Browsing by Author "Güçlü, F"

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    Effects of a statin group drug, pravastatin, on the insulin resistance in patients with metabolic syndrome
    Güçlü, F; Özmen, B; Hekimsoy, Z; Kirmaz, C
    Background. - 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.
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    The prevalence of hyperprolactinaemia in overt and subclinical hypothyroidism
    Hekimsoy, Z; Kafesçiler, S; Güçlü, F; Özmen, B
    The 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.
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    Vitamin D status among adults in the Aegean region of Turkey
    Hekimsoy, Z; Dinç, G; Kafesçiler, S; Onur, E; Güvenç, Y; Pala, T; Güçlü, F; Özmen, B
    Background: 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.
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    The Relationship Between Glycosylated Haemoglobin and Diabetic Retinopathy in Patients with Type 2 Diabetes
    Özmen, B; Güçlü, F; Kafesçiler, S; Özmen, D; Hekimsoy, Z
    Diabetes 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.
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    Psychometric properties and responsiveness of the Turkish version of the Diabetes Treatment Satisfaction Questionnaire (s) on a sample of diabetics of three consecutive monitoring periods
    Özmen, B; Eser, E; Kafesçiler, SO; Pala, T; Güçlü, F; Hekimsoy, Z
    The 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.