Diabetes Care in Turkey Prof. Dr. Taner Damcı Istanbul University Cerrahpaşa Medical Faculty Department on Endocrinology Metabolism and Diabetes

TURDEP Diabetes prevalence in Turkey due to ages P< Satman İ, TURDEP Group. Diabetes Care 2002; 25:

TURDEP Prevalence of IGT in Turkey due to ages P< Satman İ, TURDEP Group. Diabetes Care 2002; 25:

Diabetes prevalence in Turkey due to age and gender

BMI  30 kg/m 2 P< Satman I, Yilmaz MT, and the TURDEP Group. Diabetologia 2000; 43:433, A111

Prevalence of Obesity in Turkey TURDEP Çalışması

TEMD Türkiye Metabolik Sendrom Taraması - Prof. Dr. Fahri BAYRAM 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 3Diabetes Research and Clinical Practice Volume 72, Issue 3, June 2006, Pages

Baseline characteristics (FAS) Patients demographics

BMI- Type 1 Male N=93 Female N=94 < >35

BMI- Type 2 Male N=428 Female N=494 < >35

Diabetes late complications % of patientsIn Type 1 (N=191) In Type 2 (n=939) Not checked Type 1 Not checked Type 2 % of patients who have at least 1 complication 45.5%56.3% Retinopathy56.3%45%2.3%14% Neuropathy40.2%47.6%9.2%18.5% Microalbuminuria44.8%31.8%11.5%32.5% Proteinuria29.9%18.7%8%14.6% Past or present foot ulcer8%8.7%1.1%2.5% Amputation3.4%1.9%1.1%3% Angina6.9%24.4%1.1%2.5% Myocardial infarction4.6%15.9%1.1%3% Heart failure2.3%9.1%1.1%2.8% Stroke1.1%5.3%1.1%1.5% Peripheral vascular disease5.7%10.2%3.4%10.8% Erectile dysfunction (%male) 23.5%25%18.8%34.3%

Other cardiovascular risk factors % of patientsType 1 (N=191) Type 2 (N=939) Hypertension19.9%67.4% Dyslipidemia23.9%66.3% Smoking Current Past 24.1% 9.9% 15.5% 19.6%

Patients antidiabetic treatments % of patientsType 1 N=191 Type 2 N=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 2 OAD alone N=604 Type 2 OAD+insulin N=142 Glinidines 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 2 N=277 BasalPrandial aloneBas + PrandPremixOthers

Insulin treatment : Number of injections per day Type 1 N=186 Type 2 N=277 1/day2/day3/day > 3 /day

Glycemic control Type 1 (N=191) Type 2 (N=939) Last HbA1c value available n= Mean  std (%) Min – Max (%)   –15 Time since last HbA1c measurement (months) 1.08   1.54 % of patients with HbA1c < 745 (28.5%)300 (39.8%) Last laboratory FBG value (mg/dL) n= Mean  std (mg/dL) Min – Max (mg/dL)   Last laboratory FBG value (mmol/L) Mean  std Min - Max   Time since last FBG measurement (months) 0.69   0.86

Frequency of monitoring of glycemic control in the whole population Type 1 N= 191 Type 2 N= 939 % of patients for whom HbA1c measurement done at least once 89%82% Frequency of laboratory measurement of HbA1c Mean (times/ 2 years) N=  2.75 N=  2.38 Frequency of laboratory measurement of FBG Mean (times/year) N=  N=  Frequency of self monitoring of FBG Mean (times/month) N=  9.83 N= 8.48

Frequency of monitoring of glycemic control whole population (by class) Type 1 N= 191 Type 2 N= 939 % of patients who self monitor blood glucose N=170 89% N= % < once/week6.1%20.4% 1-2 times/week25%36.2% 3-4 times/week27.7%25.4% >4 times/week19.6%9.6% Once/day21.6%8.4%

Reasons for not achieving target – Type 1 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 Type 2 without insulin N=374 HypoWeight concern Concom. illness Fear of injectons

Patient education and follow up Type 1Type 2 Patients trained by a diabetes educator (%) 77%46% Frequency of training by a diabetes educator (times) Mean  Std Min - Max 4.23   Patients belonging to a patient diabetes association (%) 15.2%4% Frequency of consultation to doctor (per year) Mean  Std Min – Max 4.74  

Absenteeism and hospitalisation due to diabetes Type 1 N=191 Type 2 N=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 months Mean  Std (days/6 months) Min- Max  –  Patients hospitalised due to diabetes in the past 6 months (% of patients) 23.6%8.1% Number of days at hospital due to diabetes n Mean  Std (days/6 months)   Number of days at hospital due to hypos n Mean  Std ( days/year)   3.48

Predictive factors of « reaching target » Variables evaluated for T1DM Age BMI Time since diagnosis SMBG Training by a diabetes educator Frequency of consultations Self adjustment of insulin Factors evaluated for T2DM Age BMI Time since diagnosis SMBG Training by a diabetes educator Frequency of consultations Self adjustment of insulin Number of OADs

SUB-OPTIMAL DRUG TREATMENT OF DIABETES AND CARDIOVASCULAR RISK IN DIABETIC PATIENTS IN TURKEY; A COUNTRYWIDE SURVEY Taner DAMCI Hakan KULTURSAY Aytekin OGUZ Seckin PEHLIVANOGLU Lale TOKGOZOGLU, (The Vascular Risk Study Group) Diabetes and Metabolism

Antidiabetic drug choice

Antihypertensives %

No of antihypertensives Antihipertansif ilaç sayısı %

Drug use in microalbuminuric patients % 31 % 11 % 58

Statin % 19 Kolesterol > 200 mg/dl % 32 Fibratlar % 1 Aspirin % 30 Daha 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