Browsing by Author "Boyvada, S"

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    The relationship between self-monitoring of blood glucose control and glycosylated haemoglobin in patients with type 2 diabetes with and without diabetic retinopathy
    Özmen, B; Boyvada, S
    Background: 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.
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    Depression and anxiety in hypothyroidism
    Demet, MM; Ozmen, B; Deveci, A; Boyvada, S; Adiguzel, H; Aydemir, O
    The aim of the study was to determine the prevalence and severity of depression and anxiety inpatients with hypothyroidism and to compare this with euthyroid patients. Thirty patients with hypothyroidism and 30 euthyroid controls attending the Endocrinology outpatient department of Celal Bayar University, Medical Faculty were included in the study. The hormonal screening was done by immunoassay and haemagglutination methods. Then, 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. Total scores obtained from the scales used in the study did not differ significantly (p > 0.05). The frequency of items of both HAM-D and HAM-A did not show any differences in the two groups. By Wilks' Lambda discriminant analysis, depressive mood (HAM-D#1) was found to be the discriminating feature between the hypothyroid group and the euthyroid group. Therefore, depression and anxiety were not outstanding features in hypothyroidism. However depression was more significant in the hypothyroid than euthyroid group.
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    Depression and anxiety in hyperthyroidism
    Demet, MM; Özmen, B; Deveci, A; Boyvada, S; Adigüzel, H; Aydemir, Ö
    Background. 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.
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    Can self-monitoring blood glucose control decrease glycated hemoglobin levels in diabetes mellitus
    Özmen, B; Boyvada, S
    The 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.