001). Multiple logistic regression analysis revealed that age, BMI, WHR, familial diabetes, and hypertension were independently associated with diabetes, age, BMI, WHR, familial diabetes, and hypertension with IGT (except for familial diabetes in women with IGT). Education was related to diabetes in men but was protective for diabetes and IGT in women. Socioeconomic status appeared to decrease the risk of IGT in men while it increased the risk in women. Smoking had a protective effect for IGT in both sexes. CONCLUSIONS—Diabetes and IGT are moderately common in Turkey by international standards. Associations with obesity and hypertension have been confirmed. Other lifestyle factors had a variable relationship with glucose tolerance.

ObjectiveFibroblast growth factor 23 (FGF23), a phosphatonin, inhibits renal phosphate reabsorption and suppresses 1-α hydroxylase activity. Calcitriol stimulates FGF23 synthesis in bone. We aimed to determine the effect of vitamin D replacement therapy on serum FGF23 concentrations in vitamin D-deficient women and to compare the FGF23 concentrations of vitamin D-deficient patients with healthy subjects and patients with genetically determined hypophosphatemic rachitis.Design and methodsThe study group was composed of vitamin D-deficient females (n=18, mean age 29.1±9.9 years), vitamin D-sufficient healthy females (control group;n=19, mean age 28.5±5.2 years), and patients with genetically determined hypophosphatemic rachitis (n=13, mean age 26.5±15.1 years). The groups were compared for serum FGF23, 1,25-dihydroxyvitamin D3 (1,25(OH)2D), calcium, phosphate, bone turnover markers, intact parathyroid hormone (PTH), and urinary excretion of calcium and phosphate. The vitamin D-deficient group was re-evaluated after a standard treatment regimen.ResultsSerum FGF23 concentrations were significantly lower in vitamin D-deficient patients than in vitamin D-sufficient women and hypophosphatemic rachitis group. Serum FGF23 and phosphate concentrations further decreased significantly during replacement of vitamin D (Pr=−0.469,PConclusionDecreased FGF23 concentrations, which further decline during vitamin D replacement therapy, may have favorable action on bone mineralization by counterregulatory effect on phosphate homeostasis. Lower 1,25(OH)2D concentrations at baseline and hypophosphatemia during treatment may have dominating effects on FGF23 concentrations in vitamin D deficiency, leading to decreased FGF23 concentrations at baseline and during replacement therapy.

Diabetes mellitus can cause cardiovascular autonomic neuropathy and is associated with increased cardiovascular deaths. We investigated cardiovascular autonomic neuropathy in diabetics and healthy controls by analysis of heart rate variability. Thirty-one diabetics and 30 age- and sex-matched controls were included. In the time domain we measured the mean R-R interval (NN), the standard deviation of the R-R interval index (SDNN), the standard deviation of the 5-min R - R interval mean (SDANN), the root mean square of successive R - R interval differences (RMSSD) and the percentage of beats with a consecutive R - R interval difference > 50 ms (pNN50). In the frequency domain we measured high-frequency power (HF), low-frequency power (LF) and the LF/HF ratio. Diabetes patients had lower values for time-domain and frequency-domain parameters than controls. Most heart rate variability parameters were lower in diabetes patients with chronic complications than in those without chronic complications.

To compare the effect of acarbose and gliclazide on clinical findings, biochemical parameters and safety in type 2 diabetic patients insufficiently controlled with medical nutrition therapy (MNT).Seventy-two patients (age 35-70 years, BMIor = 35 kg/m2), who had not taken any oral antidiabetic drug previously, were randomised into two groups after a four-week placebo period, and treated for 24 weeks with acarbose (100 mg two to three times daily) and gliclazide (40-80 mg twice daily). The study was open and 57 patients (33 males and 24 females) completed it. MNT was provided for each patient based on personal requirements as defined by a dietitian. The effect of treatment was evaluated by fasting and postprandial (PP) metabolic parameters (blood glucose, insulin and C peptide levels), HbA1c and plasma lipid levels. In addition, side-effects were recorded and clinical examinations performed.Both drugs were effective in reducing of HbA1c, fasting and PP blood glucose levels. However, PP serum insulin levels in the gliclazide group increased more than those in the group treated with acarbose (p = 0.007). Moreover, a small weight reduction was obtained with acarbose treatment but not with gliclazide. Lipid levels were favourably affected by both drugs. Total cholesterol levels decreased in both groups, the decrease only reaching significance in the acarbose group (p = 0.013). However, serum levels of LDL cholesterol decreased in both groups (acarbose and gliclazide, p = 0.033 and p = 0.023, respectively), but the ratio of HDL to LDL cholesterol increased in the acarbose group only (p = 0.045). Both treatments were generally well tolerated. Common complaints in the acarbose group were flatulence and meteorism (29.6%). However, 10.0% of the patients in the gliclazide group reported at least one mild hypoglycaemic episode.The results of the study demonstrate that acarbose and gliclazide were reasonably effective in improving metabolic control in patients insufficiently controlled with diet alone, and both treatments were well tolerated. Because of its effects on weight reduction and PP hyperinsulinaemia, acarbose may be preferred as a first-line drug, particularly in the treatment of overweight type 2 diabetic patients.

To examine the influence of oxidative stress on oxidative protein damage, we studied 51 young Type 1 diabetic patients clinically free of complications and 48 healthy normolipidaemic age-matched controls. We determined: (1) plasma carbonyl (PCO), plasma total thiol (T-SH), and nitrotyrosine (NT) levels as markers of oxidative protein damage; (2) plasma lipid hydroperoxide (LHP), and nitric oxide (NO) levels as markers of oxidative stress; (3) plasma total antioxidant capacity (TAO), ceruloplasmin (Cp), transferrin (TRF), unsaturated iron binding capacity (UIBC), erythrocyte glutathione (GSH), and erythrocyte superoxide dismutase (SOD) as markers of free radical scavengers. There were no significant differences in the levels of these markers between prepubertal diabetic patients and the controls. The levels of both of PCO and LHP were increased in adolescent and young adult Type 1 diabetic patients with respect to their controls. In the adolescent group, patient versus control values for PCO were 1.04+/-0.067 versus 0.67+/-0.0274 nmol/mg and for LHP they were 2. 10+/-1.09 versus 1.00+/-0.4 nmol/mg. In the young adult group, patient versus control values for PCO were 0.99+/-0.054 versus 0. 66+/-0.02 nmol/mg and for LHP they were 1.96+/-0.78 versus 1.15+/-0. 4 nmol/mg. TAO levels were significantly decreased in adolescent diabetic patients compared to their controls (0.92+/-0.27 vs. 1. 86+/-0.37) and in young adult diabetic patients compared to their controls (0.80+/-0.27 vs. 2.11+/-0.54 nmol/mg). T-SH was not different between diabetic patients and the controls. Serum NT, NO, and erythrocyte SOD levels were not different either between three groups of diabetic patients or between the patients and their controls. We attribute this lack of difference to limited disease duration. Changes in markers of oxidative stress other than NT, NO, and SOD observed in adolescent and young adult early stage Type 1 diabetic patients contribute to the imbalance in the redox status of the plasma. We attribute this imbalance to metal-catalyzed protein oxidation in both groups of Type 1 diabetic patients clinically free from complications.