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1. Low perfusion index affects the difference in glucose level between capillary and venous blood

Author

Acar N, Ozcelik H, Cevik AA, Ozakin E, Yorulmaz G, Kebapci N, Bilge U, and Bilgin M

Subjects
Therapeutics. Pharmacology, RM1-950
Abstract

Nurdan Acar,1 Hamit Ozcelik,1 Arif Alper Cevik,1 Engin Ozakin,1 Goknur Yorulmaz,2 Nur Kebapci,2 Ugur Bilge,3 Muzaffer Bilgin4 1Emergency Department, 2Endocrinology Department, 3Family Medicine Department, 4Biostatistics Department, Medical School, Eskisehir Osmangazi University, Eskisehir, Turkey Aim: In emergency cases, finger stick testing is primarily used to check the blood glucose value of patients since it takes longer to obtain the venous value. In critical patients, under conditions that cause an increase in metabolic state and level of stress, there occurs considerable difference in glucose levels between capillary and venous measurements. This study aimed to investigate the comparability of capillary and venous glucose values, according to the perfusion index level obtained with the Masimo Radical-7® device, in critical patients aged 18 years and over.Method: We conducted this prospective and observational study in the emergency department of the Eskisehir Osmangazi University hospital between November 3, 2008 and February 2, 2009.Results: The blood glucose of 300 critical patients was checked by finger stick in the emergency unit. The participants with normal vital signs had perfusion index between 0 and 5; the results obtained by the two methods were more consistent for perfusion index values of 6 and over. The results were most consistent in aged participants with normal vital sign findings and low perfusion index and in young patients with high perfusion index. In the cases where at least one of the vital signs was abnormal, the glucose values obtained by the two methods were more consistent when the perfusion index was 6 or over. In this group, independently from the perfusion index value, the consistency was higher in younger patients compared with aged patients.Conclusion: In the emergency department, perfusion index value measured by Masimo Radical-7 and capillary blood glucose levels can serve in blood sugar management in critically ill patients. Keyword: glucose, capillary, venous, perfusion index, Masimo Radical-7®

Published
2014

10. of the Turkish Nationwide Survey of Glycemic and Other Metabolic

Author

Sonmez, A, Yumuk, V, Haymana, C, Demirci, I, Barcin, C, Kiyici, S, Guldiken, S, Oruk, G, Saydam, BO, Baldane, S, Kutluturk, F, Kucukler, FK, Deyneli, O, Cetinarslan, B, Sabuncu, T, Bayram, F, Satman, I, Ayturk, S, Yilmaz, M, Asik, M, Dinccag, N, Cakmak, R, Turker, F, Idiz, C, Hacisahinogullari, H, Bagdemir, E, Yildiz, B, Haliloglu, O, Sancak, S, Ozsari, L, Cagiltay, E, Imre, E, Sait Gonen, Boysan, SN, Altuntas, Y, Ozturk, FY, Mert, M, Piskinpasa, H, Aydin, H, Imamoglu, S, Ersoy, C, Oz Gul, O, Selek, A, Dogru, T, Kirik, A, Kebapci, N, Efe, B, Kaya, A, Cordan, I, Kirac, CO, Capa, Z, Cesur, M, Yetkin, I, Corapcioglu, D, Canlar, S, Yildiz, OB, Sendur, SN, Cakir, B, Ozdemir, D, Corakci, A, Kutlu, M, Bascil Tutuncu, N, Bozkus, Y, Cakal, E, Demirbas, B, Ertek, S, Altay, M, Dagdeviren, M, Abedi, AH, Cetinkalp, S, Ozisik, H, Yener, S, Guney, E, Unubol, M, Yaylali, GF, Topsakal, S, Hekimsoy, Z, Akbaba, G, Aslan, I, Balci, MK, Dalkiran, S, Akbay, E, Gul, K, Agbaht, K, Yilmaz, MO, Bozkirli, E, Tetiker, BT, Cetinkaya Altuntas, S, Atmaca, A, Durmus, ET, Mete, T, Dikbas, O, Akin, S, Nuhoglu, I, Ersoz, HO, Bayraktaroglu, T, Sisman, P, Sahin, I, Cetin, S, Capoglu, I, Akbas, EM, Ucler, R, Eren, MA, Tuzcu, AK, Pekkolay, Z, Ozkaya, M, Araz, M, Salman, S, Dizdar, OS, Gurkan, E, and Kargili Carlioglu, A

Abstract

Background: Obesity is the main obstacle for metabolic control in patients with type 2 diabetes. Turkey has the highest prevalence of obesity and type 2 diabetes in Europe. The effect of obesity on the metabolic control, and the macro-and microvascular complications of patients are not apparent. Objectives: This nationwide survey aimed to investigate the prevalence of overweight and obesity among patients with type 2 diabetes and to search for the impact of obesity on the metabolic control of these patients. We also investigated the independent associates of obesity in patients with type 2 diabetes. Methods: We consecutively enrolled patients who were under follow-up for at least 1 year in 69 tertiary healthcare units in 37 cities. The demographic, anthropometric, and clinical data including medications were recorded. Patients were excluded if they were pregnant, younger than 18 years, had decompensated liver disease, psychiatric disorders interfering with cognition or compliance, had bariatric surgery, or were undergoing renal replacement therapy. Results: Only 10% of patients with type 2 diabetes (n = 4,648) had normal body mass indexes (BMI), while the others were affected by overweight (31%) or obesity (59%). Women had a significantly higher prevalence of obesity (53.4 vs. 40%) and severe obesity (16.6 vs. 3.3%). Significant associations were present between high BMI levels and lower education levels, intake of insulin, antihypertensives and statins, poor metabolic control, or the presence of microvascular complications. Age, gender, level of education, smoking, and physical inactivity were the independent associates of obesity in patients with type 2 diabetes. Conclusion: The TEMD Obesity Study shows that obesity is a major determinant of the poor metabolic control in patients with type 2 diabetes. These results underline the importance of prevention and management of obesity to improve health care in patients with type 2 diabetes. Also, the results point out the independent sociodemographic and clinical associates of obesity, which should be the prior targets to overcome, in the national fight with obesity. (c) 2019 The Author(s) Published by S. Karger AG, Basel C1 [Sonmez, Alper; Haymana, Cem; Demirci, Ibrahim] Univ Hlth Sci, Gulhane Sch Med, Dept Endocrinol & Metab, TR-06018 Ankara, Turkey. [Yumuk, Volkan] Istanbul Univ, Cerrahpasa Med Fac, Dept Endocrinol & Metab, Istanbul, Turkey. [Barcin, Cem] Univ Hlth Sci, Gulhane Sch Med, Dept Cardiol, Ankara, Turkey. [Kiyici, Sinem] Univ Hlth Sci, Bursa Yuksek Ihtisas Training & Res Hosp, Dept Endocrinol & Metab, Bursa, Turkey. [Guldiken, Sibel] Trakya Univ, Med Fac, Dept Endocrinol & Metab, Edirne, Turkey. [Oruk, Gonca] Izmir Katip Celebi Univ, Ataturk Educ & Res Hosp, Dept Endocrinol & Metab, Izmir, Turkey. [Saydam, Basak Ozgen] Dokuz Eylul Univ, Med Fac, Dept Endocrinol & Metab, Izmir, Turkey. [Baldane, Suleyman] Selcuk Univ, Med Fac, Dept Endocrinol & Metab, Konya, Turkey. [Kutluturk, Faruk] Gaziosmanpasa Univ, Med Fac, Dept Endocrinol & Metab, Tokat, Turkey. [Kucukler, Ferit Kerim] Hitit Univ, Med Fac, Dept Endocrinol & Metab, Corum, Turkey. [Deyneli, Oguzhan] Marmara Univ, Med Fac, Dept Endocrinol & Metab, Istanbul, Turkey. [Cetinarslan, Berrin] Kocaeli Univ, Med Fac, Dept Endocrinol & Metab, Kocaeli, Turkey. [Sabuncu, Tevfik] Harran Univ, Med Fac, Dept Endocrinol & Metab, Urfa, Turkey. [Bayram, Fahri] Erciyes Univ, Med Fac, Dept Endocrinol & Metab, Kayseri, Turkey. [Satman, Ilhan] Istanbul Univ, Med Fac, Dept Endocrinol & Metab, Istanbul, Turkey. [Ayturk, Semra] Trakya Univ, Sch Med, Dept Endocrinol & Metab, Edirne, Turkey. [Yilmaz, Murat] Corlu REYAP Private Hosp, Dept Endocrinol & Metab, Corlu, Turkey. [Asik, Mehmet] Canakkale 18 March Univ, Sch Med, Dept Endocrinol & Metab, Canakkale, Turkey. [Dinccag, Nevin; Cakmak, Ramazan; Turker, Fulya; Idiz, Cemile; Hacisahinogullari, Hulya; Bagdemir, Elif; Yildiz, Busra; Haliloglu, Ozlem] Istanbul Univ, Sch Med, Dept Endocrinol & Metab, Cerrahpasa, Turkey. [Sancak, Seda] Univ Hlth Sci, Sch Med, Fatih Sultan Mehmet Training & Res Hosp, Dept Endocrinol & Metab, Istanbul, Turkey. [Ozsari, Levent; Cagiltay, Eylem] Univ Hlth Sci, Sch Med, Sultanabdulhamit Training & Res Hosp, Dept Endocrinol & Metab, Istanbul, Turkey. [Imre, Eren] Marmara Univ, Sch Med, Dept Endocrinol & Metab, Istanbul, Turkey. [Sait Gonen; Boysan, S. Nur] Istanbul Sci Univ, Sch Med, Dept Endocrinol & Metab, Istanbul, Turkey. [Altuntas, Yuksel; Ozturk, Feyza Yener] Univ Hlth Sci, Sch Med, Sisli Hamidiye Etfal Training & Res Hosp, Dept Endocrinol & Metab, Istanbul, Turkey. [Mert, Meral; Piskinpasa, Hamide] Univ Hlth Sci, Istanbul Bakirkoy Dr Sadi Konuk Training & Res Ho, Sch Med, Dept Endocrinol & Metab, Istanbul, Turkey. [Aydin, Hasan] Yeditepe Univ, Sch Med, Dept Endocrinol & Metab, Istanbul, Turkey. [Ersoy, Canan; Oz Gul, Ozen] Uludag Univ, Sch Med, Dept Endocrinol & Metab, Bursa, Turkey. [Selek, Alev] Kocaeli Univ, Sch Med, Dept Endocrinol & Metab, Kocaeli, Turkey. [Dogru, Teoman; Kirik, Ali] Balikesir Univ, Sch Med, Dept Internal Med, Balikesir, Turkey. [Kebapci, Nur; Efe, Belgin] Eskisehir Osmangazi Univ, Sch Med, Dept Endocrinol & Metab, Odunpazari Eskisehir, Turkey. [Kaya, Ahmet; Cordan, Ilker] Necmettin Erbakan Univ, Sch Med, Dept Endocrinol & Metab, Konya, Turkey. [Kirac, Cem Onur] Selcuk Univ, Sch Med, Dept Endocrinol & Metab, Konya, Turkey. [Capa, Zehra] Univ Hlth Sci, Gulhane Sch Med, Ankara, Turkey. [Capa, Zehra] Gulhane Training & Res Hosp, Dept Endocrinol & Metab, Ankara, Turkey. [Cesur, Mustafa] Private Guven Hosp, Dept Endocrinol & Metab, Ankara, Turkey. [Yetkin, Ilhan] Gazi Univ, Sch Med, Dept Endocrinol & Metab, Ankara, Turkey. [Corapcioglu, Demet; Canlar, Sule] Ankara Univ, Sch Med, Dept Endocrinol & Metab, Ankara, Turkey. [Yildiz, Okan Bulent; Sendur, Suleyman Nahit] Hacettepe Univ, Sch Med, Dept Endocrinol & Metab, Ankara, Turkey. [Cakir, Bekir; Ozdemir, Didem] Yildirim Beyazit Univ, Sch Med, Dept Endocrinol & Metab, Ankara, Turkey. [Corakci, Ahmet] Ufuk Univ, Sch Med, Dept Endocrinol & Metab, Ankara, Turkey. [Kutlu, Mustafa] Private Bayindir Hosp, Dept Endocrinol & Metab, Ankara, Turkey. [Bascil Tutuncu, Neslihan; Bozkus, Yusuf] Baskent Univ, Sch Med, Dept Endocrinol & Metab, Ankara, Turkey. [Cakal, Erman] Univ Hlth Sci, Sch Med, Diskapi Yildirim Beyazit Training & Res Hosp, Dept Endocrinol & Metab, Ankara, Turkey. [Demirbas, Berrin] TOBB Univ, Sch Med, Dept Endocrinol & Metab, Ankara, Turkey. [Ertek, Sibel] Private Mem Hosp, Dept Endocrinol & Metab, Ankara, Turkey. [Altay, Mustafa; Dagdeviren, Murat] Univ Hlth Sci, Sch Med, Kecioren Training & Res Hosp, Dept Endocrinol & Metab, Ankara, Turkey. [Abedi, Amir Hassein] Erciyes Univ, Sch Med, Dept Endocrinol & Metab, Kayseri, Turkey. [Cetinkalp, Sevki; Ozisik, Hatice] Ege Univ, Sch Med, Dept Endocrinol & Metab, Izmir, Turkey. [Yener, Serkan] Dokuz Eylul Univ, Sch Med, Dept Endocrinol & Metab, Izmir, Turkey. [Guney, Engin; Unubol, Mustafa] Adnan Menderes Univ, Sch Med, Dept Endocrinol & Metab, Aydin, Turkey. [Yaylali, Guzin Fidan; Topsakal, Senay] Pamukkale Univ, Sch Med, Dept Endocrinol & Metab, Denizli, Turkey. [Hekimsoy, Zeliha] Celal Bayar Univ, Sch Med, Dept Endocrinol & Metab, Manisa, Turkey. [Akbaba, Gulhan] Mugla Univ, Sch Med, Dept Endocrinol & Metab, Mugla, Turkey. [Aslan, Ibrahim] Univ Hlth Sci, Antalya Training & Res Hosp, Sch Med, Dept Endocrinol & Metab, Antalya, Turkey. [Balci, Mustafa Kemal; Dalkiran, Sefika] Akdeniz Univ, Sch Med, Dept Endocrinol & Metab, Antalya, Turkey. [Akbay, Esen] Mersin Univ, Sch Med, Dept Endocrinol & Metab, Mersin, Turkey. [Gul, Kamile] Kahramanmaras Sutcu Imam Univ, Sch Med, Dept Endocrinol & Metab, Kahramanmaras, Turkey. [Agbaht, Kemal] Private Defne Hosp, Dept Endocrinol & Metab, Antalya, Turkey. [Yilmaz, Muge Ozsan] Mustafa Kemal Univ, Sch Med, Dept Endocrinol & Metab, Antakya, Turkey. [Bozkirli, Emre] Baskent Univ, Adana Training Hosp, Dept Endocrinol & Metab, Ankara, Turkey. [Tetiker, B. Tamer; Cetinkaya Altuntas, Seher] Cukurova Univ, Sch Med, Dept Endocrinol & Metab, Adana, Turkey. [Atmaca, Aysegul; Durmus, Elif Tutku] 19 Mayis Univ, Sch Med, Dept Endocrinol & Metab, Samsun, Turkey. [Mete, Turkan] Univ Hlth Sci, Sch Med, Samsun Training & Res Hosp, Dept Endocrinol & Metab, Samsun, Turkey. [Dikbas, Oguz] Giresun Univ, Sch Med, Dept Endocrinol & Metab, Giresun, Turkey. [Akin, Safak] Recep Tayyip Erdogan Univ, Sch Med, Dept Endocrinol & Metab, Rize, Turkey. [Nuhoglu, Irfan; Ersoz, Halil Onder] Karadeniz Tech Univ, Sch Med, Dept Endocrinol & Metab, Trabzon, Turkey. [Bayraktaroglu, Taner] Bulent Ecevit Univ, Sch Med, Dept Endocrinol & Metab, Zonguldak, Turkey. [Sisman, Pinar] Kars Harakani State Hosp, Dept Endocrinol & Metab, Kars, Turkey. [Sahin, Ibrahim; Cetin, Sedat] Inonu Univ, Sch Med, Dept Endocrinol & Metab, Malatya, Turkey. [Capoglu, Ilyas; Akbas, Emin Murat] Erzincan Univ, Sch Med, Dept Endocrinol & Metab, Erzincan, Turkey. [Ucler, Rifki] Yuzuncu Yil Univ, Sch Med, Dept Endocrinol & Metab, Van, Turkey. [Eren, Mehmet Ali] Harran Univ, Sch Med, Dept Endocrinol & Metab, Sanliurfa, Turkey. [Tuzcu, Alpaslan Kemal; Pekkolay, Zafer] Dicle Univ, Sch Med, Dept Endocrinol & Metab, Diyarbakir, Turkey. [Ozkaya, Mesut] Univ Hlth Sci, Sch Med, Gaziantep Ersin Arslan Res & Training Hosp, Gaziantep, Turkey. [Araz, Mustafa] Gaziantep Univ, Sch Med, Dept Endocrinol & Metab, Gaziantep, Turkey. [Salman, Serpil] Liv Hosp Ulus, Dept Endocrinol & Metab, Istanbul, Turkey. [Dizdar, Oguzhan Sitki] Kayseri Educ & Res Hosp, Dept Internal Med, Kayseri, Turkey. [Gurkan, Eren] Mustafa Kemal Univ, Dept Endocrinol & Metab, Antakya, Turkey. [Kargili Carlioglu, Ayse] Erzurum Reg Educ & Res Hosp, Dept Endocrinol & Metab, Erzurum, Turkey.

Published
2019

11. Turkish nationwide survEy of glycemic and other Metabolic parameters of patients with Diabetes mellitus (TEMD study)

Author

Sonmez, A., Haymana, C., Bayram, F., Salman, S., Dizdar, O.S., Gurkan, E., Kargili Carlıoglu, A., Barcin, C., Sabuncu, T., Satman, I., Guldiken, S., Ayturk, S., Yilmaz, M., Asik, M., Dinccag, N., Cakmak, R., Turker, F., Idiz, C., Hacisahinogullari, H., Bagdemir, E., Yildiz, B., Yumuk, V.D., Haliloglu, O., Sancak, S., Ozsari, L., Cagiltay, E., Deyneli, O., Imre, E., Gonen, S., Boysan, S.N., Altuntas, Y., Ozturk, F.Y., Mert, M., Piskinpasa, H., Aydin, H., Imamoglu, S., Ersoy, C., Gul, O.O., Kucuksarac Kiyici, S., Cetinarslan, B., Selek, A., Dogru, T., Kirik, A., Kebapci, N., Efe, B., Kaya, A., Cordan, I., Baldane, S., Kirac, C.O., Demirci, I., Capa, Z., Cesur, M., Yetkin, I., Corapcioglu, D., Canlar, S., Bulent Yildiz, O., Sendur, S.N., Cakir, B., Ozdemir, D., Corakci, A., Kutlu, M., Bascil Tutuncu, N., Bozkus, Y., Cakal, E., Demirbas, B., Ertek, S., Altay, M., Dagdeviren, M., Abedi, A.H., Cetinkalp, S., Ozisik, H., Oruk, G.G., Yener, S., Saydam, B.O., Guney, E., Unubol, M., Yaylalı, Güzin Fidan, Topsakal, Şenay, Hekimsoy, Z., Akbaba, G., Aslan, I., Balci, M.K., Dalkiran, S., Akbay, E., Gul, K., Agbaht, K., Yilmaz, M.O., Bozkirli, E., Tetiker, B.T., Cetinkaya Altuntas, S., Atmaca, A., Durmuş, E.T., Mete, T., Kutluturk, F., Kucukler, F.K., Dikbas, O., Akin, S., Nuhoglu, I., Ersoz, H.O., Bayraktaroglu, T., Sisman, P., Sahin, I., Cetin, S., Capoglu, I., Akbas, E.M., Ucler, R., Eren, M.A., Tuzcu, A.K., Pekkolay, Z., Ozkaya, M., Araz, M., and on behalf of the TEMD Study Group

Subjects
Blood Glucose, Male, obesity, Glycated Hemoglobin A, Turkey, blood pressure measurement, low density lipoprotein cholesterol, high density lipoprotein cholesterol, Surveys and Questionnaires, middle aged, LDL-cholesterol, glucose, hemoglobin A1c, education, anthropometry, exercise, non insulin dependent diabetes mellitus, adult, Type 2 diabetes, clinical trial, health survey, Europe, Type 1 diabetes, female, risk factor, diabetes mellitus, triacylglycerol, insulin, metabolic parameters, HbA1c, hypertension, high performance liquid chromatography, prevalence, immunoturbidimetry, insulin dependent diabetes mellitus, Article, smoking, blood, turkey (bird), enzyme chemistry, cross-sectional study, Humans, controlled study, human, glycosylated hemoglobin, questionnaire, dyslipidemia, major clinical study, body mass, hypoglycemia, glucose blood level, multicenter study, Cross-Sectional Studies, Diabetes Mellitus, Type 2, glycemic control, Arterial blood pressure, metabolism
Abstract

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 < 7%, home arterial blood pressure (ABP) < 135/85 mmHg, or LDL-C < 100 mg/dL. Achieving all parameters indicated triple metabolic control. Results: HbA1c levels of patients (n = 5211) were 8.6 ± 1.9% (71 ± 22 mmol/mol) and 7.7 ± 1.7% (61 ± 19 mmol/mol), in Type 1 and Type 2 diabetes, respectively. Glycemic control was achieved in 15.3% and 40.2%, and triple metabolic control was achieved in 5.5% and 10.1%, respectively. Only 1.5% of patients met all the criteria of being non-obese, non-smoker, exercising, and under triple metabolic control. Low education level was a significant predictor of poor glycemic control in both groups. Conclusions: Few patients with Type 2, and even fewer with Type 1 diabetes have optimal metabolic control in Turkey. TEMD study will provide evidence-based information to policy makers to focus more on the quality and sustainability of diabetes care in order to reduce the national burden of the disease. © 2018 Elsevier B.V.

Published
2018

12. Blood lipids, diabetic complications and the physician attitudes on dyslipidemia treatment; data from the Turkish nationwide survey of glycemic and other metabolic parameters of patients with diabetes

Author

Bayram, F., Sonmez, A., Haymana, C., Sabuncu, T., Dizdar, O.S., Gurkan, E., Kargili carlioglu, A., Agbaht, K., Özdemir, D., Kucuk bicer, B., Barcin, C., Salman, S., Tetiker, T., Balci, M.K., Kebapci, N., Ersoy, C., Yumuk, V., Satman, I., and Temd study group

Published
2018
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14. Etiology of hypopituitarism in tertiary care institutions in Turkish population: Analysis of 773 patients from pituitary study group database

Author

Nur Kebapci, Fatih Kilicli, Hasan Aydin, Zeliha Hekimsoy, Hatice Sebila Dökmetaş, Guzide Gonca Oruk, Erdinc Erturk, Hulusi Atmaca, Mesut Ozkaya, Sema Yarman, M. Taskale, Fahri Bayram, Fahrettin Kelestimur, Inan Anaforoglu, M. Cakir, N. Ersoz, C. Culha, A. Tugrul, Fatih Tanriverdi, Zeynep Cantürk, Meral Mert, Melek Eda Ertorer, Tomris Erbas, F. Tanriverdi, H.S. Dokmetas, N. Kebapci, F. Kilicli, H. Atmaca, S. Yarman, T. Erbas, Yeditepe Üniversitesi, [Tanriverdi, F. -- Bayram, F. -- Kelestimur, F.] Erciyes Univ, Sch Med, Dept Endocrinol, TR-38039 Kayseri, Turkey -- [Dokmetas, H. S. -- Kilicli, F.] Cumhuriyet Univ, Sch Med, Dept Endocrinol, Sivas, Turkey -- [Kebapci, N.] Osmangazi Univ, Fac Med, Dept Endocrinol, Eskisehir, Turkey -- [Atmaca, H.] Karaelmas Univ, Dept Endocrinol, Zonguldak, Turkey -- [Yarman, S.] Istanbul Univ, Fac Med, Dept Endocrinol, Istanbul, Turkey -- [Ertorer, M. E.] Baskent Univ, Fac Med, Div Endocrinol, Adana, Turkey -- [Erturk, E.] Uludag Univ, Sch Med, Dept Endocrinol, Bursa, Turkey -- [Tugrul, A.] Trakya Univ, Fac Med, Endocrinol Sect, Edirne, Turkey -- [Culha, C.] Ankara Res & Training Hosp, Dept Endocrinol, Ankara, Turkey -- [Cakir, M.] Selcuk Univ, Meram Sch Med, Div Endocrinol, Konya, Turkey -- [Mert, M.] Okmeydani Training & Res Hosp, Dept Endocrinol, Istanbul, Turkey -- [Aydin, H.] Yeditepe Univ, Sch Med, Dept Endocrinol, Istanbul, Turkey -- [Taskale, M.] Dr Sadi Konuk Res Hosp, Dept Endocrinol, Istanbul, Turkey -- [Ersoz, N. -- Erbas, T.] Hacettepe Univ, Sch Med, Dept Endocrinol, Ankara, Turkey -- [Canturk, Z.] Kocaeli Univ, Sch Med, Dept Endocrinol, Izmit, Kocaeli, Turkey -- [Anaforoglu, I.] Trabzon Numune Educ & Res Hosp, Dept Endocrinol, Trabzon, Turkey -- [Ozkaya, M.] Maras Sutcuimam Sch Med, Dept Endocrinol, Kahramanmaras, Turkey -- [Oruk, G.] Ataturk Training & Res Hosp, Dept Endocrinol, Izmir, Turkey -- [Hekimsoy, Z.] Celal Bayar Univ, Fac Med, Dept Internal Med, Div Endocrinol & Metab, Manisa, Turkey, and Zonguldak Bülent Ecevit Üniversitesi

Subjects
Adult, Male, medicine.medical_specialty, Turkish population, Pediatrics, Adolescent, Databases, Factual, Turkey, Endocrinology, Diabetes and Metabolism, Population, Pituitary tumors, Hypopituitarism, Sheehan's syndrome, Tertiary Care Centers, Young Adult, Endocrinology, Anterior pituitary, Internal medicine, Prevalence, medicine, Humans, Prospective cohort study, education, Aged, Aged, 80 and over, education.field_of_study, business.industry, Middle Aged, medicine.disease, Cross-Sectional Studies, medicine.anatomical_structure, Pituitary, Etiology, Female, business
Abstract

WOS: 000344087600025, PubMed ID: 24366641, Hypopituitarism in adult life is commonly acquired and the main causes are known as pituitary tumors and/or their treatments. Since there are new insights into the etiology of hypopituitarism and presence of differences in various populations, more studies regarding causes of hypopituitarism are needed to be done in different ethnic groups with sufficient number of patients. Therefore, we performed a multi-center database study in Turkish population investigating the etiology of hypopituitarism in 773 patients in tertiary care institutions. The study was designed and coordinated by the Pituitary Study Group of SEMT (The Society of Endocrinology and Metabolism of Turkey). Nineteen tertiary reference centers (14 university hospitals and 5 training hospitals) from the different regions of Turkey participated in the study. It is a cross-sectional database study, and the data were recorded for 18 months. We mainly classified the causes of hypopituitarism as pituitary tumors (due to direct effects of the pituitary tumors and/or their treatments), extra-pituitary tumors and non-tumoral causes. Mean age of 773 patients (49.8 % male, 50.2 % female) was 43.9 +/- 16.1 years (range 16-84 years). The most common etiology of pituitary dysfunction was due to non-tumoral causes (49.2 %) among all patients. However, when we analyze the causes according to gender, the most common etiology in males was pituitary tumors, but the most common etiology in females was non-tumoral causes. According to the subgroup analysis of the causes of hypopituitarism in all patients, the most common four causes of hypopituitarism which have frequencies over 10 % were as follows: nonsecretory pituitary adenomas, Sheehan's syndrome, lactotroph adenomas and idiopathic. With regard to the type of hormonal deficiencies; FSH/LH deficiency was the most common hormonal deficit (84.9 % of the patients). In 33.8 % of the patients, 4 anterior pituitary hormone deficiencies (FSH/LH, ACTH, TSH, and GH) were present. Among all patients, the most frequent cause of hypopituitarism was non-secretory pituitary adenomas. However, in female patients, present study clearly demonstrates that Sheehan's syndromeis still one of the most important causes of hypopituitarism in Turkish population. Further, population-based prospective studies need to be done to understand the prevalence and incidence of the causes of hypopituitarism in different countries.

Published
2014

15. Utilization of statins and LDL-cholesterol target attainment in Turkish patients with type 2 diabetes - a nationwide cross-sectional study (TEMD dyslipidemia study).

Author

Bayram F, Sonmez A, Haymana C, Sabuncu T, Dizdar OS, Gurkan E, Carlioglu AK, Agbaht K, Ozdemir D, Demirci I, Barcin C, Salman S, Tetiker T, Balci MK, Kebapci N, Ersoy C, Yumuk V, Toth PP, and Satman I

Subjects
Aged, Cross-Sectional Studies, Diabetes Mellitus, Type 2 blood, Diabetes Mellitus, Type 2 epidemiology, Dyslipidemias blood, Dyslipidemias epidemiology, Female, Glycated Hemoglobin genetics, Humans, Male, Middle Aged, Surveys and Questionnaires, Tertiary Care Centers, Cholesterol, LDL blood, Diabetes Mellitus, Type 2 drug therapy, Dyslipidemias drug therapy, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use
Abstract

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.

Published
2020
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16. An Evaluation of Clinicopathological Factors Effective in the Development of Central and Lateral Lymph Node Metastasis in Papillary Thyroid Cancer.

Author

Aydin Buyruk B, Kebapci N, Yorulmaz G, Buyruk A, and Kebapci M

Subjects
Adult, Female, Follow-Up Studies, Hashimoto Disease etiology, Humans, Male, Middle Aged, Neoplasm Staging, Retrospective Studies, Thyroid Cancer, Papillary pathology, Thyroid Cancer, Papillary physiopathology, Thyroid Neoplasms physiopathology, Thyroidectomy, Lymphatic Metastasis physiopathology, Thyroid Cancer, Papillary secondary, Thyroid Neoplasms pathology
Abstract

Introduction and Aim: Papillary thyroid cancer (PTC) constitutes more than 90% of newly emerging differentiated thyroid cancers. Lymph node metastasis is often seen in PTC. There is a high risk of central metastasis in the presence of clinicopathological factors such as extrathyroidal extension, multifocality and lymphovascular invasion. The aim of this study is to evaluate the clinicopathological features that are effective in the development of lymph node metastasis., Material and Method: A retrospective examination was made of the records of patients diagnosed with papillary thyroid cancer and followed up in our clinic. Patients with and without lymph node metastasis were compared in respect of demographic features such as age, gender, pathology, histopathology, tumor size, lymph node metastasis, lymphovascular invasion, multifocality, capsule invasion, extrathyroidal extension and bilaterality., Results: Lymph node metastasis was determined in 52 of 419 papillary thyroid cancers. In the logistic regression analysis, a statistically significant relationship was determined between cervical lymph node metastasis and age <45 years (p < 0.001, OR:4.193), lymphovascular invasion (p < 0.001, OR:7.762), capsule invasion (p < 0.002, OR:3.054), extrathyroidal extension (p < 0.001, OR:6.450) and bilaterality (p < 0.001, OR: 0.217)., Conclusion: The risk of cervical lymph node metastasis was determined to be high in the presence of clinicopathological factors such as extrathyroidal extension, multifocality and lymphovascular invasion. Although lymph node metastasis does not clinically develop in all patients, knowing the risk factors related to lymph node metastasis can contribute to the evaluation of prophylactic central neck dissection in high-risk patients and follow-up of the patient in respect of recurrence., (Copyright © 2017 National Medical Association. Published by Elsevier Inc. All rights reserved.)

Published
2018
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17. Higher Insulin Resistance Level is Associated with Worse Clinical Response in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis.

Author

Bas DF, Ozdemir AO, Colak E, and Kebapci N

Subjects
Administration, Intravenous, Aged, Brain Ischemia complications, Female, Humans, Logistic Models, Male, Middle Aged, Severity of Illness Index, Stroke etiology, Tomography Scanners, X-Ray Computed, Fibrinolytic Agents adverse effects, Hemorrhage chemically induced, Insulin Resistance physiology, Stroke drug therapy, Tissue Plasminogen Activator adverse effects, Treatment Outcome
Abstract

Insulin resistance is linked to atherosclerotic cardiovascular diseases and stroke. We investigated whether there is a relationship between insulin resistance and clinical findings and outcomes of acute ischemic stroke patients treated with intravenous thrombolysis. In our study, 180 acute ischemic stroke non-diabetic patients treated with intravenous recombinant tissue-type plasminogen activator (iv rt-PA) were evaluated for insulin resistance assessed by homeostasis model assessment insulin resistance (HOMA-IR). The threshold for HOMA-IR was determined as 2.7. Patients were grouped as HOMA-IR > 2.7 and HOMA-IR ≤ 2.7. Clinical features at baseline, 24th hour, and 3rd month were examined. Computed tomography (CT) findings for hemorrhagic transformation were also assessed. Patients with HOMA-IR > 2.7 had significantly higher National Institutes of Health Stroke Scale (NIHSS) scores at 24th hour (p = 0.005) and higher modified Rankin Scale (mRS) scores at 3rd month (p = 0.011). Logistic regression analysis displayed that the presence of HOMA-IR > 2.7 increases the likelihood of poor outcome 2.93 times (confidence interval [CI] 1.001-1.079) (p = 0.003). There was no statistically significant difference between baseline clinical features, hemorrhagic transformation (p = 1.000), and mortality (p = 0.350) rates. Insulin resistance at higher levels seems to be associated with poor clinical courses and outcomes in patients who received iv rt-PA.

Published
2016
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19. Factors affecting swallowing during thyroid fine-needle aspiration biopsy.

Author

Yavas US, Calisir C, Kebapci M, Kebapci N, and Dundar E

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Chi-Square Distribution, Female, Humans, Male, Middle Aged, Prospective Studies, ROC Curve, Ultrasonography, Interventional, Biopsy, Fine-Needle methods, Deglutition, Thyroid Nodule pathology
Abstract

Objective: This prospective study was conducted to examine the factors that affect swallowing during thyroid fine-needle aspiration biopsy (FNAB)., Methods: Consecutive patients who were to undergo FNAB were approached for inclusion in the study. The depth and size of the nodule were measured in all patients. In a random fashion, patients were told not to swallow during the procedure, or they were not given any instructions regarding swallowing., Results: Regarding the 143 participants in the study, no significant differences in age (P = .07), diameter and depth of the thyroid nodules (P = .14; P = .46, respectively), or cytologic diagnosis of thyroid aspirates (P > .20) were found between the swallowing (n = 50) and nonswallowing (n = 93) patient groups. Swallowing was observed in 29 patients who were instructed not to swallow (36%) and in 21 patients who were not given any instructions regarding swallowing (34%; P = .95). The mean duration of the procedure for swallowing patients was 19.8 seconds, and it was 15.7 seconds for nonswallowing patients. The duration of the procedure was significantly shorter in patients who did not swallow (P = .001). More male patients swallowed than female patients (P = .003)., Conclusions: Giving specific instructions about not swallowing did not make a difference regarding swallowing by patients during the FNAB procedure. More male patients swallowed than female patients. A longer duration of the FNAB procedure meant that the operator was more likely to encounter swallowing (and thus displacement of the thyroid) while doing the procedure. Completing the procedure quickly is the surest method to avoid a moving thyroid while performing FNAB.

Published
2010
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20. Morbidity after urodynamic study in diabetic patients.

Author

Yenilmez A, Kebapci N, Isikli B, Hamarat M, and Donmez T

Subjects
Diabetes Mellitus, Type 2 complications, Female, Humans, Male, Middle Aged, Morbidity, Risk Factors, Urinalysis, Urinary Tract Infections etiology, Diabetes Mellitus, Type 2 epidemiology, Diagnostic Techniques, Urological adverse effects, Urodynamics physiology
Abstract

The aim of this prospective study was to evaluate the morbidity of invasive urodynamic study (UDS) in type 2 diabetic patients. Study was conducted on 94 diabetic (59.4 +/- 0.8 years) and 110 non-diabetic (58.1 +/- 0.9 years) patients who had lower urinary tract symptoms. All patients underwent pressure-flow study. The major complication rate after UDS, including urinary tract infection, fever, urinary retention and gross hematuria, was 11.8% for non-diabetics and 22.3% for diabetics (p = 0.044). No significant differences were found between diabetics and non-diabetics according to gender with respect to dysuria, hematuria and pain (p > 0.05). Existence of pyuria before UDS was significantly higher in diabetic women with major complication than without major complication (p = 0.011). On the other hand, residual urine volume (p = 0.004) and diabetic cystopathy (0.005) were found significantly higher in diabetic men with major complication than without major complication. Our study demonstrated that UDS has an important role on the occurrence of high objective and subjective morbidity in diabetic and non-diabetic patients. Therefore, UDS indication should be carefully evaluated, especially in diabetic men who have high residual urine volume and diabetic women who have pyuria before UDS.

Published
2009
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21. Bladder dysfunction in type 2 diabetic patients.

Author

Kebapci N, Yenilmez A, Efe B, Entok E, and Demirustu C

Subjects
Aged, Albuminuria, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 drug therapy, Diet, Diabetic, Female, Humans, Hypoglycemic Agents therapeutic use, Male, Middle Aged, Diabetes Mellitus, Type 2 physiopathology, Diabetic Neuropathies physiopathology, Urinary Bladder Diseases epidemiology, Urologic Diseases epidemiology
Abstract

Aims: To reevaluate urodynamic findings of bladder dysfunction (BD) in type 2 diabetic patients with patient characteristics and concommittant chronic complications., Methods: Patients (M/F:27/27) with lower urinary tract symptoms (LUTS) underwent a detailed urodynamic investigation. Urodynamic findings were classified as diabetic cystopathy [DC, characterized by impaired bladder sensation, increased post-void residual urine (PVR) and increased bladder capacity and decreased bladder contractility], detrusor overactivity, bladder outlet obstruction (BOO), urge and stress urinary incontinence or BD in which one of the alterations was included. Glycated hemoglobin (HbA1C), diabetic retinopathy, nephropathy, sensorimotor, and autonomic neuropathies were evaluated., Results: BD was present in 74.07% of men (DC, 50%; BOO, 25%; detrusor overactivity, 25%) and in 59.26% of diabetic women (DC, 43.75%; detrusor overactivity, 31%; urge incontinence, 12.5%; stress urinary incontinence 12.5%). In men, age, duration of diabetes and HbA1C threshold values predicting BD were >64 years, >9 year, >7.9%, while in women, they were >56 years, >8 years, >7%, respectively. Prolongation of QTc, abnormal esophageal transit and gastric emptying times, diabetic retinopathy, and microalbuminuria were associated with an increased risk of PVR >or= 100 ml., Conclusions: DC was the most frequent finding in patients. Ageing, duration of diabetes, worse metabolic control, PVR 100 ml, cardiac, esophageal and gastric parasympathetic autonomic neuropathies, retinopathy, and microalbuminuria provided a means to predict BD in patients in order to investigate by urodynamics. The establishment of DC in at least 8-9 years after the diagnosis of type 2 DM was an important parameter to inform our diabetic patients., ((c) 2007 Wiley-Liss, Inc.)

Published
2007
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