Diabetes Care in Turkey Prof. Dr. Taner Damcı Istanbul University Cerrahpaşa Medical Faculty...

Diabetes Care in Turkey

Prof. Dr. Taner Damcı

Istanbul University Cerrahpaşa Medical Faculty

Department on Endocrinology Metabolism and Diabetes

0

4

8

12

16

20

%

20-24

25-2930-3435-39

40-4445-4950-54

55-5960-64

65-6970+ Mean

Age

TURDEP Diabetes prevalence in Turkey due to ages

P<0.0001

Satman İ, TURDEP Group. Diabetes Care 2002; 25: 1551-6

0

4

8

12

16

20

%

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70+

Mean

Yaş Grubu

TURDEP Prevalence of IGT in Turkey due to ages

P<0.0001

Satman İ, TURDEP Group. Diabetes Care 2002; 25: 1551-6

A. Urban men

0 5 10 15 20 25 30

20-2940-49

60-69Genel

Age

C. Rural men

0 5 10 15 20 25 30

20-2930-39

40-4950-59

60-6970+

Genel

Age

%

B. Urban women0 5 10 15 20 25 30

20-29

30-39

40-49

50-59

60-69

70+Genel

Age

D.Rural women0 5 10 15 20 25 30

20-2930-39

40-4950-59

60-6970+

Genel

Age

New DM Known DM

Satman İ, TURDEP Group. Diabetes Care 2002; 25: 1551-6

Diabetes prevalence in Turkey due to age and gender

0

5

10

15

20

25

30

35

%

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70+ mean

age

TURDEP Prevalence of obesity (General)

BMI30 kg/m2

P<0.0001

Satman I, Yilmaz MT, and the TURDEP Group. Diabetologia 2000; 43:433, A111

0

10

20

30

40

50

%

age

Women

Obesity 10,4 29 42 43,9 39,6 30,4

20-29 30-39 40-49 50-59 60-69 70+

0

10

20

30

40

50

%

age

Men

Obesity 4,1 12 19 20,5 17,4 16,6

20-29 30-39 40-49 50-59 60-69 70+

Prevalence of Obesity in Turkey

TURDEP Çalışması

Obezite

33,7

20

41,8

05

1015202530354045

Genel Erkek Kadıngender

pp

TEMD Türkiye Metabolik Sendrom Taraması - Prof. Dr. Fahri BAYRAM

Results of the Turkish Obesity and Metabolic Syndrome Survey

Prevalence of metabolic syndrome

34,90%

25,20%

40,10%

0%

10%

20%

30%

40%

50%

Tüm grup Erkek Kadın

Results of the Turkish Obesity and Metabolic Syndrome Survey

Prevalence in obese children and adolescents. AGH: abnormal glucose homoeostasis, IR: insulin resistance, IGT: impaired

glucose tolerance, IFG: impaired fasting glucose, HI: hyperinsulinemia, DL: dyslipidaemia, HT: hypertension, DM:

type 2 diabetes, MS: metabolic syndrome.

Diabetes Research and Clinical Practice Volume 72, Issue 3, June 2006, Pages 315-321

Baseline characteristics (FAS)

Type 1 (N=191)

Type 2 (N=939)

Male n (%) 96 (50.3) 431 (45.9) Female n (%) 95 (49.7) 508 (54.1)

Mean age (yrs)* 31.25 10.62 57.26 10.69 Weight (kg)* 65.31 11.3 78.46 13.58

BMI (kg/m2)* 23.23 3.35 29.42 4.69 Waist circumference (cm) * Male Female

85.39 11.69 80.73 11.97

101.51 12.29 101.91 13.30

Time since diagnosis (yrs)* 9.71 8.56 8.68 7.24 *Mean SD, SD - standard deviation, BMI – body mass index

Patients demographics

BMI- Type 1

MaleN=93

FemaleN=94

< 20 25-3020-25 30-35 >35

BMI- Type 2

Male N=428

FemaleN=494

< 20 25-3020-25 30-35 >35

Diabetes late complications

% of patients In Type 1(N=191)

In Type 2(n=939)

Not checkedType 1

Not checkedType 2

% of patients who have at least 1 complication

45.5% 56.3%

Retinopathy 56.3% 45% 2.3% 14%

Neuropathy 40.2% 47.6% 9.2% 18.5%

Microalbuminuria 44.8% 31.8% 11.5% 32.5%

Proteinuria 29.9% 18.7% 8% 14.6%

Past or present foot ulcer 8% 8.7% 1.1% 2.5%

Amputation 3.4% 1.9% 1.1% 3%

Angina 6.9% 24.4% 1.1% 2.5%Myocardial infarction 4.6% 15.9% 1.1% 3%

Heart failure 2.3% 9.1% 1.1% 2.8%

Stroke 1.1% 5.3% 1.1% 1.5%

Peripheral vascular disease 5.7% 10.2% 3.4% 10.8%

Erectile dysfunction (%male)

23.5% 25% 18.8% 34.3%

Other cardiovascular risk factors

% of patients Type 1(N=191)

Type 2(N=939)

Hypertension 19.9% 67.4%

Dyslipidemia 23.9% 66.3%

Smoking Current Past

24.1%9.9%

15.5%19.6%

Patients antidiabetic treatments

% of patients Type 1N=191

Type 2N=939

No treatment 3 (1.6%) 58 (6.2%)

Receiving OAD alone 2 (1%) 604 (64.3%)

Receiving OAD + insulin 17 (8.9%) 142 (15.1%)Receiving insulin alone 169 (88.5%) 135 (14.4%)

Starting insulin treatment this day 5 (2.6%) 36 (3.8%)

Oral Hypoglycemic Agents

Type 2OAD alone

N=604

Type 2OAD+insulin

N=142Glinidines 10.4% 13.4%

Biguanides 63.0% 70.4%

TZD 12.2% 16.9%

Alpha glucosidase inhibitor

17.7% 25.3%

SU 69.2% 12.7%

Insulin treatment : Type of insulin

Type 1 N=186

Type 2N=277

Basal Prandial aloneBas + Prand Premix Others

Insulin treatment : Number of injections per day

Type 1N=186

Type 2N=277

1/day 2/day 3/day > 3 /day

Glycemic control

Type 1(N=191)

Type 2(N=939)

Last HbA1c value availablen= Mean std (%)Min – Max (%)

1588.29 2.21

3-15

7537.86 1.99

4–15Time since last HbA1c measurement (months) 1.08 1.63 0.60 1.54

% of patients with HbA1c < 7 45 (28.5%) 300 (39.8%)Last laboratory FBG value (mg/dL)n=Mean std (mg/dL)Min – Max (mg/dL)

166189.49 92.31

47-462

905175.21 72.62

45-493Last laboratory FBG value (mmol/L)Mean stdMin - Max

10.54 5.133-26

9.74 4.043-27

Time since last FBG measurement (months) 0.69 1.57 0.36 0.86

Frequency of monitoring of glycemic control

in the whole population

Type 1N= 191

Type 2N= 939

% of patients for whom HbA1c measurement done at least once 89% 82%

Frequency of laboratory measurement of HbA1c Mean (times/ 2 years)

N=1684.15 2.75

N=7543.08 2.38

Frequency of laboratory measurement of FBGMean (times/year)

N=176

16.68 23.56

N=939

9.24 14.75

Frequency of self monitoring of FBG Mean (times/month)

N=14815.59 9.83

N=3349.91 8.48

Frequency of monitoring of glycemic control

whole population (by class)Type 1N= 191

Type 2N= 939

% of patients who self monitor blood glucose

N=17089%

N=36338.7%

< once/week 6.1% 20.4%

1-2 times/week 25% 36.2%

3-4 times/week 27.7% 25.4%

>4 times/week 19.6% 9.6%

Once/day 21.6% 8.4%

Reasons for not achieving target – Type 1

05

101520253035404550

Failure ofcurr. ttt

Fear ofhypo

Noncompliance

Poor educ. Others

Hypo Weight concern

Fear of injections

Concom. illness

% of answers

N=130

Reasons for not achieving target – Type 2

Hypo Weight concern

Fear of injections

Concom. illness

%

Type 2 insulin treated N=197

0

10

20

30

40

50

60

70

Failure ofcurrent ttt

Fear of hypo Noncompliance

Pooreducation

Others

0

10

20

30

40

50

60

70

Failure ofcurrent ttt

Fear of hypo Noncompliance

Pooreducation

Others

Type 2 without insulin N=374

Hypo Weight

concern

Concom.

illness

Fear of

injectons

Patient education and follow up

Type 1 Type 2

Patients trained by a diabetes educator (%)

77% 46%

Frequency of training by a diabetes educator (times)Mean StdMin - Max

4.23 5.541-40

3 4.011-48

Patients belonging to a patient diabetes association (%) 15.2% 4%Frequency of consultation to doctor (per year)Mean StdMin – Max

4.74 4.151-40

4.08 3.431-48

Absenteeism and hospitalisation due to diabetes

Type 1N=191

Type 2N=939

Absenteeism at work due to diabetes in the past 6 months (% of patients)

(n=)30.1%

(n=)6.7%

Number of days of absenteeism due to diabetes in the past 6 monthsMean Std (days/6 months)Min- Max

21.98 25.161– 120

15.39 15.931-60

Patients hospitalised due to diabetes in the past 6 months (% of patients) 23.6% 8.1%

Number of days at hospital due to diabetesnMean Std (days/6 months)

4516.67 14.98

7512.89 12.92

Number of days at hospital due to hyposnMean Std ( days/year)

105.70 5.79

151.87 3.48

Predictive factors of « reaching target »

Variables evaluated for T1DM

AgeBMITime since diagnosisSMBGTraining by a diabetes educatorFrequency of consultationsSelf adjustment of insulin

Factors evaluated for T2DM

AgeBMITime since diagnosisSMBGTraining by a diabetes educatorFrequency of consultationsSelf adjustment of insulinNumber of OADs

SUB-OPTIMAL DRUG TREATMENT OF DIABETES AND CARDIOVASCULAR RISK IN DIABETIC PATIENTS IN TURKEY; A COUNTRYWIDE SURVEY

Taner DAMCIHakan KULTURSAY

Aytekin OGUZSeckin PEHLIVANOGLU

Lale TOKGOZOGLU, (The Vascular Risk Study Group)

Diabetes and Metabolism

Antidiabetic drug choice

0

10

20

30

40

SU Komb İns Met İns+OAD Acar Glin TZD

33 %

7 %4 %

2 %0.3 %

20 %

5 %

13 %

Antihypertensives

0

10

20

ACE inh.Alone

Ca ant.Alone

ACE inh-diuretic

ARB alone Diureticalone

Beta blockeralone

ARB-diuretic

ACE inh- Caant

20 18

11.6

6.3 6.2 5.8

% 3.4 1.2

%

No of antihypertensives

0

10

20

30

40

50

60

0 1 2 3 4 5

3-D Column 1

Antihipertansif ilaç sayısı

%

Drug use in microalbuminuric patients

ACEIARBHiçbiri

% 31

% 11% 58

Statin % 19Kolesterol > 200 mg/dl % 32Fibratlar % 1Aspirin % 30Daha önce KV olay geçiren

diabetiklerde % 54

Conclusions• Diabetes is prevalent as are the

complications of the disease in Turkey

• Care of diabetic patients is not optimal

• This is probably due to educational, economic, time constraints