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    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, Murat
    Objective: 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.
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    Out-of-Reference Range Thyroid-Stimulating Hormone Levels in Levothyroxine-Treated Primary Hypothyroid Patients: A Multicenter Observational Study
    (Frontiers Media Sa, 2017) Yavuz, Dilek Gogas; Yazici, Dilek; Keskin, Lezzan; Atmaca, Aysegul; Sancak, Seda; Sarac, Fulden; Sahin, Ibrahim
    Objective: Although levothyroxine (LT4) replacement therapy for hypothyroidism has been established as safe, inexpensive and effective, many studies from different countries reported out-of-reference range thyroid-stimulating hormone (TSH) values for the hypothyroid patients under LT4 treatment. The aim of this study was to determine TSH levels of primary hypothyroid patients under LT4 treatment and to assess self-reported compliance with daily LT4 intake in tertiary care centers in Turkey. Design: In this cross-sectional, observational study, adult patients with primary hypothyroidism, receiving LT4 treatment for at least 6 months, were included. The patients were from 12 tertiary care centers in 9 cities of Turkey. TSH and free T4 levels were recorded from patient files and self-reported compliance with daily LT4 intake was assessed by interviewing the subjects at the last visit. Results: A total of 1,755 subjects (46 +/- 13 years; F/M: 89.9/10.1%) with primary hypothyroidism were enrolled. Of the hypothyroid subjects, 44.8% had out-of-reference range serum TSH levels. TSH values were over the reference range (TSH > 4 mIU/L) in 26.2% and were under the reference range (TSH < 0.5 mIU/L) in 18.6% of the patients. Total duration of LT4 treatment was 5.9 +/- 4.7 years and mean dose was 1.2 +/- 0.6 mu g/kg/day. Non-compliant patients (31.1%) had higher TSH levels (6.9 +/- 16 vs 3.8 +/- 0.9 mIU/L, P = 0.01) compared to compliant patients. Conclusion: The results of this study revealed that nearly half of the hypothyroid patients had out-of-reference range serum TSH values, despite under LT4 treatment. Compliance with LT4 treatment seems to be one of the major determinants to reach the target TSH levels in hypothyroid patients.
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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.