Sub-optimal drug treatment of diabetes and cardiovascular risk in diabetic patients in Turkey. A countrywide survey

Damcı, Taner; Kültürsay, Hakan; Oğuz, Aytekin; Pehlivanoğlu, Seçkin; Tokgözoğlu, Lâle

doi:10.1016/s1262-3636(07)70124-6

Cited by 14 publications

(11 citation statements)

References 30 publications

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“…However, the lower rate of drugs use among immigrant elderly without command of the native language is consistent with results from similar studies in the US among non-native language speaking immigrant groups [25-28]. A study conducted in Turkey among elderly diabetics also found underutilization of drugs indicating a trend among physicians to under prescribe insulin [29]. Since our study did not address prescribing behaviour of physicians we do not know if underutilization among immigrant elderly in the Netherland can be explained by lack of knowledge among physicians.…”

Section: Discussionsupporting

confidence: 84%

Underutilization of prescribed drugs use among first generation elderly immigrants in the Netherlands

Denktaş

Koopmans

Birnie

et al. 2010

BMC Health Serv Res

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BackgroundIn developed countries, health care utilization among immigrant groups differs where the dominant interpretation is unjustified overutilization due to lack of acculturation. We investigated utilization of prescribed drugs in native Dutch and various groups of immigrant elderly.MethodsCross-sectional study using data from the survey "Social Position, Health and Well-being of Elderly Immigrants" (the Netherlands, 2003). Ethnicity-matched interviewers conducted the survey among first generation immigrants aged 55 years and older. Outcome measure is self-reported use of prescribed drugs. Utilization is explained by need, and by enabling and predisposing factors, in particular acculturation; analysis is conducted by multiple logistic regression.ResultsThe study population consisted of immigrants from Turkey (n = 307), Morocco (n = 284), Surinam (n = 308) and the Netherlands Antilles (n = 300), and a native Dutch reference group (n = 304). Prevalence of diabetes mellitus (DM), COPD and musculoskeletal disorders was relatively high among immigrant elderly. Drug utilization in especially Turkish and Moroccan elderly with DM and COPD was relatively low. Drugs use for non-mental chronic diseases was explained by more chronic conditions (OR 2.64), higher age (OR 1.03), and modern attitudes on male-female roles (OR 0.74) and religiosity (OR 0.89). Ethnicity specific effects remained only among Turkish elderly (OR 0.42). Drugs use for mental health problems was explained by more chronic conditions (OR 1.43), better mental health (OR 0.95) and modern attitudes on family values (OR 0.59). Ethnicity specific effects remained only among Moroccan (OR 0.19) and Antillean elderly (OR 0.31). Explanation of underutilization of drugs among diseased with diabetes and musculoskeletal disorders are found in number of chronic diseases (OR 0.74 and OR 0.78) and regarding diabetes also in language proficiency (OR 0.66) and modern attitudes on male-female roles (OR 1.69).ConclusionsNeed and predisposing factors (acculturation) are the strongest determinants for drugs utilization among elderly immigrants. Significant drugs underutilization exists among migrants with diabetes and musculoskeletal disorders.

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Section: Discussionsupporting

confidence: 84%

Underutilization of prescribed drugs use among first generation elderly immigrants in the Netherlands

Denktaş

Koopmans

Birnie

et al. 2010

BMC Health Serv Res

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“…Although maintaining blood glucose and glycosylated hemoglobin concentrations as close to the normal range as possible would prevent or delay long-term complications, [14] The Turkish Diabetes Epidemiology-II (TURDEP-II) population research revealed that in Turkey, the diabetes prevalence was 13.7% and that glycemic control was insufficient [15] Factors contributing to the prevalence of diabetes in Turkey include undertreatment [16] ; a lack of patient compliance with treatment; and insufficient control of modifiable risk factors, such as body weight, physical inactivity, and diet. [17] Research indicates that diabetes prevention focusing on change-of-lifestyle interventions is likely to be cost-saving.…”

Section: Discussionmentioning

confidence: 99%

Is There a Relation Between Serum Vitamin D Level and Microvascular Comlications in Type 2 Diabetes?

Böyük

2017

EJMO

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V itamin D is absorbed into the body through exposure to sunlight, a diet of vitamin-fortified foods, and dietary supplements. The major source of vitamin D absorption is through skin synthesis. Vitamin D receptors have been found in various tissues, including the brain, prostate, breast, colon, pancreas, and immune cells.[1] The estimated worldwide prevalence of vitamin D (25-hydroxyvitamin D [25(OH) D]) deficiency is 30% to 87%.[2] A study in Turkey in 2000 demonstrated that the deficiency prevalence ranged between 44% and 100% in women.[3] Furthermore, studies have revealed a high prevalence of vitamin D deficiency in type 2 diabetes mellitus (T2DM) patients in the Turkish population. [4,5] Recently, vitamin D was found to have various effects on glucose metabolism, obesity, metabolic syndrome, cardiovascular diseases, and cancer, as well as bone metabolism. It has been suggested that vitamin D is involved in insulin sensitivity by controlling calcium flux through the membrane in both beta-cells and peripheral Objectives:The aim of this study was to further investigate the prevalence of Vitamin D deficiency in diabetes mellitus (DM) patients, as well as the association between hypovitaminosis D and the microvascular complications of type 2 (T2) DM. Methods: This was a cross-sectional, case-control study of 206 T2DM patients and 34 healthy control subjects. Participants were evaluated for the presence of diabetic retinopathy, nephropathy, and neuropathy. Results: The level of serum 25-hydroxyvitamin D (25(OH) D) was significantly lower in the T2DM patients (11.16±3.99 ng/mL vs. 15.58±3.16 ng/mL; p<0.05). Furthermore, 2.7% of the patients were found to have retinopathy (n=53), 3.6% had neuropathy (n=65), and 29.1% of the patients had microalbuminuria (n=60). Although serum 25(OH) D levels were significantly lower in the presence of retinopathy and neuropathy (p<0.05 for both), no significant association between Vitamin D level and microalbuminuria was found. Conclusion: An inverse relationship between the circulating 25(OH) D level and the prevalence of retinopathy and neuropathy in T2DM patients was determined. However, there was no significant association between microalbuminuria and the 25(OH) D level.

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“…Accordingly, patients are often exposed to a prolonged glycemic load, and insulin treatment is initiated only after complications appear (10). (11). In addition, 30% of patients with A1C values >8% were reported to be under OAD monotherapy and 32.6% were under insulin therapy, despite the presence of poor metabolic control (11).…”

Section: Importance Of Timely Insulinizationmentioning

confidence: 99%

“…(11). In addition, 30% of patients with A1C values >8% were reported to be under OAD monotherapy and 32.6% were under insulin therapy, despite the presence of poor metabolic control (11). Based on the SOLVE study data, insulin treatment was started considerably late in Turkey, given the average duration of diabetes (8.1 ±5.6 years) and the duration of OAD use (7.6 ±6.6 years).…”

Section: Importance Of Timely Insulinizationmentioning

confidence: 99%

Use of Biphasic Insulin Aspart 30 in Type 2 Diabetes Treatment: Expert Panel Recommendations

Akalın¹,

Aydın²,

Balci³

et al. 2018

Turk J Endocrinol Metab

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The goals of Type 2 diabetes treatment are to eliminate the hyperglycemia resulting from insulin insufficiency and/or insulin resistance, delay beta cell damage/depletion, and prevent other metabolic co-morbidities and complications. In the current treatment algorithms, lifestyle changes (medical nutrition therapy, physical exercise) and oral anti-diabetics are followed by insulin therapy, which is considered a replacement therapy for Type 2 diabetes. Pre-mixed insulin preparations, which are an option for patients with poor blood glucose level control under oral anti-diabetics treatment, have been developed to meet both basal and prandial insulin needs by simulating the physiological changes in insulin levels. The consensus on the necessity of individualizing insulin therapy requires physicians to have a detailed knowledge of the various uses of insulin. Therefore, this comprehensive consensus statement has been prepared by a panel of expert endocrinologists from different regions of Turkey to help physicians use biphasic insulin aspart 30 in suitable patients at the right time. In this statement, expert panel opinions on (a) Recommendations for the appropriate initiation, titration, and intensification of insulin treatment, and (b) The treatment algorithms in initiation, titration, and intensification of biphasic insulin aspart 30 treatment and special conditions specific to changing treatment regimen are presented.Keywords: Biphasic insulin aspart 30; insulin intensification; premixed insulin; insulin analog Tip 2 diyabet (T2D) tedavisinde amaç, insülinin yetersiz salgısı ve/veya insülin direnci sonucu oluşan hiperglisemiyi ortadan kaldırmak, beta hücre harabiyetini/tükenişini yavaşlatmak, eşlik eden diğer metabolik sorunları düzeltmek ve komplikasyonları önlemektir. Güncel tedavi algoritmalarında yaşam tarzı değişikliği (tıbbi beslenme tedavisi, egzersiz) ve oral antidiyabetikler ile tedavi seçeneklerini izleyen aşamada yer alan insülin, T2D için bir yerine koyma tedavisi olarak değerlendirilmektedir. Hazır karışım insülinler, oral antidiyabetikler ile kan glukoz düzeyleri kontrol altına alınamayan hastaların tedavisinde yer alması önerilen tedavi seçeneklerinden olup, hem bazal hem de prandiyal insülin ihtiyacını fizyolojiye yakın biçimde karşılamak amacıyla geliştirilmişlerdir. İnsülin tedavisinin kişiye özel olması gerektiği konusundaki konsensüs, hekimlerin değişik insülinlerin kullanımları ile ilgili daha ayrıntılı bilgiye sahip olmalarını gerektirmektedir. Bu nedenle, ülkemiz koşullarında bifazik insülin aspart 30'un doğru hastada, doğru zamanda ve doğru biçimde kullanılmasını kolaylaştırmak ve hekimlere yardımcı olmak için Türkiye'nin farklı bölgelerinde görev yapmakta olan deneyimli endokrinologlardan oluşan bir uzman paneli tarafından, bu kapsamlı uzlaşı metni hazırlanmıştır. Bu uzlaşı metninde, uzman paneli görüşleri; a) İnsülin tedavisine uygun başlangıç, titrasyon ve yoğunlaştırma algoritma önerileri ve b) Bifazik insülin aspart 30 tedavisine özgü başlangıç, titrasyon ve yoğunlaştırma tedavi algor...

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Sub-optimal drug treatment of diabetes and cardiovascular risk in diabetic patients in Turkey. A countrywide survey

Cited by 14 publications

References 30 publications

Underutilization of prescribed drugs use among first generation elderly immigrants in the Netherlands

Underutilization of prescribed drugs use among first generation elderly immigrants in the Netherlands

Is There a Relation Between Serum Vitamin D Level and Microvascular Comlications in Type 2 Diabetes?

Use of Biphasic Insulin Aspart 30 in Type 2 Diabetes Treatment: Expert Panel Recommendations

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