Browsing by Author "Özmen, B"
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Item β2-microglobulin and cystatin C in type 2 diabetesAksun, SA; Özmen, D; Özmen, B; Parildar, Z; Mutaf, I; Turgan, N; Habif, S; Kumanliogluc, K; Bayindir, OBackground: Changes in glomerular filtration rate (GFR) provide a valuable indicator of the progression of diabetic nephropathy (DN). This study was designed to demonstrate the clinical values of serum cystatin C (Cys C) and beta2-microglobulin in the assessment of renal function in type 2 diabetics by comparing them with the GFR, estimated from the uptake phase of 99 in technetium dimetiltriamino pentaacetic acid renogram (GFR-DTPA) and creatinine clearances. Materials and Methods: 68 type 2 diabetic patients with (urinary albumin excretions (UAE) 30-300 mg/24h) (n = 39) and without (UAE <30mg/24h) (n = 29) microalbuminuria and 32 controls were enrolled in the study. Serum Cys C, beta2-microglobulin, creatinine, urinary microalbumin levels, creatinine clearances and GFR-DTPA values were determined in all groups. Nonparametric ROC curves, using a cut-off GFR-DTPA of 60 mL/min/ 1.73 m(2), were obtained for these markers. Results: Serum Cys C, beta2-microglobulin, glucose and HbA1c concentrations were significantly higher in the group with diabetes compared to controls. In the patients with microalbuminuria, serum Cys C and glucose concentrations increased significantly in comparison to patients with normoalbuminuria, while no differences were observed for beta2-microglobulin levels. Serum creatinine concentrations, GFR-DTPA values and creatinine clearances were not different between both diabetic groups and controls. Cys C was positively correlated with beta2-microglobulin and creatinine and negatively with GFR values; beta2-microglobulin was also positively correlated with serum creatinine in microalbuminurics. A significant inverse correlation was found between beta2-microglobulin and GFR values in both microalbuminurics and normoalbuminurics. Conclusions: Increased Cys C and beta2-microglobulin in diabetics may be early indicators of incipient DN. The diagnostic accuracies of Cys C and beta2-microglobulin are superior to that of serum creatinine in distinguishing between mild and moderately reduced GFR.Item Effects of a statin group drug, pravastatin, on the insulin resistance in patients with metabolic syndromeGüçlü, F; Özmen, B; Hekimsoy, Z; Kirmaz, CBackground. - In West of Scotland Coronary Prevention Study (WOSCOPS), development of type 2 diabetes mellitus (DM) was found to decrease by 30% in pravastatin-treated patients. In the study, it is suggested that pleiotropic effects of pravastatin may be responsible too as well as its lipid lowering effect. Objective. - The aim of this study was to assess the effects of pravastatin treatment on the insulin resistance in patients with metabolic syndrome with impaired glucose tolerance (IGT), by Homeostasis Model Assessment (HOMA) test, insulin sensitivity indices and glucose half activation time (glucose t1/2). Methods. - Study population consisted of 25 women who were diagnosed with metabolic syndrome. At baseline and 10 weeks after the 20 mg/daily tablet pravastatin treatment, waist/hip circumference, body weight and arterial blood pressure measurements, plasma glucose, total cholesterol, triglyceride, high density lipoprotein (HDL)-cholesterol, transaminases, glycosylated haemoglobin (A1C) and insulin level measurements were obtained along with HOMA test and insulin tolerance test after 12 h of fasting. Insulin sensitivity indices and glucose t1/2 were assessed. Results. - After the treatment, a statistically significant decrease was observed in arterial blood pressure values (P < 0.0001). While plasma total cholesterol, low density lipoprotein (LDL)-cholesterol, and triglyceride levels were found to decrease significantly and HDL-cholesterol levels increased significantly, a decrease in baseline insulin levels, an increase in insulin sensitivity levels were observed along with an decrease in glucose t1/2. Related to the improvement in aforementioned parameters, statistically significant decreases were noted in HOMA, postprandial and fasting glucose levels and A1C values (P < 0.0001). Conclusion. - Our study suggests that using pravastatin in the dyslipidemia treatment of metabolic syndrome with IGT may be an effective approach by its advantageous effects on insulin resistance. Based on this result, it is possible to say that this can be a risk lowering treatment approach for the development of type 2 DM. (C) 2004 Elsevier SAS. All rights reserved.Item The relationship between self-monitoring of blood glucose control and glycosylated haemoglobin in patients with type 2 diabetes with and without diabetic retinopathyÖzmen, B; Boyvada, SBackground: Diabetes mellitus (DM) is a major health problem with long-term microvascular and macrovascular complications responsible for the majority of its mortality and morbidity. The development and progression of diabetic complications are strongly related to the degree of glycemic control. To decrease the occurrence of these complications, instruments for self-monitoring of blood glucose (SMBG) have been developed and have become widely used among diabetic patients. In this study, we determined the relationship between SMBG control and glycosylated haemoglobin (HbA(1c)) levels in patients with type 2 diabetes, with and without diabetic retinopathy. Methods: Two hundred and sixty-seven type 2 diabetic patients (mean age [mean +/-S.D.]: 58.07 +/- 9.13 years, duration of diabetes: 8.63 +/- 6.8 years) participated in this study. Following an educational program on SMBG, glucometers and usage of oral antidiabetic agents or insulin, optic fundi were examined and HbA(1c) levels were measured at baseline and after 6 and 12 months. The patients were classified in three groups according to their funduscopic findings: without retinopathy (n = 140, 52.4%), background retinopathy (n = 75, 28.1%) and proliferative retinopathy (n = 52, 19.5%). Results: HbA(1c) levels at baseline, after 6 and 12 months were 9.09 +/- 2.69%, 7.47 +/- 1.78% and 7.12 +/- 1.4%, respectively, mean +/-S.D. The values decreased significantly after the education program (P < .001 for both values compared with baseline). The prevalence of retinopathy (both background and proliferative) was 0.8% in the group of diabetics with a mean HbA(1c) level <6%, 7.1% in those between 6.1% and 6.9%; 9.4% in those between 7% and 7.9%; 11.8% between 8% and 8.9%; and 70.9% in those exceeding a mean HbA(1c) level of 9%. There was a statically significant relationship between proliferative diabetic retinopathy and body mass index (BMI; P < .001). The same relationship was observed between duration of diabetes and diabetic retinopathy (P < .001), but not between sex and diabetic retinopathy (P = .46). Conclusions: Implementing a program of SMBG control in type 2 diabetic patients results in lower levels of HbA(1c) at 6 and 12 months. In the group without diabetic retinopathy at 6- and 12-month controls, the mean HbA(1c) concentration is less than 7%, but in the group with diabetic (background and proliferative) retinopathy, this value could not be reduced below 7%. These results imply that SMBG would allow us to maintain better metabolic control by improving HbA(1c) levels and we have always kept in mind that SMBG was a part of an educational program. On the other hand, improving glycemic control prevents the onset or progression of diabetic microvascular complications, such as diabetic retinopathy, nephropathy and neuropathy. Long-term clinical studies should be performed to determine cost-effectiveness and the effects of SMBG on diabetic complications, morbidity and mortality. (C) 2003 Elsevier Science Inc. All rights reserved.Item Diagnosis and treatment of primary hyperaldosteronismÖzmen, B; Özmen, DPrimary hyperaldosteronism is the syndrome of excessive aldosterone secretion and concomitant suppression of the angiotensin-renin system. Its main pathophysiological features are hypertension, altered potassium homeostasis and accelerated target organ damage. Prospective studies on its prevalence around the world reveal that primary hyperaldosteronism occurs in 5-15% of patients with essential hypertension. The major causes of primary hyperaldosteronism are aldosterone-producing adenoma and bilateral idiopathic adrenal hyperplasia. Patients with hypertension and hypokalemia and most patients with treatment-resistant hypertension should be screened for primary aldosteronism with the calculation of plasma concentration to plasma renin activity ratio. The diagnosis is generally 3-tiered, involving an initial screening, confirmation of diagnosis, and determination of the specific subtype of primary hyperaldosteronism. Primary hyperaldosteronism is often refractory to conventional medical treatment. Unilateral laparoscopic adrenalectomy is an excellent treatment option for patients with unliateral aldosterone-producing-adenoma. But bilateral idiopathic hyperaldosteronism should be treated medically. Sprinolactone has been the drug of choice to treat primary hyperaldosteronism for more than three decades. The treatment goal is to prevent morbidity and mortality associated with hypertension, hypokalemia and cardiovascular damage.Item The prevalence of hyperprolactinaemia in overt and subclinical hypothyroidismHekimsoy, Z; Kafesçiler, S; Güçlü, F; Özmen, BThe aims of this study were to: 1) determine the prevalence of hyperprolactinaemia in patients with newly diagnosed subclinical and overt hypothyroidism, and 2) investigate the change in PRL levels with treatment. In this observational study, patients with a new diagnosis of hypothyroidism in our endocrinology clinic were approached for participation, as were healthy controls. Patients with medical reasons for having elevated PRL levels, lactating and pregnant women were excluded from the study. No patient had kidney or liver disease. After examination to determine if clinical causes of PRL elevation were present, serum levels of thyrotropin (TSH), free thyroxine, free triiodothyronine and PRL were measured and correlation of PRL levels with the severity of hypothyroidism (overt or subclinical) was performed. Fifty-three patients (45 women, 8 men, mean age 45.3 +/- 12.2 years) had overt hypothyroidism. One hundred forty-seven patients (131 women, 16 men, mean age 42.9 +/- 12.6 years) had subclinical hypothyroidism. One hundred healthy persons (85 women, 15 men, mean age 43.9 +/- 11.4 years) participated as controls. The same blood tests were repeated in patients after normalization of TSH levels with L-thyroxine treatment. PRL elevation was found in 36% of patients with overt hypothyroidism, and in 22% of patients with subclinical hypothyroidism. PRL levels decreased to normal in all patients after thyroid functions normalized with L-thyroxine treatment. In the hypothyroid patients (overt and subclinical) a positive correlation was found between TSH and PRL levels (r=0.208, p=0.003). PRL regulation is altered in overt and subclinical hypothyroidism, and PRL levels normalize with appropriate L-thyroxine treatment.Item Pulmonary function parameters in patients with diabetes mellitusÖzmen, B; Çelik, P; Yorgancioglu, A; Özmen, B; Özmen, D; Çok, GItem Depression and anxiety in hyperthyroidismDemet, MM; Özmen, B; Deveci, A; Boyvada, S; Adigüzel, H; Aydemir, ÖBackground. Our objective was to determine symptomatology of depression and anxiety in patients with untreated hyperthyroidism and compare with euthyroid patients. Methods. Thirty-two patients with hyperthyroidism (high free T3 and free T4, and suppressed TSH) and 30 euthyroid (normal free T3, free T4, and TSH) controls attending the Endocrinology Out-Patient Department at Celal Bayar University Hospital in Manisa, Turkey were included in the study. Hormonal screening was performed by immunoassay and hernagglutination method. For psychiatric assessment, Hospital Anxiety and Depression Scale [HAD], Hamilton Depression Rating Scale [HAM-D], and Hamilton Anxiety Rating Scale [HAM-A] were used. There was no difference between the two groups in terms of demographic features. Results. Total scores obtained both from HAM-D and HAM-A were significantly greater in the hyperthyroidism group than that of the euthyroid group (P < 0.05); there was no difference in terms of HAD. When compared in terms of symptomatology, early insomnia (HAM-D#6), work and activities (HAM-D#7), psychic anxiety (HAM-D#10), weight loss (HAM-D#16), insomnia (HAM-A#4), and cardiovascular symptoms (HAM-A#8) were significantly more frequent in the hyperthyroidism group. By Wilks lambda discriminant analysis, psychomotor agitation (HAM-D#9), weight loss (HAM-D#16), and insomnia (HAM-A#4) were found as the discriminating symptoms for the hyperthyroidism group, whereas somatic anxiety (HAM-A#11) and loss of interest (HAD#14) were distinguishing symptoms of the euthyroidism group. Conclusions. Hyperthyroidism and syndromal depression-anxiety have overlapping features that can cause misdiagnosis during acute phase. For differential diagnosis, one should follow-up patients with hyperthyroidism with specific hormonal treatment and evaluate persisting symptoms thereafter. In addition to specific symptoms of hyperthyroidism, psychomotor retardation, guilt, muscle pain, energy loss, and fatigue seem to appear more frequently in patients with comorbid depression and hyperthyroidism; thus, presence of these symptoms should be a warning sign to nonpsychiatric professionals for the need for psychiatric consultation. (C) 2002 IMSS. Published by Elsevier Science Inc.Item Influence of the selective oestrogen receptor modulator (raloxifene hydrochloride) on IL-6, TNF-α, TGF-β1 and bone turnover markers in the treatment of postmenopausal osteoporosisÖzmen, B; Kirmaz, C; Aydin, K; Kafesciler, SO; Guclu, F; Hekimsoy, ZBackground. Osteoporosis that is encountered frequently in postmenopausal women, may cause an increased incidence of vertebral and iliac fractures that are associated with excess morbidity. Raloxifene hydrochloride, a selective oestrogen receptor modulator, has been shown to increase bone mineral density and decrease biochemical markers of bone turnover in postmenopausal women, without stimulatory effects on breast or uterus. Levels of proinflammatory cytokines, including IL-6, and TNF-alpha and TGF-beta 1 which are important cytokines involved in remodeling, have been evaluated previously in in vitro studies of osteoporosis. However, there seems to be a paucity of in vivo research concerned with changes in these cytokines in osteoporosis. Objective. In this study, we evaluated the effects of raloxifene (Evista (R); Lilly Pharmaceutical Co. USA, 60 mg/day) on biochemical bone turnover markers, serum parathyroid hormone, and 25-OH vitamin D, as well as the serum levels of IL-6, TNF-alpha and TGF-beta 1, in 22 postmenopausal, osteoporotic women before and after 12 weeks of raloxifene treatment. Methods. Well-matched, postmenopausal, non-osteoporotic control subjects were also enrolled in the study. Serum levels of all the parameters were measured in postmenopausal, osteoporotic women at baseline and end of the study. Results. It was found that serum osteocalcin and parathyroid hormone, and urine deoxypyridinoline levels decreased to normal levels with treatment. Serum 25-OH vitamin D levels after treatment in the patient group were higher than those in the control group. Serum IL-6, TNF-alpha and TGF-beta 1 levels did not change significantly with treatment. However, serum levels of IL-6 and TGF-beta 1 in the patient group after treatment, decreased to levels lower than those found in the control group. Serum TNF-alpha levels in the patient group before and after treatment, were lower than those in the control group. Conclusion. Raloxifene treatment reduces bone turnover biochemical markers, parathyroid hormone and induces 25-OH vitamin D in postmenopausal women. Moreover, it also affects some serum cytokine levels in the postmenopausal period.Item Macular edema in unregulated type 2 diabetic patients following glycemic controlKayykcyoolu, Ö; Özmen, B; Seymenoglu, G; Tunali, D; Kafesçiler, SO; Güclü, F; Hekimsoy, ZBackground. We undertook this study to evaluate the changes in macular edema of uncontrolled type 2 diabetes mellitus patients with the regulation of hyperglycemia. Methods. The study population was comprised of 35 type 2 diabetes mellitus patients who had poorly regulated blood glucose values. Ophthalmic examinations including baseline and 6-month macular edema index values of patients by Heidelberg Retinal Tomography (HRT) macular module were done. Results. Twenty four (68.6%) female patients and 11 (31.4%) male patients with a mean age of 50.7 +/- 10.3 (mean +/- SD) years and mean diabetic duration of 9.8 +/- 7.5 years participated in the study. Twenty two (62.9%) did not have diabetic retinopathy (DR), whereas 13 (37.2%) had background DR with macular edema. There was a significant correlation between duration of diabetes and HRT-II macula edema index for the right and left eyes (r = 0.40, p = 0.21 and r = 0.40, p = 0.22, respectively). Conclusions. Macular edema did not change significantly by regulation of glycemic control in the study group. (C) 2007 IMSS. Published by Elsevier Inc.Item Impact of renal function or folate status on altered plasma homocysteine levels in hypothyroidismÖzmen, B; Özmen, D; Parildar, Z; Mutaf, I; Turgan, N; Bayindir, OHyperhomocysteinemia is an independent risk factor for coronary, peripheral and cerebrovascular diseases. Moderately elevated total homocysteine (tHcy) levels have been reported in patients with overt hypothyroidism. Plasma tHcy concentration is affected by several physiological factors and is elevated tinder conditions of impaired folate and cobalamin status and in renal failure. The aim of this Study was to assess plasma tHcy concentrations and to evaluate the role of potential determinants of plasma tHcy levels in hypothyroid patients. Fasting plasma tHcy, serum homocysteine-related vitamins folate and vitamin B-12, serum cystatin C (CysC) and creatinine, were determined in 22 hypothyroid patients and compared with 25 healthy control subjects. Creatinine clearance (CCr) was calculated using the Cockroft-Gault formula. Plasma tHcy levels were determined by HPLC with fluorescence detection and serum CysC by automated particle enhanced immunoturbidimetry. Plasma tHcy, creatinine levels were significantly higher, and serum CysC levels, and creatinine clearance values were lower in hypothyroid patients than in control subjects. Folate levels were lower in hypothyroidic group compared to the control group. There were no differences in vitamin 13, levels between hypothyroid and control groups. Positive correlation was noted between tHcy and creatinine levels in hypothyroid patients (r = 0.596); however, an inverse correlation was found between tHcy and folate levels (r = -0.705) in hypothyroid patients. In conclusion, tHcy was increased in hypothyroidism, and this increase was more strongly associated with changes in serum folate than in serum creatinine and CysC, suggesting an altered folate status.Item Evaluation of markers of inflammation, insulin resistance and endothelial dysfunction in children at risk for overweightAkinci, G; Akinci, B; Coskun, S; Bayindir, P; Hekimsoy, Z; Özmen, BOBJECTIVE: Childhood obesity is associated with impaired endothelial function, insulin resistance and inflammation. Being at risk for overweight has been defined as having a body mass index (BMI) between the 85(th) and 94(th) percentile for age and sex. In this study, we looked for features linked to cardiovascular, risk in children who are at risk for overweight. DESIGN: Twenty-one children who were at risk for overweight (study group) and 20 children with a BMI between the 25(th)-74(th) percentiles (controls) were studied. Fasting blood levels of glucose, insulin, total cholesterol, HDL cholesterol, triglycerides, uric acid, fibrinogen and high sensitive C-reactive protein (CRP) were assessed in both groups. LDL-cholesterol, HOMA-IR and QUICKI indices were calculated. Flow-Mediated Vasodilatation (FMD) was determined for the evaluation of endothelial function. RESULTS: Increased HOMA-IR was observed in children who were at risk for overweight. Waist circumference was the main predictor of insulin resistance in these children. Higher levels of CRP were found in the study group compared to controls, while plasma fibrinogen died not differ in the two groups. The children who were at risk for overweight had lower FMD values and slightly elevated lipids compared to controls; however, these differences were not statistically significant. CONCLUSION: Insulin resistance and inflammation indices were higher in children who were at risk for overweight as has been shown for obese children. The data suggest that appropriate treatment strategies for weight control are essential not only for obese children but also for those at risk for overweight.Item Vitamin D status among adults in the Aegean region of TurkeyHekimsoy, Z; Dinç, G; Kafesçiler, S; Onur, E; Güvenç, Y; Pala, T; Güçlü, F; Özmen, BBackground: Vitamin D is a lipid-soluble hormone found in certain foods and synthesized from precursors in the skin when exposed to ultraviolet light. Vitamin D plays a critical role in bone metabolism and many cellular and immunological processes and low levels have been associated with several chronic and infectious diseases. Vitamin D status is assessed by measuring the concentration of serum 25-hydroxyvitamin D [25(OH)D]. Vitamin D deficiency is reported to be common worldwide, but little has been reported about the vitamin D status of adults in Turkey. In this cross-sectional study, we determined the prevalence of 25(OH)D deficiency in adults residing in a city in the Aegean region of Turkey. Methods: A survey was conducted on a representative sample of adults over 20 years old in a non-coastal city at the end of the winter season. Of the 209 households selected by random sampling, 8.6% (n = 18) were unoccupied and 21.5% (n = 45) refused to participate. Blood samples were taken and questions about medical history, vitamin supplementation, sunlight exposure, and dietary calcium and vitamin D intake were asked in face-to-face interviews of 391 adults living in the remaining households. Results: The mean serum 25(OH)D concentration was 16.9 +/- 13.09 ng/mL, with 74.9% of the subjects having 25(OH)D deficiency (<20 ng/mL), 13.8% having insufficiency (20-29.99 ng/mL), and 11.3% of the subjects having sufficient 25(OH)D (>= 30 ng/mL) levels. 25(OH)D deficiency was more common among females (78.7%) than males (66.4%, p < 0.05). Conclusion: Adults living in an urban, non-coastal setting in Turkey have a high prevalence of vitamin D deficiency.Item The Relationship Between Glycosylated Haemoglobin and Diabetic Retinopathy in Patients with Type 2 DiabetesÖzmen, B; Güçlü, F; Kafesçiler, S; Özmen, D; Hekimsoy, ZDiabetes mellitus (DM) is a major health problem with long-term micro and macrovascular complications. Diabetic retinopathy (DR) is a sight-threating chronic complication of diabetes mellitus in adults. In this study, we determined the frequency of DR and the relationship between HbA1c levels, duration of diabetes and BMI with DR in type 2 diabetic patients. Six-hundred eighteen type 2 diabetic patients participated in this study. In the first examination, retinopathy was evaluated by ophthalmoscopy through dilated pupil by experienced ophthalmologist. Based on their optic fundi findings they were classified into three groups; without retinopathy, had non-proliferative DR (NPDR) and had proliferative diabetic retinopathy (PDR). In addition, the patients were classified in four groups according to their HbA1c levels; below 6.0 %, between 6.1 and 6.9%; between 7.0 and 9.9%, and; above 10.0%. According to the duration of diabetes the patients were divided into three groups. First group consisted of patients who were diabetic for less than five years, the second group consists of patients who had diabetes for a period 6-10 years and the third group, who were diabetic for more than 10 years. All patients were divided into four groups according BMI; lower 25 kg/m(2), between 25.1 and 29.9 kg/m(2), between 30 and 39.9 kg/m(2) and over 40 kg/m(2). In our study, the frequency of DR was 46.6% [28.8% have NPDR and 17.8% have PDR]. There was a stastically significant relationship between HbA1c levels and DR (both NPDR and PDR) (p<0.000). The frequency of retinopathy (both background and proliferative) was 4.8% in the group of diabetics with a mean HbA1c level <6%, 8.7 % in those between 6.1 and 6.9%, 62.8% in those between 7 and 9.9% and 82.2% in those exceeding a mean HbA1c level of 10%. According to our results, there was a significant relationship between duration of diabetes and DR (both nonproliferative and proliferative) (p<0.001). A similar relationship between PDR and BMI (p<.001), between NPDR and BMI (p<.01) was found. But there was no relationship between gender and DR (p=0.51). These results imply that duration of diabetes, HbA1c level and BMI are important risk factors for onset or progression of DR in type 2 DM. Therefore decrease in HbA1c values and BMI prevent or delay the onset/or progression of DR.Item Serum N-terminal-pro-B-type natriuretic peptide (NT-pro-BNP) levels in hyperthyroidism and hypothyroidismÖzmen, B; Özmen, D; Parildar, Z; Mutaf, I; Bayindir, ONatriuretic peptides represent a novel diagnostic tool in the assessment of heart failure. N-terminal-pro-B-type natriuretic peptide (NT-proBNP), a member of the natriuretic peptid family, is produced and released from cardiac ventricles. Changes in cardiac functions are observed in thyroid dysfunctions. The aim of this study was to assess the changes in serum NT-proBNP levels and to evaluate impact of thyroid hormones on serum NT-proBNP in patients with hyperthyroidism and hypothyroidism. Serum NT-proBNP levels were measured in 21 patients with hyperthyroidism and in 24 patients with hypothyroidism and compared with 20 healthy control subjects. Patients without cardiac disease were included into the study as well. Serum NT-proBNP levels were measured by electrochemiluminescence immunoassay. Serum NT-proBNP levels were higher in hyperthyroid patients than in hypothyroid patients and in control subjects, with mean values of 239.03 +/- 47.33, 45.97 +/- 13.48, 55.57 +/- 13.01 pg/ml, respectively (p < 0.0001). Serum NT-proBNP and thyroid hormones were correlated in all patients. Moreover, there was a significant positive correlation between serum NT-proBNP and serum free T4 (FT4) levels (r = 0,549, p = 0.012) in hyperthyroidic patients. Multiple regression analyses demonstrated that increasing FT4 was independently associated with a high serum NT-proBNP levels, whereas heart rate was not in hyperthyroid patients. Serum NT-proBNP levels are higher in the hyperthyroid state as compared with the hypothyroid and euthyroid state. Thyroid dysfunction affects serum NT-proBNP levels, possibly influencing the secretion of the peptide. Therefore, thyroid function has to be considered when evaluating high serum NT-proBNP levels in patients without cardiac dysfunction.Item Lens superoxide dismutase and catalase activities in diabetic cataractÖzmen, B; Özmen, D; Erkin, E; Güner, I; Habif, S; Bayindir, OObjective: Biochemical evidence suggests that the oxidative damage of the tens proteins is involved in the genesis of senile cataract and the development of diabetes-related pathologic changes such as the formation of cataracts. In particular, lens proteins are subject to extensive oxidative modification. Oxidative damage either decreases the antioxidant capacity or decreased antioxidant capacity results in oxidative damage. The purpose of this study was to analyze the activities of the antioxidant enzymes such as Cu,Zn Superoxide Dismutase (Cu,Zn-SOD) and catalase in the cataractous tenses of the type 2 diabetic group and cataractous lenses of the senile group. Method: Eighteen diabetic cataractous lenses and twenty six senile cataractous lenses were studied. Cu,Zn-SOD activity was measured in lenses by enzymatic method and catalase activity was measured by colorimetric method. Results: Cu,Zn-SOD levels were significantly lower in the diabetic cataractous lenses than senile cataractous tenses (respectively 8.052 +/- 0.818, 18.216 +/- 4.217 mug/g prot. p < 0.05). Similary, catalase levels were significantly lower in the diabetic cataractous lenses than senile cataractous lenses (respectively 0.326 +/- 0.134, 0.665 +/- 0.322 kU/g prot. p < 0.001). Conclusion: The results of the present study indicate that the antioxidant capacity in the diabetic cataractous lenses were decreased and this result suggests a role of antioxidant enzymes in the genesis of diabetic cataracts. (C) 2002 The Canadian Society of Clinical Chemists. All rights reserved.Item Can self-monitoring blood glucose control decrease glycated hemoglobin levels in diabetes mellitusÖzmen, B; Boyvada, SThe development and progression of diabetic complications is strongly related to the degree of glycemic control. To decrease the occurrence of these problems, instruments for self monitoring of blood glucose (SMBG) control have been developed and have become widely used among diabetic patients. In this study, the authors determined the effect of SMBG control on glycated hemoglobin (HbAld levels in type 1 and type 2 diabetic patients. Three hundred fifteen diabetic patients agreed to participate in this study and attended 8,hour training program that focused on what diabetes is, meat planning, physical activity, life behaviors, foot and dental care, complications, and infections of diabetes. Two hundred fifty-nine diabetic patients (21 with type I diabetes mellitus [DM] [group 1], 238 patients with type 2 DM [group 2]) all received glucometers and education on SMBG through an additional 2 hour training program. HbA(1c) levels were measured at baseline and at 6 and 12 months in all patients. The other 56 patients (all type 2 diabetic patients) did not use glucometers for SMBG control and were considered our control group (group 3). Thirteen of the 21 patients with type 1 diabetes used an intensive insulin protocol and eight used a continuous subcutaneous insulin infusion pump (CSII). Overall, the HbA(1c) levels were slightly lower at the 6 and 12,month checkups in the type 1 patients, but the decrease was not statistically significant (p = 0.23). However, the HbA(1c) levels in the CSII group were significantly lower at 12 months (p = 0.04). Conventional insulin treatment was used in 65 of the 99 patients with type 2 diabetes (non-obese) whereas 34 were treated with a combination of insulin and acarbose. In both of these groups, the HbA(1c) levels were slightly diminished at 6 and 12 months, but these decreases were not statistically significant (p = 0.26). Of the 80 obese (body mass index [BMI] > 30 kg/m(2)) patients, 30 were treated with orlistat and metformin, 30 with sibutramine and metformin, and 20 with metformin only. The levels of HbA(1c) in the two multi-medication groups were not significantly different from those of the metformin-only group (p = 0.35). The mean levels of HbA(1c) at the 6 and 12 month checkups in the control group patients did not change (p = 0.92). Implementing a program of SMBG control in DM patients results in lower levels of HbA(1c) at 6 and 12 months in only some DM patient groups. This intervention was especially effective in patients using a continuous subcutaneous insulin in fusion pump. However, in group 1 and group 2, the decrease of the level HbA(1c) was not statistically significant, and no decreases in the HbA(1c) levels were seen in the authors' control group (education only). SMBG results in better glycemic control as reflected by lower HbA(1c) levels; however, cost-effectiveness studies and longer-term clinical studies should be performed to determine the effects of SMBG on glycemic control, morbidity, and mortality.Item Psychometric properties and responsiveness of the Turkish version of the Diabetes Treatment Satisfaction Questionnaire (s) on a sample of diabetics of three consecutive monitoring periodsÖzmen, B; Eser, E; Kafesçiler, SO; Pala, T; Güçlü, F; Hekimsoy, ZThe aim of this study is to test the psychometric properties and the responsiveness of the original (status) version of Turkish DTSQ. The study sample included 88 patients with diabetes mellitus who were evaluated in three consecutive time points. The first data collection time point was during their initial contact to the clinic, and the two following (3rd month and 6th month) were during the monitoring visits to the Celal Bayar University Endocrinology Department in 2007. After the adaptation of the DTSQ to Turkish language by following standard procedures, this instrument was applied to the patients along with WBQ-12 and World Health Organization Quality of Life Measure (WHOQOL-Bref). The reliability of the DTSQ was evaluated by running internal consistency analysis (Cronbach Alpha) and item analysis. Construct validity of the instrument was evaluated by various tests such as Principal Components analysis, Confirmatory Factor Analysis, Concurrent validity and Known Groups comparisons. Finally the sensitivity (responsiveness to change) of the DTSQ scores to the changes of the metabolic conditions were assessed. 50.0% of the participants were male with a mean age of 51.1 +/- 11.4 (min 22, max 78). Majority of them had type 2 diabetes (86.4%) and 72.7% of these patients had at least one co-morbid chronic conditions. While 53.4% of the patients had been treated by insulin the remaining 46.6% had been taking oral anti-diabetic agents. The results revealed satisfactory alpha values for DTSQ (alpha > 0.70). All of the three metabolic measures (i.e., FBG, PBG, and HbA1c) had significant correlations with the DTSQ scores. The criterion and construct validity of the scale were found to be very satisfactory. The Turkish version of the DTSQ showed acceptable fit indices (RMSEA = 0.03, CFI > 0.90) with the original (hypothetic) construct. Almost all of the sub-dimensions of the WBQ and WHOQOL were correlated with the DTSQ as expected, indicating a good concurrent validity. DTSQ status version was found to be a reliable and valid instrument for the assessment of treatment satisfaction in Turkish diabetes mellitus patients.Item Glukagon like peptid-1Güclü, F; Özmen, B; Hekimsoy, Z; Kafesciler, SÖGlucagon-like peptide-1 (GLP-1) is a 30 amino-acid hormone produced by the pancreatic islet alpha cells, intestinal-L cells and central nervous sytem cells. The main target of action of GLP-1 is the islet, where the hormone stimulates insulin secretion, promotes beta cell proliferation and neogenesis, and inhibits glucagon secretion. However, GLP-1 receptors are also expressed outside the islets, increasing the likelihood that GLP-1 also plays a role in other organs. These functions are mainly the inhibition of gastric emptying, gastric acid secretion and exocrine pancreatic secretion, indicating that the hormone acts as an enterogastrone hormone released from the distal portion of the small intestine that inhibits proximal gastrointestinal events. Another important action of GLP-1 is to induce satiety. Other effects of the hormone include cardioprotection, neuroprotection, induction of antidiabetic actions unrelated to islet function. Thus, GLP-1 clearly has several manifestations of activity. The physiological relevance of these actions and their contribution to the overall antidiabetic action of GLP-1 when used in treatment of type 2 diabetes remains to be established.Item Serum N-terminal-pro-brain natriuretic peptide (NT-pro-BNP) and homocysteine levels in type 2 diabetic patients with asymptomatic left ventricular diastolic dysfunctionGörmüs, U; Özmen, D; Özmen, B; Parildar, Z; Özdogan, Ö; Mutaf, I; Bayindir, OAims: : The aim of this study was to determine serum NT-proBNP and plasma Hcy levels and to explore the relationship between serum NT-proBNP and plasma Hcy levels in type 2 diabetic patients with and without asymptomatic LVDD. Methods: : NT-proBNP and Hcy levels were measured 31 patients with type 2 diabetes mellitus. According to echocardiographic data, diabetic patients were divided into two groups: normal LV function or LV diastolic dysfunction. Results: : Serum NT-proBNP levels in diabetic patients with LVDD were significantly higher than in diabetic patients with normal LV function and controls. The area under the receiver-operating characteristic (ROC) curve for NT-proBNP to separate normal vs. diastolic dysfunction was 0.96 in type 2 diabetic patients. Plasma Hcy levels were significantly higher in both diabetic groups than in controls. Positive correlation was noted between NT-proBNP and Hcy levels in diabetic patients with LVDD (r = 0.881, p = 0.0001). Conclusions: : The correlation between elevated NT-proBNP and Hcy levels in diabetic patients with LVDD suggest an association between homocysteinemia and increased NT-proBNP secretion. Our data indicate that NT-proBNP may be a simple screening tool to select diabetic patients with LVDD requiring further examination with echocardiography. (C) 2009 Elsevier Ireland Ltd. All rights reserved.Item Homocysteine levels in acromegaly patientsHekimsoy, Z; Özmen, B; Ulusoy, SAcromegaly is associated with a two to three-fold increase in mortality related predominantly to cardiovascular disease. The excess mortality is associated most closely with higher levels of growth hormone (GH). Survival in acromegaly may be normalized to a control age-matched rate by controlling GH levels; in particular, GH levels less than 2.5 ng/mL are associated with survival rates equal to those of the general population. Hyperhomocysteinemia has also been recognized as a risk factor for cardiovascular disease, yet there are limited data on the prevalence of hyperhomocysteinemia in patients with acromegaly. Eighteen acromegaly patients (7 male, 11 female, mean age 42.8 +/- 11.0 years) in our endocrine clinic consented to having the following tests performed: complete blood count (CBC), thyroid hormones, folic acid, vitamin B12, plasma homocysteine levels, uric acid, fibrinogen, CRP, fasting glucose, insulin, C-peptide, total serum cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, GH, insulin-like growth factor-1 (IGF-1) and GH levels after an oral glucose tolerance test (OGTT). By history, fourteen had macroadenomas and four had microadenomas; eight had hypertension; two had glucose intolerance, and four had diabetes. Fifteen had had transsphenoidal or transfrontal surgery: two had been cured, but 13 others were taking long-acting octreotide. Five patients had undergone radiotherapy and the acromegaly in two was treated primarily with long-acting octreotide. CBC, thyroid hormone, folic acid, and vit B12 levels were normal in all patients. We divided the patients into two groups according to mean GH levels after an OGTT: Group 1 (GH < 2.5 ng/mL, n=10), and Group 2 (GH >= 2.5 ng/mL, n=8). Comparison of the two groups using Mann-Whitney U testing revealed statistically significant lower levels in Group 1 of the following parameters: GH (1.91 +/- 0.90 vs. 8.58 +/- 5.55 ng/mL, p=0.002), IGF-1 (338.30 +/- 217.90 vs. 509.60 +/- 293.58 ng/dL, p=0.06), GH after an OGTT (1.42 +/- 0.81 vs. 9.01 +/- 4.53 ng/mL, p=0.001), plasma homocysteine (12.85 +/- 4.47 vs. 18.20 +/- 4.99 mu mol/L, p=0.05), total cholesterol (164.0 +/- 20.81 vs. 188.0 +/- 22.26 mg/dL, p=0.05) and LDL cholesterol (81.0 +/- 9.64 vs. 116.70 +/- 13.03 mg/dl, p=0.01). Differences between the other parameters were not significantly different. Acromegaly patients with high GH levels after an OGTT have much higher levels of homocysteine than patients with lower GH levels. The role of elevated homocysteine levels as an independent cardiovascular risk factor in the mortality of acromegaly patients should be determined in future studies.