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    Impact of Obesity on the Metabolic Control of Type 2 Diabetes: Results of the Turkish Nationwide Survey of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Obesity Study)
    (Karger, 2019) Sonmez, Alper; Yumuk, Volkan; Haymana, Cem; Demirci, Ibrahim; Barcin, Cem; Kiyici, Sinem; Guldiken, Sibel
    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
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    Summary of Bariatric Surgery Guideline of the Society of Endocrinology and Metabolism of Turkey
    (Aves, 2017) Sabuncu, Tevfik; Kiyici, Sinem; Eren, Mehmet Ali; Sancak, Seda; Sonmez, Alper; Guldiken, Sibel; Kutluturk, Faruk
    Obesity is a common condition affecting approximately one-third of the adult population worldwide. Obesity results in a number of medical, psychosocial and economical problems, in many patients, it is usually difficult to achieve the desired weight loss with medical therapies, several surgical approaches for weight loss have been developed in the recent years and are described as bariatric or metabolic surgery. Though bariatric surgery promotes dramatic and reliable improvement in obesity and related complications, yet proper patient selection and careful selection of the bariatric method along with good pre- and post-operative management is very important for a successful therapy. Therefore, the authors aim to present a short review on the Bariatric Surgery Guideline of the Society of Endocrinology and Metabolism of Turkey. The indications and contraindications for bariatric surgery, description of commonly used bariatric surgical methods, preoperative preparation of obese patients prior to the surgery, early and late postoperative management and follow-up of the patients have been summarized in this review. This review has been written in accordance with the opinions and recommendations of the Hypertension, Lipid Metabolism and Obesity Study Group of the Society of Endocrinology and Metabolism of Turkey.
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    Vitamin D receptor gene BsmI, FokI, ApaI, TaqI polymorphisms and bone mineral density in a group of Turkish type 1 diabetic patients
    (Springer-Verlag Italia Srl, 2011) Yavuz, Dilek Gogas; Keskin, Lezan; Kiyici, Sinem; Sert, Murat; Yazici, Dilek; Sahin, Ibrahim; Yuksel, Meral
    Previous studies have suggested an influence of vitamin D receptor alleles on bone metabolism and on susceptibility to type 1 diabetes mellitus in different ethnic populations. We aimed to investigate the distribution of vitamin D receptor (VDR) alleles in relation to biochemical bone turnover parameters and bone densitometry measurements in a group of Turkish type 1 diabetic patients. One hundred and seventeen patients (M/F 57/60, 27.6 +/- A 7.3 y duration of diabetes 8.1 +/- A 6.3 y) and 134 healthy controls (M/F 61/73, 26.2 +/- A 5.3 y) were included in the study. Bone mineral density (BMD) was evaluated by dual-energy X-ray absorptiometry (DEXA). The vitamin D receptor gene (VDR) polymorphisms FokI, Bsm1, Apa1, and Taq1 were examined using a PCR-based restriction analysis. Serum levels of calcium, phosphor osteocalcin, intact parathyroid hormone, and C telopeptide were measured. Vitamin D receptor Bsm1 Fok1, Apa1, and Taq1 genotype distributions were not different between patient with diabetes and control groups. BMD was 0.77 +/- A 0.2 g/cm(2) vs. 0.97 +/- A 0.2 g/cm(2) (P = 0.0001) for the femur, 1.0 +/- A 0.1 g/cm(2) vs. 1.13 +/- A 0.1 g/cm(2) (P = 0.001) for type 1 diabetic patients and controls. Bone turnover markers were significantly lower in type 1 diabetic group. BMD measurements and bone metabolic markers were not different between the genotypes in either the patient with diabetes or the controls. The VDR gene polymorphisms, Bsm1, Fok 1, Apa1, and Taq1 showed no influence on bone metabolism in our group of type 1 diabetic patients.