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