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Öğe Alteration in Bone Metabolism Markers Fallowing 3-Months Insulin Therapy in Patients with Type 2 Diabetes Mellitus: Analogues Vs. Human Insulins(Endocrine Soc, 2014) Sahin, Ibrahim; Karaca, Zuhal; Taskapan, Cagatay; Ozyalin, Fatma; Yologlu, Saim[Abstract Not Available]Öğe Angiotensin-converting enzyme gene polymorphism and risk of insulin resistance in PCOS(Elsevier Sci Ltd, 2010) Celik, Onder; Yesilada, Elif; Hascalik, Seyma; Celik, Nilufer; Sahin, Ibrahim; Keskin, Lezzan; Ozerol, ElifThe aim of this study was to establish the frequency of angiotensin-converting enzyme (ACE) insertion (I) or deletion (D) gene polymorphism in women with polycystic ovary syndrome (PCOS) and to examine the association of this polymorphism with insulin resistance. A total of 32 women with PCOS and 31 healthy, age- and body mass index-matched controls were studied. Serum lipids, fasting glucose, insulin and other hormones concentrations were measured. Homeostasis model assessment was used to estimate insulin resistance (HOMA-IR). DNA was extracted from peripheral blood leukocytes and genotyping of ACE I/D polymorphism was carried out by polymerase chain reaction. ACE genotypes were distributed as follows: DD was present in 16 (50%), ID in 12 (37.5%) and II in four (12.5%) PCOS patients, and DD in seven (22.6%), ID in 20 (64.5%) and II in four (12.9%) of healthy subjects. The frequency of D and I alleles were found in 69% and 31% of the PCOS group and 55% and 45% in the control group, respectively. There were no significant differences regarding the genotypic distribution and allelic frequency between the groups. However the ACE DD genotype was significantly associated with serum insulin concentrations and HOMA-IR measurement (both P = 0.005). ACE DD genotype is associated with an increased insulin resistance in women with PCOS. (C) 2010, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.Öğe An appraisal of serum preptin levels in PCOS(Elsevier Science Inc, 2011) Celik, Onder; Celik, Nilufer; Hascalik, Seyma; Sahin, Ibrahim; Aydin, Suleyman; Ozerol, ElifPlasma preptin levels were higher in women with PCOS compared with the control group (mean +/- SD, 823.2 +/- 140.7 vs. 324.9 +/- 147.3 pg/mL). This article suggests a potential role of preptin in the pathogenesis of PCOS. (Fertil Steril (R) 2011; 95:314-6. (c) 2011 by American Society for Reproductive Medicine.)Öğe Characteristics of patients with hypertension in a population with type 2 diabetes mellitus. Results from the Turkish Nationwide SurvEy of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Hypertension Study)(Elsevier Sci Ltd, 2021) Sabuncu, Tevfik; Sonmez, Alper; Eren, Mehmet Ali; Sahin, Ibrahim; Corapcioglu, Demet; Ucler, Rifki; Akin, SafakBackground: 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. Methods: 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. Results: 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 p < 0.001) 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 p < 0.001). The percentage of macro and microvascular complications was higher in the hypertensive group than in the normotensive one (both p < 0.001). 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. Conclusion: 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. (c) 2020 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.Öğe Clinical Characteristics and Outcomes of COVID-19 Patients with Overweight and Obesity: Turkish Nationwide Cohort Study (TurCObesity)(Georg Thieme Verlag Kg, 2022) Sahin, Ibrahim; Haymana, Cem; Demir, Tevfik; Demirci, Ibrahim; Tasci, Ilker; Atmaca, Aysegul; Cakal, ErmanPurpose 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<0.001) were associated with a higher intubation/mechanical ventilation rate but only obesity was associated with increased mortality (OR, 95% CI: 2.56, 1.40-4.67; p=0.002). Old age, male gender, chronic kidney disease, and high C reactive protein levels were independently associated with COVID-19 mortality in overweight or obese patients. 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.Öğe Comment on: Risk Factors and Outcomes of the Post-Liver Transplantation Diabetes Mellitus(Aves, 2023) Topaloglu, Omercan; Topaloglu, Seda Nur; Sahin, Ibrahim[Abstract Not Available]Öğe A Cross-Sectional Study of the Prevalence of Cardiovascular Disease in Adults with Type 2 Diabetes in Turkiye: The CAPTURE Study(Aves, 2022) Bayram, Fahri; Bayraktaroglu, Taner; Sargin, Mehmet; Sahin, Ibrahim; Guldiken, Sibel; Dalbeler, Aysegul; Sonmez, AlperObjective: The primary objective of the CAPTURE study was to estimate the prevalence of cardiovascular disease (CVD) in adults with Type 2 diabetes mellitus (T2DM) across 13 countries from 5 continents. Here, we present the findings from Turkiye. Material and Methods: The non-interventional, cross-sectional CAPTURE study (NCT03811288; NCT03786406) was conducted across 15 centers in Turkiye. Standardized demographic and clinical data were collected from adults with T2DM who were treated by primary or specialist care physicians. The prevalences of CVD and its 7 subtypes were estimated. Descriptive statistics were used for data analysis. Results: Amongst the 801 participants (n=200 from primary care, n=601 from specialist care) with T2DM enrolled, 250 had established CVD, an estimated weighted prevalence of 31.2% (28.0-34.4) 95% confidence interval. Atherosclerotic CVD contributed to the majority (85.6%) of the CVD cases. An estimated 24.0% of the Turkiye sample had coronary heart disease (CHD). Heart failure was the second most predominant CVD subtype in Turkiye is correct sample (5.4%), followed by cardiac arrhythmia and conduction abnormalities (4.7%). Sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists with cardiovascular (CV) benefits were prescribed to 17.5% and 0.1% of the patients, respectively. Conclusion: Approximately 30% of participants with T2DM had established CVD in the CAPTURE Turkiye population, comparable to the global pooled prevalence. CHD was the major contributor and encompassed approximately 75% of the CVD cases. The use of glucose-lowering medication with CV benefits was low compared to the global pooled population, which may be due to the lack of reimbursement of these medications in Turkiye.Öğe Current Position of Gliclazide and Sulfonylureas in the Contemporary Treatment Paradigm for Type 2 Diabetes: A Scoping Review(Springer Heidelberg, 2024) Sahin, Ibrahim; Bakiner, Okan; Demir, Tevfik; Sari, Ramazan; Atmaca, AysegulThe increasing burden of type 2 diabetes (T2D), in relation to alarming rise in the prevalence; challenges in the diagnosis, prevention, and treatment; as well as the substantial impact of disease on longevity and quality of life, is a major concern in healthcare worldwide. Sulfonylureas (SUs) have been a cornerstone of T2D pharmacotherapy for over 60 years as oral antidiabetic drugs (OADs), while the newer generation SUs, such as gliclazide modified release (MR), are known to be associated with low risk of hypoglycemia in addition to the cardiovascular neutrality. This scoping review aimed to specifically address the current position of gliclazide MR among other SUs in the contemporary treatment paradigm for T2D and to provide a practical guidance document to assist clinicians in using gliclazide MR in real-life clinical practice. The main topics addressed in this paper include the role of early and sustained glycemic control and use of SUs in T2D management, the properties of gliclazide MR in relation to its effectiveness and safety, the use of gliclazide therapy in special populations, and the place of SUs as a class and gliclazide MR specifically in the current T2D treatment algorithm.Öğe Cytological and cytomorphometric characteristics of buccal mucosa cells from smokeless tobacco users(Wiley, 2017) Dagli, Adile Ferda; Sahin, Nurhan; Bozdag, Zehra; Ucer, Ozlem; Akatli, Ayse Nur; Artas, Gokhan; Sahin, IbrahimBackgroundUse of smokeless tobacco (ST) is increasing in many communities. We investigated whether ST alters the cytological and cytomorphometric features of buccal mucosa cells. MethodsTwenty male participants who had used Nicotiana rustica Linn.-containing ST (Maras powder) for at least 10 years, and 20 healthy male controls who did not use ST, were included in this study. After rinsing the mouth with water, samples were taken using a toothbrush from the buccal mucosa of subjects in both groups. Samples were gently spread over a glass slide. After applying a cytofixative spray, the Papanicolaou method was used to stain the slides. The presence of dysplasia, dyskeratosis, parakeratosis, hyperkeratosis, hypergranulosis, karyorrhexis, and pyknosis was evaluated by light microscopy, as were the increment amount of candida, cocco-bacillus, and Leptotrichia buccalis. Cytomorphometric analysis was performed and at least 20 cells with well-defined borders were evaluated from each slide, and the cellular diameter (CD), nuclear diameter (ND), and nucleus/cytoplasm (N/C) ratio of the cells were analyzed using a 60x objective. ResultsOther than the presence of dysplasia and candida, all measured cytological parameters were significantly higher in the ST users than in the non-ST users. Furthermore, CD was lower while nuclear/cytoplasmic ratio was higher in the ST users than in those non-ST users. ConclusionCytological changes associated with the use of ST, include dyskeratosis, parakeratosis, hyperkeratosis, hypergranulosis, karyorrhexis, pyknosis together with increase in the bacterial population of cocco-bacillus and L. buccalis. There were no significant differences in patients with dysplasia in spite of reduction of CD, increased nuclear size and N/C ratio.Öğe Diabetic muscle infraction: An unusual cause of muscle pain in a diabetic patient on hemodialysis(Springer, 2005) Sahin, Ibrahim; Taskapan, Cagatay; Taskapan, Hulya; Baysal, Tamer; Bentli, Recep; Tekes, Selda; Kosar, FeridunDiabetic muscle infarction (DMI) is a rare, painful and potentially serious complication in patients with poorly controlled diabetes mellitus and frequently misdiagnosed clinically as abscess, neoplasm, or myositis. A 36-year-old diabetic woman referred to our clinic with severe pain in the left anteromedial thigh. She had a 15-year history of Type 2 diabetes mellitus (DM). She was complicated by diabetic nephropathy and requiring hemodialysis. She had first noticed pain and swelling in her left thigh after a minimal trauma for 2 days prior to presentation. Clinical and laboratory evaluation, and muscle biopsy revealed the diagnosis of muscle infarctions. She did no respond to the conservative therapy. Pain and swelling in her thigh worsened progressively. She underwent surgical debridment and then, her clinical status improved. We describe the characteristic clinical and pathologic findings and the course of the illness with emphasis on the importance of recognition of the syndrome so that unnecessary investigation and overzealous therapy can be avoided.Öğe Diagnostic potential of serum N-terminal pro-B-type brain natriuretic peptide level in detection of cardiac wall stress in women with polycystic ovary syndrome: a cross-sectional comparison study(Oxford Univ Press, 2007) Celik, Onder; Sahin, Ibrahim; Celik, Nilufer; Hascalik, Seyma; Keskin, Lezzan; Ozcan, Hamdi; Uckan, AhmetBACKGROUND: In addition to the negative effect on fertility, polycystic ovary syndrome (PCOS) has been associated with cardiac pathology. Brain natriuretic peptide (BNP) is a possible marker for cardiac risk, therefore we investigated whether N-terminal pro-B-type BNP (NT-proBNP) increases in women with PCOS compared with healthy women of comparable age and body mass index. METHODS: Thirty women with PCOS and 30 healthy women not suffering from overt cardiac disease were involved in the study. Fasting insulin and serum NT-proBNP levels were measured, and M-Mode echocardiography was performed. Insulin resistance was calculated using the homeostasis model assessment insulin resistance index (BOMA-IR). RESULTS: PCOS subjects had higher NT-proBNP levels than the control subjects (P < 0.001). Abnormal echocardiography indices were detected in 14 of the PCOS subjects (but none of the controls), including valvular heart disease in nine, diastolic dysfunction in two, right ventricular enlargement in one, right atrial enlargement in one and pulmonary hypertension in one. PCOS subjects (n = 30) showed an increased left ventricular mass (LVM) (P < 0.001) and left ventricular posterior wall thickness (LVPWT) (P = 0.006). In addition, NT-proBNP concentration was positively correlated with LVM (r = 0.587, P = 0.001) and negatively correlated with sex-hormone-binding globulin (r = -0.528, P = 0.003). There was a positive correlation between LVM and HOMA-IR (r = 0.295, P = 0.03) while LVPWT was positively correlated with fasting insulin and HOMA-IR (r = 0.335, P = 0.031 and r = 0.346, P = 0.045, respectively) in PCOS subjects (n = 30). CONCLUSION: The present study demonstrated that the level of NT-proBNP was increased in PCOS subjects with asymptomatic heart disease.Öğe Diffusion-Weighted Images Differentiate Benign From Malignant Thyroid Nodules(Wiley, 2010) Erdem, Gulnur; Erdem, Tamer; Karakas, Hakki Muammer; Mutlu, Deniz Yakar; Firat, Ahmet Kemal; Sahin, Ibrahim; Alkan, AlpayPurpose: To reveal the possible role of diffusion-weighted images (DWI) in the differential diagnosis of benign and malignant thyroid nodules by comparing the results of fine-needle aspiration cytology (FNAC). Materials and Methods: In an 18-month period (December 2005 to May 2007), 27 cases with benign thyroid nodules with a total of 52 benign nodules, nine cases with thyroid gland malignancy and 24 healthy control cases were included in the study. Cases that were indicated to undergo to FNAC examination and sent by a clinician for biopsy to the radiology unit were included in the study to assess the cytopathologic confirmation of the clime, ultrasonographic, and magnetic resonance imaging (MRI) findings. Results: The mean apparent diffusion coefficient (ADC) values of thyroid nodules were 2745.3 +/- 601.1 x 10(-6) mm(2)/s (1605-3899 x 10(-6)mm(2)/s) in the benign group and 695.2 +/- 312.5 x 10(-6)mm(2)/s (165-1330 x 10(-6)mm(2)/s) in the malignant group. Normal thyroid tissues had mean ADC values of 1344.1 +/- 276.4 x 10(-6) mm(2)/s (1015-1764 x 10(-6)mm(2)/s). The ADC values of three subgroups were significantly different (P = 0.0001). A reduced ADC was observed in most. types of malignant tumors due to the consequent decrease of the extracellular extravascular space. Conclusion: Our preliminary results showed that ADC values of nodules may provide useful data about the nature of a thyroid nodule.Öğe Diffusion-weighted imaging features of brain in obesity(Elsevier Science Inc, 2008) Alkan, Alpay; Sahin, Ibrahim; Keskin, Lezan; Cikim, Ayse Sertkaya; Karakas, Hakki Muammer; Sigirci, Ahmet; Erdem, GulnurPurpose: Obesity is characterized by an altered distribution of body fluid. However, distribution of fluid (extracellular/intracellular) in brain tissues has not been studied in obese subjects yet. The purpose of this study was to detect possible brain diffusion changes especially in satiety and hunger related centers in obese subjects by diffusion weighted imaging (DWI). Methods: Conventional MRI and DWI of the brain was obtained from 81 obese patients (obese=68, morbid obese= 13) and 29 age-matched, nonobese. The apparent diffusion coefficient (ADC) values were calculated in hypothalamus; amygdala; hippocampal gyrus-1 thalamus; insula; cingulate gyrus; orbitofrontal, dorsomedial and dorsolateral frontal, middle temporal and occipital cortex; cerebellum; midbrain and corpus striatum. Results: The ADC values of hypothalamus, hippocampal gyrus, amygdala, insula, cerebellum and midbrain were significantly increased in patients (n:81) when compared to nonobese subjects. The ADC values of thalamus, hippocampal gyrus, amygdala, orbitofrontal, occipital, dorsolateral and middle temporal cortex, insula and midbrain were significantly increased in morbid obese when compared to nonobese subjects. The ADC values of orbitofrontal and occipital cortex were significantly higher in morbid obese than the values in the obese. The body mass index positively correlated with ADC values of amygdala, insula, orbitofrontal and middle temporal cortex. Conclusion: We observed increased ADC values of distinct locations related to satiety and hunger that suggest altered fluid distribution and/or vasogenic edema in obese subjects. Awareness of this abnormalities in brain tissue composition/function in obesity may contribute to better understanding of the underlying mechanisms. (0 2008 Elsevier Inc. All rights reserved.Öğe The Effect of Body Mass Index on the Sexual Functions of Morbidly Obese Female Patients(Yerkure tanıtım & yayıncılık hızmetlerı a s, cumhuryet cad 48-3b, harbıye, ıstanb, 34367, turkey, 2017) Erbay, Lale Gonenir; Ozlu, Mustafa; Sahin, Ibrahim; Evren, Bahri; Kayaalp, Cuneyt; Karlidag, RifatObjective: The aim of this study is to investigate whether morbidly obese female patients are suffering sexual dysfunction, in addition to analyzing the effect of body mass index (BMI) on sexual functions. Method: A total of 72 morbidly obese women admitted to the Endocrinology Department, whose BMI scores were 40 or over, and 28 healthy women age-matched with the morbidly obese group, whose BMI scores were under 30 were included in this study. Considering the effects on sexual functioning, the patients and the control group were evaluated by a psychiatric specialist. women with a psychiatric disorder according to DSM-5, taking medicines that could affect sexual functions, and those with a chronic physical or any neurological disease or being pregnant or breastfeeding were excluded from the study. A sociodemographic data form and the Arizona Sexual Experiences Scale (ASEX) were administered to both the treatment and control group. Results: Statistical analyses revealed that morbidly obese female patients more frequently suffered from sexual dysfunction compared to the control group. The Arizona Sexual Experiences Scale (ASEX) and all subscale scores except the sexual satisfaction rate were significantly higher in morbidly obese female patients than in the control group. There was no correlation found between the BMI and sexual function in the analyses conducted. Conclusion: In our study, morbidly obese female patients were found to show more impairments in all areas of sexual functions except sexual satisfaction rate when compared to the control group. Previous studies have suggested that obesity is the cause of sexual dysfunction in men; however, the same relationship could not be demonstrated in women. In a limited study of female patients, conflicting results were attributed to the inability to control variables. The fact that variables such as depression, anxiety, and chronic physical illness, which may affect sexual function, had been assessed in our study is important for accurately interpreting the findings. The data in our study reveals the importance of investigating sexual functions in morbidly obese female patients.Öğe The effect of exercise induced weight-loss on myokines and adipokines in overweight sedentary females: steps-aerobics vs. jogging-walking exercises(Edizioni Minerva Medica, 2018) Duzova, Halil; Gullu, Esin; Cicek, Guner; Koksal, Burcu K.; Kayhaayhan, Basak; Gullu, Abdullah; Sahin, IbrahimBACKGROUND: The objectives of this study were to verify effects of step-aerobic exercise (SAE) and jogging-walking exercise (JWE) program on myokines and adipokines levels in overweight sedentary females. METHODS: Volunteer subjects (N.=25) were assigned to two exercise groups: steps aerobics and jogging-walking. The exercise program given to them was for five days a week and for twelve weeks period. Serum samples were collected from venous blood before and immediately after Cardio-Respiratory Fitness Test (CRF) by Bruce protocol and stored at -80 degrees C until they were assayed before 12 weeks exercise program. After 12-weeks training program this procedure was repeated. Serum TNF-alpha, IL-6, IL-15, IL-17, IL-18, leptin, resistin and adiponectin levels were assayed by ELISA. RESULTS: Leptin and IL-15 levels were increased whereas resistin levels were decreased after CRF Test in JWE training group following 12-weeks exercise program. TNF-alpha, IL-15 and IL-18 levels were higher and leptin levels were lower in SAE group than JWE group after 12-weeks exercise period. However, both SAE and JWE did not lead to significant change in serum levels of IL-17, IL-6 and adiponectin levels. CONCLUSIONS: This study has added to existing knowledge that both SAE and JWE may cause weight loss especially in fat mass. But, the effect of SAE and JWE on myokines and adipokines levels may be the different. Further studies are needed to find out clinical importance of these findings.Öğe Endothelial Dysfunction in Patients with Acromegaly(Galenos Yayincilik, 2005) Sahin, Ibrahim; Bentli, Recep; Topal, Ergun; Keskin, LezzanIt has been shown that Growth hormone (GH) and insulin like growth factor 1 (IGF-1) has important effects on heart and vascular system. However, little is known about endothelial function in acromegaly. The aim of this study was to determine endothelial function in patients with acromegaly. Endothelial function was evaluated in 10 patients with active acromegaly (eight men, two women) and in 11 age, sex and weight matched control (eight men, two women) using a flow mediated dilatation (FMD) technique in the brachial artery. In acromegalic patients mean FMD was 8.3 +/- 3.5 % and significantly lower than that of control group (p=.023). However, there were no significant correlations between GH, IGF-1 levels and percentage of FMD. These findings suggest that endothelial function impaired in patients with acromegaly.Öğe Evaluation of in vivo cerebral metabolism on proton magnetic resonance spectroscopy in patients with impaired glucose tolerance and type 2 diabetes mellitus(Elsevier Science Inc, 2008) Sahin, Ibrahim; Alkan, Alpay; Keskin, Lezzan; Cikim, Ayse; Karakas, Hakki M.; Firat, Ahmet K.; Sigirci, AhmetThe aim of this study was to investigate possible metabolic alterations in cerebral tissues on magnetic resonance spectroscopy (MRS) in patients with impaired glucose tolerance (IGT) and with type 2 diabetes mellitus (T2-DM). Twenty-five patients with T2-DM, 13 patients with IGT, and 14 healthy volunteers were included. Single-voxel spectroscopy (TR: 2000 ms, TE: 31 ms) was performed in all subjects. Voxels were placed in the frontal cortex, thalamus, and parietal white matter. N-acetylaspartate (NAA)/creatine (Cr), choline (Cho)/Cr, and myo-inositol (MI)/Cr ratios were calculated. Frontal cortical Cho/Cr ratios were increased in patients with IGT compared to control subjects. Parietal white matter Cho/Cr ratios were significantly higher in patients with IGT when compared to patients with T2-DM. In the diabetic group, frontal cortical MI/Cr ratios were increased, and parietal white matter Cho/Cr ratios were decreased when compared to the control group. Frontal cortical NAA/Cr and Cho/Cr ratios and parietal white matter Cho/Cr ratios were decreased in diabetic patients with poor glycemic control (AlC>10%). AlC levels were inversely correlated with frontal cortical NAA/Cr and Cho/Cr ratios and with parietal white matter Cho/Cr ratios. T2-DM and IGT may cause subtle cerebral metabolic changes, and these changes may be shown with MRS. Increased Cho/Cr ratios may suggest dynamic change in membrane turnover in patients with IGT. Diabetic patients with poor glycemic control may be associated with neuronal dysfunction/damage in brain in accordance with AlC levels and, in some, extend with insulin resistance. (C) 2008 Elsevier Inc. All rights reserved.Öğe Expert opinion on screening, diagnosis and management of diabetic peripheral neuropathy: a multidisciplinary approach(Frontiers Media Sa, 2024) Atmaca, Aysegul; Ketenci, Aysegul; Sahin, Ibrahim; Sengun, Ihsan Sukru; Oner, Ramazan Ilyas; Tilki, Hacer Erdem; Adas, MineThe proposed expert opinion aimed to address the current knowledge on conceptual, clinical, and therapeutic aspects of diabetic peripheral neuropathy (DPN) and to provide a guidance document to assist clinicians for the best practice in DPN care. The participating experts consider the suspicion of the disease by clinicians as a key factor in early recognition and diagnosis, emphasizing an improved awareness of the disease by the first-admission or referring physicians. The proposed screening and diagnostic algorithm involves the consideration of DPN in a patient with prediabetes or diabetes who presents with neuropathic symptoms and/or signs of neuropathy in the presence of DPN risk factors, with careful consideration of laboratory testing to rule out other causes of distal symmetric peripheral neuropathy and referral for a detailed neurological work-up for a confirmative test of either small or large nerve fiber dysfunction in atypical cases. Although, the first-line interventions for DPN are currently represented by optimized glycemic control (mainly for type 1 diabetes) and multifactorial intervention (mainly for type 2 diabetes), there is a need for individualized pathogenesis-directed treatment approaches for DPN. Alpha-lipoic acid (ALA) seems to be an important first-line pathogenesis-directed agent, given that it is a direct and indirect antioxidant that works with a strategy targeted directly against reactive oxygen species and indirectly in favor of endogenous antioxidant capacity for improving DPN conditions. There is still a gap in existing research in the field, necessitating well-designed, robust, multicenter clinical trials with sensitive endpoints and standardized protocols to facilitate the diagnosis of DPN via a simple and effective algorithm and to track progression of disease and treatment response. Identification of biomarkers/predictors that would allow an individualized approach from a potentially disease-modifying perspective may provide opportunities for novel treatments that would be efficacious in early stages of DPN, and may modify the natural course of the disease. This expert opinion document is expected to increase awareness among physicians about conceptual, clinical, and therapeutic aspects of DPN and to assist them in timely recognition of DPN and translating this information into their clinical practice for best practice in the management of patients with DPN.Öğe Hyperostosis Frontalis Interna(Aves, 2022) Topaloglu, Omercan; Bayraktaroglu, Taner; Tekin, Sakin; Topaloglu, Seda Nur; Sahin, Ibrahim; Canturk, ZeynepHyperostosis frontalis interna is the thickening of the inner layer of the frontal bone due to the formation of cancellous bone. In hyperostosis frontalis interna, nodular protrusions occur due to the formation of cancellous bone in the inner table of frontal bone. These nodular protrusions may be unilateral or on both sides of the midline but spare midline. Hyperostosis frontalis interna is associated with aging, obesity, menopause, or other endocrinopathies such as diabetes mellitus. The prevalence is shown to be 5%-12% in autopsy series or imaging-based studies. It may be classified according to the extensiveness and appearance of the lesion. The clinical significance is not clear, and hyperostosis frontalis interna is generally an incidental finding detected by imaging methods. But, sometimes headache, dural irritation, or brain atrophy may occur. Neurological or mental signs may be associated with hyperostosis frontalis interna. Underlying endocrinopathies ( acromegaly, primary hyperparathyroidism, osteopetrosis, fibrous dysplasia, or Paget's disease) or malignancies should be excluded. Treatment is supportive and needs to be planned against the underlying disease.Öğe Impact of telephonic interviews on persistence and daily adherence to insulin treatment in insulin-naive type 2 diabetes patients: dropout study(Dove Medical Press Ltd, 2016) Yavuz, Dilek Gogas; Bilen, Habip; Sancak, Seda; Garip, Tayfun; Hekimsoy, Zeliha; Sahin, Ibrahim; Yilmaz, MuratObjective: The objective of this study is to evaluate the impact of sequential telephonic interviews on treatment persistence and daily adherence to insulin injections among insulin-naive type 2 diabetes patients initiated on different insulin regimens in a 3-month period. Methods: A total of 1,456 insulin-naive patients with type 2 diabetes (mean [standard deviation, SD] age: 56.0 [12.0] years, 49.1% were females) initiated on insulin therapy and consecutively randomized to sequential (n=733) and single (n=723) telephonic interview groups were included. Data on insulin treatment and self-reported blood glucose values were obtained via telephone interview. Logistic regression analysis was performed for factors predicting increased likelihood of persistence and skipping an injection. Results: Overall, 76.8% patients (83.2% in sequential vs 70.3% in single interview group, (P<0.001) remained on insulin treatment at the third month. Significantly higher rate for skipping doses was noted in basal bolus than in other regimens (27.0% vs 15.0% for premixed and 15.8% basal insulin, respectively, P<0.0001). Logistic regression analysis revealed sequential telephonic interview (odds ratio [OR], 1.531; 95% confidence interval [CI], 1.093-2.143; P=0.013), higher hemoglobin A1c levels (OR, 1.090; 95% CI, 0.999-1.189; P=0.049), and less negative appraisal of insulin therapy as significant predictors of higher persistence. Basal bolus regimen (OR, 1.583; 95% CI, 1.011-2.479; P=0.045) and higher hemoglobin A1c levels (OR, 1.114; 95% CI, 1.028-1.207; P=0.008) were the significant predictors of increased likelihood of skipping an injection. Conclusion: Our findings revealed positive influence of sequential telephonic interview, although including no intervention in treatment, on achieving better treatment persistence in type 2 diabetes patients initiating insulin.
