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Tip 2 Diyabette İnsülin Tedavisinin Etkinliğini Belirleyen Faktörler

PREDICTIVE FACTORS FOR SUCCESSFUL INSULIN THERAPY IN PATIENTS WITH TYPE 2 DIABETES

Journal Name:

  • Türkiye Aile Hekimliği Dergisi

Publication Year:

  • 2002

Key Words:

Keywords (Original Language):

Author Name
Abstract (2. Language): 
Objective: Predictive factors for successful insulin therapy in type 2 diabetic patıents with poor glycemic control despite using maximum dose of oral antidiabetic therapy were investigated. Method: One hundred forty five patients (age 57.00+11.05 yrs, body mass index (BMI) 28.8+5.4 kg/m2, diabetes durati¬on 11.6+7.8 yrs) with type 2 diabetes according to WHO cri¬teria using insulin therapy for at least 6 months because of poor glycemic control with maximum dose of oral antidiabetic drugs for a minimum of 6 months were included in the study. Fasting blood sugar, basal c-peptide level, HbA1c, blo¬od presure, BMI, and serum lipids were evaluated before and after insulin therapy. Results: Fasting blood sugar and HbA1c levels decreased significantly after insulin treatment (p<0.001, for both). The ove¬rall increase in body weight was about 4.3 kg (p<0.001). When we evaluated the patients at the end of the second ye¬ar of insulin treatment, there were a strong correlation betwe¬en the age of onset of diabetes, insulin treatment beginning age, diabetes duration, and insulin requirement (r = 0.19, p<0.01, r = -0.24, p<0.05, r = -0.21, p<0.01). We also found significant correlation between diabetes duration, insulin tre¬atment beginning age (r = 0.90, p<0.01), and c-peptide levels (r = -0.37, p<0.01). Patients were divided into two groups ac¬cording to the age of onset of diabetes (group 1 t 40 yrs, gro¬up 2 >40 yrs). In the first group, HbA1c level and insulin requ¬irement were found to be high, although c-peptide levels we¬re low. Insulin treatment beginning age was found to be low compared to the second group. Patients with diabetes durati¬on longer than 10 years had poor metabolic control (HbA1c % 8.12+0.95, p<0.05) and low c-peptide levels (2.92+1.41 ng/ml, p<0.05). Conclusion: At the end of the second year of the insulin tre¬atment in type 2 diabetics, patients had weight gain about 4.3 kg despite good metabolic control values. Earlier age of onset of diabetes (especially t 40 yrs), longer diabetes durati¬on and high BMI were the independent predictors of the suc¬cessful insulin treatment.
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Abstract (Original Language): 
Amaç: Maksimal dozda oral antidiyabetik ilaç tedavisine rağmen istenilen kan şekeri regülasyonu sağlanamayan tip 2 diyabetli hastalarda, insülin tedavisinin etkinliğini belirleyen faktörlerin irdelenmesi. Gereç ve Yöntem: Çalışmaya WHO kriterlerine göre tip 2 diabetes mellitus tanısı konmuş, 6 aydan uzun süredir maksimal dozda oral antidiyabetik almasına rağmen istenilen düzeyde kan şekeri regülasyonu sağlanamadığı için insülin tedavisine geçilen ve en az 6 aydır insülin tedavisi alan 145 hasta (yaş 57.00+11.05 yıl, vücut kitle indeksi (VKİ) 28.8±5.4 kg/m2, diyabet süresi 11.6+7.8 yıl) dahil edilmiştir. Açlık kan şekeri, bazal c-peptid düzeyi, HbA1c, kan basıncı, vücut ağırlığı ile serum lipidleri insülin tedavisine başlamadan önce ve takip periyo-dundaki son vizitte değerlendirilmiştir. Bulgular: Açlık kan şekeri (AKfi) ve HbA1c düzeyleri tedavi sonrasında anlamlı olarak azalmıştır (p<0.001, her ikisi için). Vücut ağırlığındaki ortalama artış 4.3 kg'dır (p<0.001). İnsülin tedavisinin ikinci yılı sonunda hastalar değerlendirildiğinde, di¬yabetin başlangıç yaşıyla insüline başlama zamanı, diyabet sü¬resi ve insülin ihtiyacı arasında belirgin korelasyon mevcuttu (r = 0.19, p<0.01, r = -0.24, p<0.05, r = -0.21, p<0.01). Diyabet süresi ile insüline başlama zamanı (r = 0.90, p<0.01) ve c-peptid düzeyleri arasında da belirgin korelasyon vardı (r = -0.37, p<0.01). Hastalar diyabet başlangıç yaşına göre 2 gruba ayrıldığında (grup 1140 yaş, grup 2>40 yaş), grup 1'de HbA1c düzeyleri ve insülin ihtiyacı yüksek, c-peptid düzeyi düşük bulun¬du. 10 yıldan daha uzun süredir diyabeti olan hastalarda me-tabolik kontrolün daha kötü olduğu (HbA1c % 8.12+0.95, p<0.05) ve c-peptid düzeyinin düşük olduğu görüldü (2.92+1.41 ng/ml, p<0.05). Yorum: Tip 2 diyabetlilerde insülin tedavisinin ikinci yılı değer¬lendirildiğinde metabolik kontrol iyi olmasına rağmen hastala¬rın kilo aldıkları (4.3 kg) tespit edildi. Diyabetin erken yaşta başlaması (özellikle t 40 yaş), daha uzun süredir diyabetik olmak ve yüksek VKİ değeri insülin tedavisine başlama zamanın¬da ve tedaviye cevapta bağımsız belirleyicilerdir.
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