Search

Background/aim: To evaluate the impact of treatment with sodium-glucose co-transporter-2 (SGLT2) Inhibitors on quality of life (QoL), sleep quality (SQ), and anxiety levels in patients with Type 2 diabetes mellitus (T2DM). Materials and methods: Ninety-seven patients with type 2 diabetes admitted to tertiary care hospital diabetes clinic were included. Fifty patients were randomized to receive SGLT2 inhibitors in addition to baseline treatment (Group A), 47 subjects continued with their baseline treatment or were added other medications as needed (Group B). Thirty healthy controls (HC) were recruited (Group C). All groups were subjected to the Turkish version of Short Form-36 (SF-36), Pittsburgh Sleep Quality (PSQ), and Beck Anxiety Inventory (BAI) scales both at baseline and final visit. Results: Physical function, emotional role limitation, vitality, mental health, pain, general health perception scores of SF-36 were significantly improved in Group A, at the end of the follow-up period. There was no significant change in terms of PSQ, BAI scores, and hypoglycaemia documented in all groups. The intervention-related change in HbA1c level, body weight, and body mass index were significantly higher in Group A. Conclusion: The QoL was improved in people with diabetes who were taking SGLT2 inhibitors. This may be explained by weight loss observed in participants.

WOS:000579120800001 Objective: Diabetes and insomnia are serious public health problems worldwide. The cause-and-effect relationship between them is rather complicated. This study planned to evaluate the presence of insomnia and associated factors in patients with type 2 diabetes mellitus (T2DM). Materials and Methods: A total of 81 (36 male and 45 female) patients with T2DM were recruited into our study. Pulmonary disease, congestive heart failure, Obstructive Sleep Apnea syndrome, and cognitive disorders were determined as exclusion criteria from the study. Demographic and disease characteristics were noted. Pittsburgh Insomnia Rating scale 20 (PIRS-20), Pittsburgh Sleep Quality index (PSQI), Beck Depression inventory (BDI), Beck Anxiety inventory (BAI), Berlin questionnaire, and Douleur neuropathique-4 questionnaire (DN-4) to detect neuropathic pain were filled in a face-to-face interview. Results: The mean age of our patients was 60.0 +/- 11.6 years, and median diabetes duration was 15 years (7-18 years). Median PIRS-20 score was 16 points (9-24 points) and 43.2% (n=35) had insomnia. Median PSQI score was 6 points (3, 5-8 points), and poor sleep quality was present in 50.6% (n=41) of the patients. There was no statistically significant difference between patients who had diabetes, with and without insomnia, in terms of sociodemographic features, micro- and macro-vascular complications, glycemic control, and Restless Legs syndrome. Conversely, significant association was observed between PIRS-20 and PSQI (r=0.78; p

Background: The effect of diabetic polyneuropathy (DPN) and autonomic neuropathy (AN) on bone turnover in type 2 diabetes mellitus (DM) is uncertain due to the lack of data. In this study, we tried to determine the effect of DPN and AN on bone metabolism. Materials and Methods: The study included patients with type 2 DM (aged 18-80 years) and age-matched healthy individuals who presented to the Departments of Metabolism and Diabetes, Geriatrics, and General Internal Medicine, Cerrahpasa Medical School, Istanbul University. The patients were examined to find out whether they had AN, and neuropathy scores were recorded by exploring peripheral neuropathy. Bone mineral density was measured by dual-energy X-ray (DXA). Demographic characteristics, the presence of microvascular complications, and biochemical data were obtained from patients' files. Serum cross-linked C-telopeptide (Ctx), osteocalcin, and bone-specific alkaline phosphatase (B-ALP) were analyzed. Results: The study comprised a total of 64 patients: 23 had type 2 DM and osteoporosis (OP) (duration of diabetes 10.1 ± 7 years; mean age 63 ± 9.1 years; female/male 18/5; Group 1), 41 had type 2 DM and non-OP (duration of diabetes 10.3 ± 7.6 years; mean age 58 ± 7.4 years; female/male 30/11; Group 2), and 26 healthy volunteers made up the control group (mean age 62 ± 11.9 years; female/male 14/12; Group 3). The bone turnover parameters were lower in type 2 DM individuals. The levels of osteocalcin (13.3 ± 5.2 ng/mL) and B-ALP (44.7 ± 10.9 IU/L) in patients with type 2 DM were lower than those of healthy subjects: osteocalcin (20.6 ± 10 ng/mL) and B-ALP (111 ± 31.4 IU/L; P = 0.001 and P = 0.000, respectively). Ctx levels (193.5 ± 49.3; 207.6 ± 40 ng/mL) were recorded to be similar (P = 0.2). AN was also noted as a risk factor for OP. For patients without AN, the likelihood of developing OP (odds ratio) was 0.7. The corresponding ratio for patients with AN was 9.3. Conclusions: Among the independent variables, the neuropathy score was determined to have an impact on bone turnover. AN was identified to be a significant risk factor for OP.

WOS:000520008400006 Objective: Fatigue is a common symptom in diabetes mellitus. The aim of this study was to determine the factors leading to fatigue and to investigate the effect of insulin use on fatigue among the diabetic population. Material and Methods: One-hundred diabetic patients attending the diabetes clinic of Cerrahpasa Medical Faculty between October 2017-January 2018 and 42 healthy controls were evaluated in this cross-sectional study. Questionnaires including demographic and disease characteristics, Fatigue Impact Scale (FIS), Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), quality of life scale (SF-36), Epworth Sleepiness Scale (ESS), and Pittsburgh Sleep Quality Index (PSQI) were used. Results: Ages (47.6 +/- 14.8 and 45.7 +/- 14.1 years; p=0.47) and body mass indices (26.6 +/- 4.1 and 25.3 +/- 3.5 kg/m(2); p=0.08) of 100 patients with diabetes (Type 1 Diabetes/Type 2 Diabetes=29/71) and 42 healthy volunteers were similar. The diabetic group had worse FIS total (p=0.05), FIS psychological (p=0.04) scores and SF-36 scores compared to the healthy controls. When the patients with diabetes were divided into two groups according to insulin use and compared with healthy controls, the ESS and PSQI were similar but all FIS parameters (total p=0.005, cognitive p=0.007, physical p=0.01, psychological p=0.009) and BDI (p=0.05) were significantly worse in patients with insulin use than non-insulin and control groups. The relationship between fatigue and insulin use was independent of glycemic control and duration of diabetes but was affected by the BDI (p=0.001). Conclusion: Insulin use leads to fatigue in patients with diabetes, regardless of diabetes type, and this effect is influenced by depressive mood. Psychotherapeutic approaches prior to insulin treatment might yield fruitful results.

Background Chronic migraine has a well-documented association with increased insulin resistance and metabolic syndrome. The hypothalamus may play a role in the progression of insulin resistance in chronic migraine through the regulation of orexigenic peptides such as neuropeptide Y. Insulin resistance may lead to increased risk of future type 2 diabetes mellitus in patients with chronic migraine, which is more likely to occur if other pathogenetic defects of type 2 diabetes mellitus, such as impaired pancreatic β-cell functions and defects in intestinal glucagon-like peptide-1 secretion after meals. We studied the relationship of fasting neuropeptide Y with insulin resistance, β-cell function, and glucagon-like peptide-1 secretion in non-obese female chronic migraine patients. We also aimed to investigate glucose-stimulated insulin and glucagon-like peptide-1 secretions as early pathogenetic mechanisms responsible for the development of carbohydrate intolerance. Methods In this cross-sectional controlled study, 83 non-obese female migraine patients of reproductive age categorized as having episodic migraine or chronic migraine were included. The control group consisted of 36 healthy females. We studied glucose-stimulated insulin and glucagon-like peptide-1 secretion during a 75 g oral glucose tolerance test. We investigated the relationship of neuropeptide Y levels with insulin resistance and β-cell insulin secretion functions. Results Fasting glucose levels were significantly higher in migraine patients. Plasma glucose and insulin levels during the oral glucose tolerance test were otherwise similar in chronic migraine, episodic migraine and controls. Patients with chronic migraine were more insulin resistant than episodic migraine or controls ( p = 0.048). Glucagon-like peptide-1 levels both at fasting and two hours after glucose intake were similar in chronic migraine, episodic migraine, and controls. Neuropeptide Y levels were higher in migraineurs. In chronic migraine, neuropeptide Y was positively correlated with fasting glucagon-like peptide-1 levels (r = 0.57, p = 0.04), but there was no correlation with insulin resistance (r = 0.49, p = 0.09) or β-cell function (r = 0.50, p = 0.07). Discussion Non-obese premenopausal female patients with chronic migraine have higher insulin resistance, but normal β-cell function is to compensate for the increased insulin demand during fasting and after glucose intake. Increased fasting neuropeptide Y levels in migraine may be a factor leading to increased insulin resistance by specific alterations in energy intake and activation of the sympathoadrenal system.

Purpose: To evaluate whether fibroblast growth factor-23 (FGF-23) has a common role in the pathogenesis of peripheral arterial disease (PAD) and chronic kidney disease (CKD) in type-2 diabetes mellitus (DM). Material and Method: Twenty-one patients with diabetic nephropathy composed the diabetic nephropathy (DM-NP) group and 20 subjects with DM but without NP constituted the DM group. The control group was comprised of 10 age- and gender-matched non-diabetic individuals with CKD. Results: FGF-23 levels were similar in DM-NP and CKD groups (p=0.5). Both groups had higher FGF-23 levels compared to DM group (p

Aim: Insulin degludec/aspart (IDegAsp) co-formulation therapy is a novel drug in Turkey and the aim of this study was to retrospectively evaluate the effects of IDegAsp therapy on glycemic control and hypoglycemia in a single tertiary center in Turkey.Material and Methods: The medical records of patients with type 2 diabetes mellitus, who were evaluated at diabetes clinic of Cerrahpasa Medical Faculty between January and April 2018 and had started to use IDegAsp, were investigated. The demographic characteristics of the patients, anti-diabetic medications they were currently using, causes of treatment change, the IDegAsp doses, fasting blood glucose (FBG), HbA1c and hypoglycemic episodes at treatment onset, the third and sixth months of therapy were evaluated.Results: Sixty-six patients (F/M:34/32; mean age:57.8±11,6years) were evaluated. Uncontrolled hyperglycemia (80.3%) and frequent hypoglycemic attacks (19,7%) were the causes of treatment change. IDegAsp was started as a single dose in 53% and double dose in 47% of patients. Sixty-two patients (93.9%) were using insulin and the number of injections were significantly reduced with IDegAsp (p0.001). There was no statistically significant difference in terms of insulin doses in sixth months of treatment (p=0.054), whereas FBG (p0.001), HbA1c (p0.001) levels and hypoglycemic attacks (p0.001) were reduced and the improvement in glycemic control occured particularly in the first 3 months of therapy.Conclusion: Glycemic control and hypoglycemic episodes were improved and the number of daily injections decreased with 6-months of IDegAsp treatment. IDegAsp, which is a novel drug for our country, may increase the treatment compliance of the patients and thus facilitate reaching the glycemic targets.

Introduction: Using the Turkish and rest of world (ROW) Injection Technique Questionnaire (ITQ) data we address key insulin injection complications. Methods: Summarized in first ITQ paper. Results: Nearly one-third of Turkish insulin users described lesions consistent with lipohypertrophy (LH) at heir injection sites and 27.4% were found to have LH by the examining nurse (using visual inspection and palpation). LH lesions in the abdomen and thigh of Turkish patients are slightly smaller than those measured in ROW but more than half of Turkish patients who have LH continue to inject into them at least daily. More than a quarter of Turkish patients have frequent unexplained hypoglycemia and nearly 2 out of 5 have glycemic variability, both of which have been linked to the presence of LH and the habit of injecting into it. Nearly half of Turkish injectors report having pain on injection. Of these, just over half report having painful injections only several times a month or year (i.e., not with every injection). In Turkey the diabetes nurse has by far the major role in teaching patients how to inject. Nearly 40% of Turkish injectors get their sites checked at least annually, and a larger roportion than ROW had received recent (within the last 12 months) instruction on how to inject properly. Conclusion: Turkish patients and professionals have clearly made progress in injection technique, but there are still considerable challenges ahead which the new Turkish guidelines will help address., BD Diabetes Care

Background: The level of glycemic control is considered to be too low among patients with type 2 diabetes mellitus (DM) in Turkey. Despite availability of several anti-diabetic treatment alternatives, substantial amount of diabetic patients are at increased risk of diabetes-related macrovascular as well as microvascular complications.Objective: To evaluate glycemic control, disease-related complications and treatment patterns in patients with type 2 DM in Turkey and the effect of novel anti-diabetic therapeutics, especially, insulin analogues in on these parameters. Material and Method: In this systematic review, we included studies on type 2 diabetes mellitus patients published in national and international journals and the abstracts presented in the congresses held in Turkey from 1990 to 2010. The common property of these publications was the inclusion of study population ofadult type 2 diabetes mellitus patients with available data regarding HbA1c values, frequency of diabetes-related complications, and treatments. Of 136 publications screened, a total of 92 were considered eligible to be analysed and were included in the present systematic review. Results and Conclusion: The mean±SD HbA1c level was determined to be 8.34%±0.90% in studies providing data on HbA1c level (64 publications with 16.378 patients) This value was 8.90% in publications of 1990-1999 while decreased to 8.28% in 2000-2008. The rates of patients with appropriate glycemic control (HbA1c level of

Recently, the prevalence of type 2 diabetes has reached pandemic levels all over the world, and the problem is still growing. Type 2 diabetes is a progressive disease, in which insulin resistance and decrease in beta cell function accompany obesity. Early disorder, which ensues in clinical progression of the disease, is the defect of early phase insulin secretion. Patients have already lost approximately half of their beta cell reserve at the time of diagnosis. Aims of type 2 diabetes treatment are to eliminate hyperglycemia caused by insufficient insulin secretion and/or insulin resistance, to slow down beta cell destruction/depletion, to improve concomitant metabolic problems and to prevent complications. In treatment algorithms, insulin is evaluated as a replacement therapy at the following stage after life style changes (medical nutrition therapy, exercise) and oral anti-diabetic drugs (OADs) options. Since beta cell depletion is present at initial stages of the disease, it transforms insulin therapy into an earlier approach in treatment stages. Premixed insulin forms are one of the proposed treatment options in patients with hyperglycemia that is not controlled by OADs. These types of insulins are developed to meet both basal and postprandial insulin requirements of patients. Currently, premixed human insulin forms are replaced by analogue insulin forms, which can mimic the physiological secretion in more acceptable manner. Biphasic analogue insulin is one of the readily available pre-mixed analogue insulin forms, an example of this, Biphasic Insulin aspart 30 which is the one of the premixed analoge insulin forms, contains 30% insulin aspart and 70% protaminated insulin aspart. Consensus recommending the individualized approach in insulin therapy implies that physicians should have more detailed information about the use of different insulin forms. Although a global consensus report about initiation, titration and intensification and the use of Biphasic Insulin Aspart 30 treatment has been published recently, these types of guidelines cannot always respond to all of the local requirements. Therefore, it is aimed to prepare a guideline to facilitate the use of Biphasic Insulin Aspart 30 in the right patient, at the right time and in the right manner, as well as to help the physicians. A guideline, aiming to contain current evidences and to meet local requirements, was developed in May and June 2010 by an expert panel composed of experienced endocrinologists working at different parts of Turkey. The guideline includes initial treatment, optimization of initiation dose, and intensification of Biphasic Insulin Aspart 30 during the disease progression. Although previously published global guidelines about initiation, intensification, dose division, dose addition and combination of Biphasic Insulin Aspart 30 with OADs is in applicable situation in general, the content is enlarged by adding some special conditions. Administration information presented in this article forms simply a suggestion rather than a strict recommendation. Since the treatment of every diabetic patient should be individualized, suggestions of this guideline do not have any obligatory power on physicians. Turk Jem 2011; 15: 65-70

In diabetes mellitus, chronic hyperglycemia leads to formation of advanced glycation end products (AGEs). Binding of AGEs to receptors of AGE (RAGE) causes deleterious effects. In populations with a high consumption of n-3 long-chain polyunsaturated fatty acids, a lower prevalence of diabetes mellitus has been reported. We aimed to investigate the effects of n-3 fatty acid (EPA and DHA) supplementation on the levels of AGEs (carboxymethyl lysine (CML) and pentosidine), sRAGE, and nuclear factor kappa B (NF-kB) in type 2 diabetes mellitus (T2DM). T2DM patients (n = 38) treated with oral hypoglycemic agents, without insulin were supplemented with n-3 fatty acids (1.2 g/day) for 2 months. Plasma CML, pentosidine, sRAGE, and NF-kB levels were measured by ELISA both before and after the supplementation. n-3 fatty acid supplementation significantly reduced fasting glucose (p

Background Comorbidity of migraine with anxiety and depression may play a role in the link between migraine and obesity. We examined the moderating and mediating roles of ghrelin in the relationship between depression (and anxiety) and body weight in newly diagnosed migraineurs. Methods Participants were 63 newly diagnosed migraine patients (using the ICHD-II criteria) and 42 healthy volunteers. Body mass index (BMI) was calculated by measuring height and weight. Ghrelin was assessed at fasting. Depression was assessed with the Hamilton Depression scale, and anxiety with the Hamilton Anxiety scale. Results The data did not support the mediating role of ghrelin in the relationship between depression (or anxiety) and BMI for either the migraine or the control group. The interaction between ghrelin and depression as well as anxiety was significant for the migraine group, but not for the control group. Depressed (or anxious) migraineurs had a positive association between ghrelin and BMI, whereas for the non-depressed (or non-anxious) migraineurs this association was negative. Conclusions Depression and anxiety moderated the effect of ghrelin on BMI for migraineurs. Management of anxiety and depression might be regarded as part of migraine treatment.