Alper Sonmez1, Volkan Yumuk2, Cem Haymana3, Ibrahim Demirci3, Cem Barcin4, Sinem Kıyıcı5, Sibel Güldiken6, Gonca Örük7, Basak Ozgen Saydam8, Süleyman Baldane9, Faruk Kutlutürk10, Ferit Kerim Küçükler11, Oğuzhan Deyneli12, Berrin Çetinarslan13, Tevfik Sabuncu14, Fahri Bayram15, Ilhan Satman16. 1. Department of Endocrinology and Metabolism, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey, alpersonmez@yahoo.com. 2. Department of Endocrinology and Metabolism, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey. 3. Department of Endocrinology and Metabolism, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey. 4. Department of Cardiology, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey. 5. Department of Endocrinology and Metabolism, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey. 6. Department of Endocrinology and Metabolism, Medical Faculty, Trakya University, Edirne, Turkey. 7. Department of Endocrinology and Metabolism, Atatürk Education and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey. 8. Department of Endocrinology and Metabolism, Medical Faculty, Dokuz Eylül University, Izmir, Turkey. 9. Department of Endocrinology and Metabolism, Medical Faculty, Selçuk University, Konya, Turkey. 10. Department of Endocrinology and Metabolism, Medical Faculty, Gaziosmanpaşa University, Tokat, Turkey. 11. Department of Endocrinology and Metabolism, Medical Faculty, Hitit University, Corum, Turkey. 12. Department of Endocrinology and Metabolism, Medical Faculty, Marmara University, Istanbul, Turkey. 13. Department of Endocrinology and Metabolism, Medical Faculty, Kocaeli University, Kocaeli, Turkey. 14. Department of Endocrinology and Metabolism, Medical Faculty, Harran University, Urfa, Turkey. 15. Department of Endocrinology and Metabolism, Medical Faculty, Erciyes University, Kayseri, Turkey. 16. Department of Endocrinology and Metabolism, Medical Faculty, Istanbul University, Istanbul, Turkey.
Abstract
BACKGROUND: Obesity is the main obstacle for metabolic control in patients with type 2 diabetes. Turkey has the highest prevalence of obesity and type 2 diabetes in Europe. The effect of obesity on the metabolic control, and the macro- and microvascular complications of patients are not apparent. OBJECTIVES: This nationwide survey aimed to investigate the prevalence of overweight and obesity among patients with type 2 diabetes and to search for the impact of obesity on the metabolic control of these patients. We also investigated the independent associates of obesity in patients with type 2 diabetes. METHODS: We consecutively enrolled patients who were under follow-up for at least 1 year in 69 tertiary healthcare units in 37 cities. The demographic, anthropometric, and clinical data including medications were recorded. Patients were excluded if they were pregnant, younger than 18 years, had decompensated liver disease, psychiatric disorders interfering with cognition or compliance, had bariatric surgery, or were undergoing renal replacement therapy. RESULTS: Only 10% of patients with type 2 diabetes (n = 4,648) had normal body mass indexes (BMI), while the others were affected by overweight (31%) or obesity (59%). Women had a significantly higher prevalence of obesity (53.4 vs. 40%) and severe obesity (16.6 vs. 3.3%). Significant associations were present between high BMI levels and lower education levels, intake of insulin, antihypertensives and statins, poor metabolic control, or the presence of microvascular complications. Age, gender, level of education, smoking, and physical inactivity were the independent associates of obesity in patients with type 2 diabetes. CONCLUSION: The TEMD Obesity Study shows that obesity is a major determinant of the poor metabolic control in patients with type 2 diabetes. These results underline the importance of prevention and management of obesity to improve health care in patients with type 2 diabetes. Also, the results point out the independent sociodemographic and clinical associates of obesity, which should be the prior targets to overcome, in the national fight with obesity.
BACKGROUND: Obesity is the main obstacle for metabolic control in patients with type 2 diabetes. Turkey has the highest prevalence of obesity and type 2 diabetes in Europe. The effect of obesity on the metabolic control, and the macro- and microvascular complications of patients are not apparent. OBJECTIVES: This nationwide survey aimed to investigate the prevalence of overweight and obesity among patients with type 2 diabetes and to search for the impact of obesity on the metabolic control of these patients. We also investigated the independent associates of obesity in patients with type 2 diabetes. METHODS: We consecutively enrolled patients who were under follow-up for at least 1 year in 69 tertiary healthcare units in 37 cities. The demographic, anthropometric, and clinical data including medications were recorded. Patients were excluded if they were pregnant, younger than 18 years, had decompensated liver disease, psychiatric disorders interfering with cognition or compliance, had bariatric surgery, or were undergoing renal replacement therapy. RESULTS: Only 10% of patients with type 2 diabetes (n = 4,648) had normal body mass indexes (BMI), while the others were affected by overweight (31%) or obesity (59%). Women had a significantly higher prevalence of obesity (53.4 vs. 40%) and severe obesity (16.6 vs. 3.3%). Significant associations were present between high BMI levels and lower education levels, intake of insulin, antihypertensives and statins, poor metabolic control, or the presence of microvascular complications. Age, gender, level of education, smoking, and physical inactivity were the independent associates of obesity in patients with type 2 diabetes. CONCLUSION: The TEMD Obesity Study shows that obesity is a major determinant of the poor metabolic control in patients with type 2 diabetes. These results underline the importance of prevention and management of obesity to improve health care in patients with type 2 diabetes. Also, the results point out the independent sociodemographic and clinical associates of obesity, which should be the prior targets to overcome, in the national fight with obesity.
Authors: Benjamin M Scirica; Deepak L Bhatt; Eugene Braunwald; P Gabriel Steg; Jaime Davidson; Boaz Hirshberg; Peter Ohman; Robert Frederich; Stephen D Wiviott; Elaine B Hoffman; Matthew A Cavender; Jacob A Udell; Nihar R Desai; Ofri Mosenzon; Darren K McGuire; Kausik K Ray; Lawrence A Leiter; Itamar Raz Journal: N Engl J Med Date: 2013-09-02 Impact factor: 91.245
Authors: Juan Pablo Domecq; Gabriela Prutsky; Aaron Leppin; M Bassam Sonbol; Osama Altayar; Chaitanya Undavalli; Zhen Wang; Tarig Elraiyah; Juan Pablo Brito; Karen F Mauck; Mohammed H Lababidi; Larry J Prokop; Noor Asi; Justin Wei; Salman Fidahussein; Victor M Montori; Mohammad Hassan Murad Journal: J Clin Endocrinol Metab Date: 2015-01-15 Impact factor: 5.958
Authors: Jeanine B Albu; Jiang Lu; Arshag D Mooradian; Ronald J Krone; Richard W Nesto; Marty H Porter; Jamal S Rana; William J Rogers; Burton E Sobel; Sheldon H Gottlieb Journal: Obesity (Silver Spring) Date: 2009-10-29 Impact factor: 5.002
Authors: Claudia Langenberg; Stephen J Sharp; Matthias B Schulze; Olov Rolandsson; Kim Overvad; Nita G Forouhi; Joachim Spranger; Dagmar Drogan; José María Huerta; Larraitz Arriola; Blandine de Lauzon-Guillan; Maria-Jose Tormo; Eva Ardanaz; Beverley Balkau; Joline W J Beulens; Heiner Boeing; H Bas Bueno-de-Mesquita; Françoise Clavel-Chapelon; Francesca L Crowe; Paul W Franks; Carlos A Gonzalez; Sara Grioni; Jytte Halkjaer; Goran Hallmans; Rudolf Kaaks; Nicola D Kerrison; Timothy J Key; Kay Tee Khaw; Amalia Mattiello; Peter Nilsson; Teresa Norat; Luigi Palla; Domenico Palli; Salvatore Panico; J Ramón Quirós; Dora Romaguera; Isabelle Romieu; Carlotta Sacerdote; María-José Sánchez; Nadia Slimani; Ivonne Sluijs; Annemieke M W Spijkerman; Birgit Teucher; Anne Tjonneland; Rosario Tumino; Daphne L van der A; Yvonne T van der Schouw; Edith J M Feskens; Elio Riboli; Nicholas J Wareham Journal: PLoS Med Date: 2012-06-05 Impact factor: 11.069