Journal of Istanbul Faculty of Medicine

SUBMITINFORMATION
EnglishTürkçe

Research Article


DOI :10.26650/IUITFD.2021.828573   IUP :10.26650/IUITFD.2021.828573    Full Text (PDF)

HOW DO WE FOLLOW THE GUIDELINES IN THE TREATMENT OF PATIENTS WITH TYPE 2 DIABETES?

İlkim Deniz Toprak, Özlem Kandemir Alibakan, Betül Köstek, Mehmet Alptekin Acar, İpek Bilge Aslan, Uğur Yılmaz, Hasan Eruzun, Yücel Arman, Tufan Tükek

Objective: We aimed to retrospectively investigate compliance with guidelines in order to increase the awareness of physicians towards current treatment approaches and goals in Type 2 diabetes mellitus (DM). Material and Method: Our study was designed as a retrospective, cross-sectional, analytical study. Patients who received treatment for Type 2 DM between January 2018 and January 2019 were randomly identified. Laboratory values, accompanying diseases, and medications used by the patients in their last one-year follow-up were recorded. Results: A total of 1,154 patients were included in the study. When the patients who came for regular check-ups every three months and those who did not were compared, there was no statistically significant difference between the initial hemoglobin A1c (HbA1c) and the final values (7.83%±1.94% and %7.99%±1.97%). At the end of one year, HbA1c values were statistically significantly lower than those of patients who did not come for control (7.18%±1,.5% and 7.91%±1.96%). 887 (76.8%) of a total of 1154 patients were using metformin regularly. In 149 of our patients, the initial HbA1c level was above 10% and insulin treatment was started immediately in 120 (80.5%) of these patients. Conclusion: In patients with Type 2 Diabetes, the frequency of follow-up and regulation of metformin and insulin treatment is generally good, but the use of GLP-1 receptor agonists or SGLT2 inhibitors, which are new anti-diabetic drug groups, is low. The rate of adding secondary therapy in dyslipidemic patients who do not achieve the targeted results with statin therapy has been found to be very low.

Keywords: Treatment of diabetes, guidelines, diabetes, insulin
DOI :10.26650/IUITFD.2021.828573   IUP :10.26650/IUITFD.2021.828573    Full Text (PDF)

TİP 2 DİYABETLİ HASTALARIN TEDAVİSİNDE KILAVUZLARA NE KADAR UYGUN HAREKET EDİYORUZ?

İlkim Deniz Toprak, Özlem Kandemir Alibakan, Betül Köstek, Mehmet Alptekin Acar, İpek Bilge Aslan, Uğur Yılmaz, Hasan Eruzun, Yücel Arman, Tufan Tükek

Amaç: Biz bu çalışma ile, Tip 2 diabetes mellitusta (DM) güncel tedavi yaklaşımları ve hedeflere yönelik hekimlerin farkındalığını artırmak için retrospektif olarak kılavuzlara uygunluğu araştırmayı hedefledik. Gereç ve Yöntem: Çalışmamız retrospektif, kesitsel, analitik bir çalışma olarak tasarlandı. Ocak 2018-Ocak 2019 tarihleri arasında Tip 2 DM nedeniyle tedavi alan hastalar, randomize olarak tespit edildi. Hastaların son bir yıllık takiplerindeki laboratuvar değerleri, eşlik eden hastalıkları ve kullandıkları ilaçlar kaydedildi. Bulgular: Çalışmaya toplam 1154 hasta dahil edilmiştir. Üç ayda bir düzenli kontrole gelenler ile gelmeyenler karşılaştırıldığında, başlangıç hemoglobin A1c (HbA1c) değerleri arasında istatistiksel olarak anlamlı bir fark saptanmaz iken (%7,83±%1,94 ve %7,99±%1,97), bir yılın sonunda, düzenli kontrole gelenlerin HbA1c değerleri kontrole gelmeyenlere göre istatistiksel olarak anlamlı olacak şekilde daha düşüktü (%7,18±%1,85 ve %7,91±%1,96). Toplam 1154 hastanın, 887’si (%76,8) düzenli olarak metformin kullanmaktaydı. Hastalarımızın 149’unda, başlangıç HbA1c düzeyi %10’un üzerinde idi ve bu hastaların 120’sine (%80,5) insülin tedavisi hemen başlanmıştı. Sonuç: Tip 2 diyabetli hastalarda takip sıklığı, metformin ve insülin tedavisinin düzenlenmesi konusunda genel olarak kılavuzlara uyumun iyi olduğu ancak yeni anti-diyabetik ilaç grupları olan GLP-1 reseptörü agonisti veya SGLT2 inhibitörlerinin kullanım oranlarının düşük olduğu ve statin tedavisi ile hedeflenen sonuçlara ulaşılamayan dislipidemik hastalarda ikincil tedavi eklenmesi oranlarının çok düşük olduğu saptanmıştır.

Keywords: Diyabet tedavisi, kılavuzlar, diyabet, insülin

PDF View

References

  • 1. Kleinberger JW, Pollin TI. Personalized medicine in diabetes mellitus: current opportunities and future prospects. Ann N Y Acad Sci 2015;1346(1):45-56. [CrossRef] google scholar
  • 2. Schmidt AM. Highlighting Diabetes Mellitus: The Epidemic Continues. Arterioscler Thromb Vasc Biol 2018;38(1):e1-8. [CrossRef] google scholar
  • 3. American Diabetes Association. Standards of Medical Care in Diabetes-2019 Abridged for Primary Care Providers. Clin Diabetes 2019;37(1):11-34. [CrossRef] google scholar
  • 4. World Health Organization. WHO Fact Sheets on Palliative Care. http://www.who.int/news-room/fact-sheets/detail/ palliative-care google scholar
  • 5. Kanter JE, Bornfeldt KE. Impact of Diabetes Mellitus. ArteriosclerThrombVasc Biol 2016;36(6):1049-53. [CrossRef] google scholar
  • 6. Türkiye Endokrinoloji ve Metabolizma Derneği Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu-2020 14. Baskı (Çevrimiçi Yayın): 25 Haziran 2020 (Güncellenmiş Baskı). (Erişim Tarihi: 01.07.2020, http:// temd. org.tr/admin/uploads/tbl_kilavuz/20200625154506-2020tbl_ kilavuz86bf012d90.pdf google scholar
  • 7. Sekimoto M, Ii M. Supplier-Induced Demand for Chronic Disease Care in Japan: Multilevel Analysis of the Association between Physician Density and Physician-Patient Encounter Frequency. Value Health Reg Issues 2015;6:103-10. [CrossRef] google scholar
  • 8. Anjana RM, Shanthirani CS, Unnikrishnan R, Mugilan P, Amutha A, Nair HD, et al. Regularity of follow-up, glycemic burden, and risk of microvascular complications in patients with type 2 diabetes: a 9-year follow-up study. Acta Diabetol 2015;52(3):601-9. [CrossRef] google scholar
  • 9. Javorsky E, Robinson A, Boer Kimball A. Evidence-based guidelines to determine follow-up intervals: a call for action. Am J Manag Care 2014;20(1):17-9. google scholar
  • 10. Hu M, Zhou Z, Zeng F, Sun Z. Effects of frequency of follow-up on quality of life of type 2 diabetes patients on oral hypoglycemics. Diabetes Technol Ther 2012;14(9):777-82. [CrossRef] google scholar
  • 11. American Diabetes Association, Standards of Medical Care in Diabetes-2016: Summary of Revisions. Diabetes Care 2016;39(Suppl 1):S4-5. [CrossRef] google scholar
  • 12. Bolen S, Tseng E, Hutfless S, Segal JB, Suarez-Cuervo C, Berger Z, et al. Diabetes Medications for Adults With Type 2 Diabetes: An Update, Comparative Effectiveness Reviews 173. Rockville (MD): Agency for Healthcare Research and Quality (US), 2016 Apr. Report No.: 16-EHC013-EF. google scholar
  • 13. Tuot DS, Lin F, Shlipak MG, Grubbs V, Hsu CY, Yee J, et al. CDC CKD Surveillance Team. Potential Impact of Prescribing Metformin According to eGFR Rather Than Serum Creatinine. Diabetes Care 2015;38(11):2059-67. [CrossRef] google scholar
  • 14. Inzucchi SE, Lipska KJ, Mayo H, Bailey CJ, McGuire DK. Metformin in patients with type 2 diabetes and kidney disease: a systematic review. JAMA 2014;312(24):2668-75. [CrossRef] google scholar
  • 15. Flory JH, Hennessy S. Metformin use reduction in mild to moderate renal impairment: possible inappropriate curbing of use based on food and drug administration contraindications. JAMA Intern Med 2015;175(3):458-9. [CrossRef] google scholar
  • 16. Crowley MJ, Diamantidis CJ, McDuffie JR, Cameron CB, Stanifer JW, Mock CK, et al. Clinical Outcomes of Metformin Use in Populations With Chronic Kidney Disease, Congestive Heart Failure, or Chronic Liver Disease: A Systematic Review. Ann Intern Med 2017;166(3):191-200. [CrossRef] google scholar
  • 17. DeFronzo RA, Abdul-Ghani MA. Preservation of p-cell function: the key to diabetes prevention. J Clin Endocrinol Metab 2011;96(8):2354-66. [CrossRef] google scholar
  • 18. Nathan DM, Kuenen J, Borg R, Zheng H, Schoenfeld D, Heine RJ; A1c-Derived Average Glucose Study Group. Translating the A1C assay into estimated average glucose values. Diabetes Care 2008;31(8):1473-8. Erratum in: Diabetes Care 2009;32(1):207. [CrossRef] google scholar
  • 19. Hou X, Liu J, Song J, Wang C, Liang K, Sun Y, et al. Relationship of Hemoglobin A1c with p Cell Function and Insulin Resistance in Newly Diagnosed and Drug Naive Type 2 Diabetes Patients. J Diabetes Res 2016;2016:8797316. [CrossRef] google scholar
  • 20. Haymana C, Sonmez A, Demirci I, Yaylalı GF, Nuhoğlu İ, Sancak S, et al., TEMD Study Group. Patterns and preferences of antidiabetic drug use in Turkish patients with type 2 diabetes - A nationwide cross-sectional study (TEMD treatment study). Diabetes Res Clin Pract 2021;171:108556. [CrossRef] google scholar
  • 21. Sharma D, Verma S, Vaidya S, Kalia K, Tiwari V. Recent updates on GLP-1 agonists: Current advancements & challenges. Biomed Pharmacother 2018;108:952-62. [CrossRef] google scholar
  • 22. Andrikou E, Tsioufis C, Andrikou I, Leontsinis I, Tousoulis D, Papanas N. GLP-1 receptor agonists and cardiovascular outcome trials: An update. Hellenic J Cardiol 2019;60(6):347-51. [CrossRef] google scholar
  • 23. Armstrong MJ, Hull D, Guo K, Barton D, Hazlehurst JM, Gathercole LL, et al. Glucagon-like peptide 1 decreases lipotoxicity in non-alcoholic steatohepatitis. J Hepatol 2016;64(2):399-408. [CrossRef] google scholar
  • 24. Kosiborod M, Lam CSP, Kohsaka S, Kim DJ, Karasik A, Shaw J, et al; CVD-REAL Investigators and Study Group. Cardiovascular Events Associated With SGLT-2 Inhibitors Versus Other Glucose-Lowering Drugs: The CVD-REAL 2 Study. J Am Coll Cardiol 2018;71(23):2628-39. [CrossRef] google scholar
  • 25. Sillars A, Sattar N. Management of Lipid Abnormalities in Patients with Diabetes. Curr Cardiol Rep 2019;21(11):147. [CrossRef] google scholar
  • 26. Fox CS, Pencina MJ, Wilson PW, Paynter NP, Vasan RS, D’Agostino RB Sr. Lifetime risk of cardiovascular disease among individuals with and without diabetes stratified by obesity status in the Framingham heart study. Diabetes Care 2008;31(8):1582-4. [CrossRef] google scholar
  • 27. Cholesterol Treatment Trialists’ (CTT) Collaboration, Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010;376(9753):1670-81. [CrossRef] google scholar
  • 28. Newman CB, Preiss D, Tobert JA, Jacobson TA, Page RL, Goldstein LB, et al. A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol 2019;39(2):e38-81. Erratum in: Arterioscler Thromb Vasc Biol 2019;39(5):e158. google scholar

Citations

Copy and paste a formatted citation or use one of the options to export in your chosen format


EXPORT



APA

Toprak, İ.D., Kandemir Alibakan, Ö., Köstek, B., Acar, M.A., Aslan, İ.B., Yılmaz, U., Eruzun, H., Arman, Y., & Tükek, T. (2020). HOW DO WE FOLLOW THE GUIDELINES IN THE TREATMENT OF PATIENTS WITH TYPE 2 DIABETES?. Journal of Istanbul Faculty of Medicine, 84(3), 369-375. https://doi.org/10.26650/IUITFD.2021.828573


AMA

Toprak İ D, Kandemir Alibakan Ö, Köstek B, Acar M A, Aslan İ B, Yılmaz U, Eruzun H, Arman Y, Tükek T. HOW DO WE FOLLOW THE GUIDELINES IN THE TREATMENT OF PATIENTS WITH TYPE 2 DIABETES?. Journal of Istanbul Faculty of Medicine. 2020;84(3):369-375. https://doi.org/10.26650/IUITFD.2021.828573


ABNT

Toprak, İ.D.; Kandemir Alibakan, Ö.; Köstek, B.; Acar, M.A.; Aslan, İ.B.; Yılmaz, U.; Eruzun, H.; Arman, Y.; Tükek, T. HOW DO WE FOLLOW THE GUIDELINES IN THE TREATMENT OF PATIENTS WITH TYPE 2 DIABETES?. Journal of Istanbul Faculty of Medicine, [Publisher Location], v. 84, n. 3, p. 369-375, 2020.


Chicago: Author-Date Style

Toprak, İlkim Deniz, and Özlem Kandemir Alibakan and Betül Köstek and Mehmet Alptekin Acar and İpek Bilge Aslan and Uğur Yılmaz and Hasan Eruzun and Yücel Arman and Tufan Tükek. 2020. “HOW DO WE FOLLOW THE GUIDELINES IN THE TREATMENT OF PATIENTS WITH TYPE 2 DIABETES?.” Journal of Istanbul Faculty of Medicine 84, no. 3: 369-375. https://doi.org/10.26650/IUITFD.2021.828573


Chicago: Humanities Style

Toprak, İlkim Deniz, and Özlem Kandemir Alibakan and Betül Köstek and Mehmet Alptekin Acar and İpek Bilge Aslan and Uğur Yılmaz and Hasan Eruzun and Yücel Arman and Tufan Tükek. “HOW DO WE FOLLOW THE GUIDELINES IN THE TREATMENT OF PATIENTS WITH TYPE 2 DIABETES?.” Journal of Istanbul Faculty of Medicine 84, no. 3 (Dec. 2024): 369-375. https://doi.org/10.26650/IUITFD.2021.828573


Harvard: Australian Style

Toprak, İD & Kandemir Alibakan, Ö & Köstek, B & Acar, MA & Aslan, İB & Yılmaz, U & Eruzun, H & Arman, Y & Tükek, T 2020, 'HOW DO WE FOLLOW THE GUIDELINES IN THE TREATMENT OF PATIENTS WITH TYPE 2 DIABETES?', Journal of Istanbul Faculty of Medicine, vol. 84, no. 3, pp. 369-375, viewed 23 Dec. 2024, https://doi.org/10.26650/IUITFD.2021.828573


Harvard: Author-Date Style

Toprak, İ.D. and Kandemir Alibakan, Ö. and Köstek, B. and Acar, M.A. and Aslan, İ.B. and Yılmaz, U. and Eruzun, H. and Arman, Y. and Tükek, T. (2020) ‘HOW DO WE FOLLOW THE GUIDELINES IN THE TREATMENT OF PATIENTS WITH TYPE 2 DIABETES?’, Journal of Istanbul Faculty of Medicine, 84(3), pp. 369-375. https://doi.org/10.26650/IUITFD.2021.828573 (23 Dec. 2024).


MLA

Toprak, İlkim Deniz, and Özlem Kandemir Alibakan and Betül Köstek and Mehmet Alptekin Acar and İpek Bilge Aslan and Uğur Yılmaz and Hasan Eruzun and Yücel Arman and Tufan Tükek. “HOW DO WE FOLLOW THE GUIDELINES IN THE TREATMENT OF PATIENTS WITH TYPE 2 DIABETES?.” Journal of Istanbul Faculty of Medicine, vol. 84, no. 3, 2020, pp. 369-375. [Database Container], https://doi.org/10.26650/IUITFD.2021.828573


Vancouver

Toprak İD, Kandemir Alibakan Ö, Köstek B, Acar MA, Aslan İB, Yılmaz U, Eruzun H, Arman Y, Tükek T. HOW DO WE FOLLOW THE GUIDELINES IN THE TREATMENT OF PATIENTS WITH TYPE 2 DIABETES?. Journal of Istanbul Faculty of Medicine [Internet]. 23 Dec. 2024 [cited 23 Dec. 2024];84(3):369-375. Available from: https://doi.org/10.26650/IUITFD.2021.828573 doi: 10.26650/IUITFD.2021.828573


ISNAD

Toprak, İlkimDeniz - Kandemir Alibakan, Özlem - Köstek, Betül - Acar, MehmetAlptekin - Aslan, İpekBilge - Yılmaz, Uğur - Eruzun, Hasan - Arman, Yücel - Tükek, Tufan. “HOW DO WE FOLLOW THE GUIDELINES IN THE TREATMENT OF PATIENTS WITH TYPE 2 DIABETES?”. Journal of Istanbul Faculty of Medicine 84/3 (Dec. 2024): 369-375. https://doi.org/10.26650/IUITFD.2021.828573



TIMELINE


Submitted25.11.2020
Accepted13.04.2021
Published Online25.11.2020

LICENCE


Attribution-NonCommercial (CC BY-NC)

This license lets others remix, tweak, and build upon your work non-commercially, and although their new works must also acknowledge you and be non-commercial, they don’t have to license their derivative works on the same terms.


SHARE




Istanbul University Press aims to contribute to the dissemination of ever growing scientific knowledge through publication of high quality scientific journals and books in accordance with the international publishing standards and ethics. Istanbul University Press follows an open access, non-commercial, scholarly publishing.