diabetes care in turkey prof. dr. taner damcı istanbul university cerrahpaşa medical faculty...
DESCRIPTION
TURDEP Prevalence of IGT in Turkey due to ages P< Satman İ, TURDEP Group. Diabetes Care 2002; 25:TRANSCRIPT
Diabetes Care in Turkey
Prof. Dr. Taner Damcı
Istanbul University Cerrahpaşa Medical Faculty
Department on Endocrinology Metabolism and Diabetes
0
4
8
12
16
20
%
20-24
25-2930-3435-39
40-4445-4950-54
55-5960-64
65-6970+ Mean
Age
TURDEP Diabetes prevalence in Turkey due to ages
P<0.0001
Satman İ, TURDEP Group. Diabetes Care 2002; 25: 1551-6
0
4
8
12
16
20
%
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70+
Mean
Yaş Grubu
TURDEP Prevalence of IGT in Turkey due to ages
P<0.0001
Satman İ, TURDEP Group. Diabetes Care 2002; 25: 1551-6
A. Urban men
0 5 10 15 20 25 30
20-2940-49
60-69Genel
Age
C. Rural men
0 5 10 15 20 25 30
20-2930-39
40-4950-59
60-6970+
Genel
Age
%
B. Urban women0 5 10 15 20 25 30
20-29
30-39
40-49
50-59
60-69
70+Genel
Age
D.Rural women0 5 10 15 20 25 30
20-2930-39
40-4950-59
60-6970+
Genel
Age
New DM Known DM
Satman İ, TURDEP Group. Diabetes Care 2002; 25: 1551-6
Diabetes prevalence in Turkey due to age and gender
0
5
10
15
20
25
30
35
%
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70+ mean
age
TURDEP Prevalence of obesity (General)
BMI30 kg/m2
P<0.0001
Satman I, Yilmaz MT, and the TURDEP Group. Diabetologia 2000; 43:433, A111
0
10
20
30
40
50
%
age
Women
Obesity 10,4 29 42 43,9 39,6 30,4
20-29 30-39 40-49 50-59 60-69 70+
0
10
20
30
40
50
%
age
Men
Obesity 4,1 12 19 20,5 17,4 16,6
20-29 30-39 40-49 50-59 60-69 70+
Prevalence of Obesity in Turkey
TURDEP Çalışması
Obezite
33,7
20
41,8
05
1015202530354045
Genel Erkek Kadıngender
pp
TEMD Türkiye Metabolik Sendrom Taraması - Prof. Dr. Fahri BAYRAM
Results of the Turkish Obesity and Metabolic Syndrome Survey
Prevalence of metabolic syndrome
34,90%
25,20%
40,10%
0%
10%
20%
30%
40%
50%
Tüm grup Erkek Kadın
Results of the Turkish Obesity and Metabolic Syndrome Survey
Prevalence in obese children and adolescents. AGH: abnormal glucose homoeostasis, IR: insulin resistance, IGT: impaired
glucose tolerance, IFG: impaired fasting glucose, HI: hyperinsulinemia, DL: dyslipidaemia, HT: hypertension, DM:
type 2 diabetes, MS: metabolic syndrome.
Diabetes Research and Clinical Practice Volume 72, Issue 3, June 2006, Pages 315-321
Baseline characteristics (FAS)
Type 1 (N=191)
Type 2 (N=939)
Male n (%) 96 (50.3) 431 (45.9) Female n (%) 95 (49.7) 508 (54.1)
Mean age (yrs)* 31.25 10.62 57.26 10.69 Weight (kg)* 65.31 11.3 78.46 13.58
BMI (kg/m2)* 23.23 3.35 29.42 4.69 Waist circumference (cm) * Male Female
85.39 11.69 80.73 11.97
101.51 12.29 101.91 13.30
Time since diagnosis (yrs)* 9.71 8.56 8.68 7.24 *Mean SD, SD - standard deviation, BMI – body mass index
Patients demographics
BMI- Type 1
MaleN=93
FemaleN=94
< 20 25-3020-25 30-35 >35
BMI- Type 2
Male N=428
FemaleN=494
< 20 25-3020-25 30-35 >35
Diabetes late complications
% of patients In Type 1(N=191)
In Type 2(n=939)
Not checkedType 1
Not checkedType 2
% of patients who have at least 1 complication
45.5% 56.3%
Retinopathy 56.3% 45% 2.3% 14%
Neuropathy 40.2% 47.6% 9.2% 18.5%
Microalbuminuria 44.8% 31.8% 11.5% 32.5%
Proteinuria 29.9% 18.7% 8% 14.6%
Past or present foot ulcer 8% 8.7% 1.1% 2.5%
Amputation 3.4% 1.9% 1.1% 3%
Angina 6.9% 24.4% 1.1% 2.5%Myocardial infarction 4.6% 15.9% 1.1% 3%
Heart failure 2.3% 9.1% 1.1% 2.8%
Stroke 1.1% 5.3% 1.1% 1.5%
Peripheral vascular disease 5.7% 10.2% 3.4% 10.8%
Erectile dysfunction (%male)
23.5% 25% 18.8% 34.3%
Other cardiovascular risk factors
% of patients Type 1(N=191)
Type 2(N=939)
Hypertension 19.9% 67.4%
Dyslipidemia 23.9% 66.3%
Smoking Current Past
24.1%9.9%
15.5%19.6%
Patients antidiabetic treatments
% of patients Type 1N=191
Type 2N=939
No treatment 3 (1.6%) 58 (6.2%)
Receiving OAD alone 2 (1%) 604 (64.3%)
Receiving OAD + insulin 17 (8.9%) 142 (15.1%)Receiving insulin alone 169 (88.5%) 135 (14.4%)
Starting insulin treatment this day 5 (2.6%) 36 (3.8%)
Oral Hypoglycemic Agents
Type 2OAD alone
N=604
Type 2OAD+insulin
N=142Glinidines 10.4% 13.4%
Biguanides 63.0% 70.4%
TZD 12.2% 16.9%
Alpha glucosidase inhibitor
17.7% 25.3%
SU 69.2% 12.7%
Insulin treatment : Type of insulin
Type 1 N=186
Type 2N=277
Basal Prandial aloneBas + Prand Premix Others
Insulin treatment : Number of injections per day
Type 1N=186
Type 2N=277
1/day 2/day 3/day > 3 /day
Glycemic control
Type 1(N=191)
Type 2(N=939)
Last HbA1c value availablen= Mean std (%)Min – Max (%)
1588.29 2.21
3-15
7537.86 1.99
4–15Time since last HbA1c measurement (months) 1.08 1.63 0.60 1.54
% of patients with HbA1c < 7 45 (28.5%) 300 (39.8%)Last laboratory FBG value (mg/dL)n=Mean std (mg/dL)Min – Max (mg/dL)
166189.49 92.31
47-462
905175.21 72.62
45-493Last laboratory FBG value (mmol/L)Mean stdMin - Max
10.54 5.133-26
9.74 4.043-27
Time since last FBG measurement (months) 0.69 1.57 0.36 0.86
Frequency of monitoring of glycemic control
in the whole population
Type 1N= 191
Type 2N= 939
% of patients for whom HbA1c measurement done at least once 89% 82%
Frequency of laboratory measurement of HbA1c Mean (times/ 2 years)
N=1684.15 2.75
N=7543.08 2.38
Frequency of laboratory measurement of FBGMean (times/year)
N=176
16.68 23.56
N=939
9.24 14.75
Frequency of self monitoring of FBG Mean (times/month)
N=14815.59 9.83
N=3349.91 8.48
Frequency of monitoring of glycemic control
whole population (by class)Type 1N= 191
Type 2N= 939
% of patients who self monitor blood glucose
N=17089%
N=36338.7%
< once/week 6.1% 20.4%
1-2 times/week 25% 36.2%
3-4 times/week 27.7% 25.4%
>4 times/week 19.6% 9.6%
Once/day 21.6% 8.4%
Reasons for not achieving target – Type 1
05
101520253035404550
Failure ofcurr. ttt
Fear ofhypo
Noncompliance
Poor educ. Others
Hypo Weight concern
Fear of injections
Concom. illness
% of answers
N=130
Reasons for not achieving target – Type 2
Hypo Weight concern
Fear of injections
Concom. illness
%
Type 2 insulin treated N=197
0
10
20
30
40
50
60
70
Failure ofcurrent ttt
Fear of hypo Noncompliance
Pooreducation
Others
0
10
20
30
40
50
60
70
Failure ofcurrent ttt
Fear of hypo Noncompliance
Pooreducation
Others
Type 2 without insulin N=374
Hypo Weight
concern
Concom.
illness
Fear of
injectons
Patient education and follow up
Type 1 Type 2
Patients trained by a diabetes educator (%)
77% 46%
Frequency of training by a diabetes educator (times)Mean StdMin - Max
4.23 5.541-40
3 4.011-48
Patients belonging to a patient diabetes association (%) 15.2% 4%Frequency of consultation to doctor (per year)Mean StdMin – Max
4.74 4.151-40
4.08 3.431-48
Absenteeism and hospitalisation due to diabetes
Type 1N=191
Type 2N=939
Absenteeism at work due to diabetes in the past 6 months (% of patients)
(n=)30.1%
(n=)6.7%
Number of days of absenteeism due to diabetes in the past 6 monthsMean Std (days/6 months)Min- Max
21.98 25.161– 120
15.39 15.931-60
Patients hospitalised due to diabetes in the past 6 months (% of patients) 23.6% 8.1%
Number of days at hospital due to diabetesnMean Std (days/6 months)
4516.67 14.98
7512.89 12.92
Number of days at hospital due to hyposnMean Std ( days/year)
105.70 5.79
151.87 3.48
Predictive factors of « reaching target »
Variables evaluated for T1DM
AgeBMITime since diagnosisSMBGTraining by a diabetes educatorFrequency of consultationsSelf adjustment of insulin
Factors evaluated for T2DM
AgeBMITime since diagnosisSMBGTraining by a diabetes educatorFrequency of consultationsSelf adjustment of insulinNumber of OADs
SUB-OPTIMAL DRUG TREATMENT OF DIABETES AND CARDIOVASCULAR RISK IN DIABETIC PATIENTS IN TURKEY; A COUNTRYWIDE SURVEY
Taner DAMCIHakan KULTURSAY
Aytekin OGUZSeckin PEHLIVANOGLU
Lale TOKGOZOGLU, (The Vascular Risk Study Group)
Diabetes and Metabolism
Antidiabetic drug choice
0
10
20
30
40
SU Komb İns Met İns+OAD Acar Glin TZD
33 %
7 %4 %
2 %0.3 %
20 %
5 %
13 %
Antihypertensives
0
10
20
ACE inh.Alone
Ca ant.Alone
ACE inh-diuretic
ARB alone Diureticalone
Beta blockeralone
ARB-diuretic
ACE inh- Caant
20 18
11.6
6.3 6.2 5.8
% 3.4 1.2
%
No of antihypertensives
0
10
20
30
40
50
60
0 1 2 3 4 5
3-D Column 1
Antihipertansif ilaç sayısı
%
Drug use in microalbuminuric patients
ACEIARBHiçbiri
% 31
% 11% 58
Statin % 19Kolesterol > 200 mg/dl % 32Fibratlar % 1Aspirin % 30Daha önce KV olay geçiren
diabetiklerde % 54
Conclusions• Diabetes is prevalent as are the
complications of the disease in Turkey
• Care of diabetic patients is not optimal
• This is probably due to educational, economic, time constraints