İyi ve kötü kontrollü tip 2 diabetes mellitus'lu hastalarda total antioksidan status (TAS), total oksidan status (TOS) düzeyleri ve metabolik parametrelerin değerlendirilmesi
Küçük Resim Yok
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Bolu Abant İzzet Baysal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Diyabet yaşadığımız yüzyılın en önemli sağlık sorunlarından biri olarak kabul edilmektedir. Diyabetli sayısının her geçen gün artması, diyabetle ilişkili sağlık sorunlarının toplum sağlığını ve ülke ekonomilerini ciddi derecede etkilemesi bu düşünceyi desteklemektedir. Diyabet ve komplikasyonları gelişiminde serbest oksijen radikalleri ile antioksidan sistem arasındaki denge önemli rol oynamaktadır. Dr. Erel tarafından yeni bir kalorimetrik ölçüm tekniğiyle genel antioksidan seviyeyi tespit etmek amacıyla total antioksidan status (TAS) kiti ve genel oksidan seviyeleri tespit etmek amacıyla total oksidan status (TOS) kiti geliştirilmiştir. Bu çalışmada iyi kontrollü tip 2 diyabetli hastalardaki TAS ve TOS düzeyleri ile metabolik parametreleri kötü kontrollü tip 2 diyabetli hastalardaki TAS ve TOS düzeyleri ile metabolik parametrelerle karşılaştırmayı amaçladık. Üniversitemiz hastanesi İç Hastalıkları polikliniklerine Mart 2019 ile Eylül 2019 tarihleri arasında tip 2 diyabet teşhisiyle başvuran kötü ve iyi kontrollü hastalar çalışmaya dahil edildi. Demografik veriler ve antropometrik ölçümler, tansiyon ve nabız verileri, TAS-TOS sonuçları, metabolik parametreler, böbrek ve karaciğer fonksiyon testleri, tam kan ve anemi parametreleri, diyabetin mikrovasküler ve makrovasküler komplikasyonları varlığı, tedaviye uyum, diyet ve egzersiz alışkanlıkları kaydedildi. İyi ve kötü kontrollü tip 2 diyabetik hastaların verileri karşılaştırıldı. Çalışmaya 96 kötü diyabetik kontrollü ve 43 iyi diyabetik kontrollü olmak üzere toplam 139 hasta alındı. Demografik veriler ve antropometrik ölçümler açısından her iki grup arasında fark izlenmedi. Kötü kontrollü tip 2 diyabet grubunda ortalama HbA1c %9.1 ve açlık kan glukozu 169 mg/dL iken iyi kontrollü tip 2 diyabet grubunda ortanca HbA1c %6.4 ve açlık kan glukozu 113 mg/dL olup glisemi kontrolü açısından gruplar arasında belirgin fark mevcuttur (HbA1c için p<0.001; açlık kan glukozu için p<0.001). Çalışmamızda TOS düzeyi kötü kontrollü tip 2 diyabetlilerde iyi kontrollü tip 2 diyabetiklere kıyasla belirgin yüksek (p=0.002), TAS düzeyi ise belirgin düşük saptandı (p<0.001). Kötü kontrollü tip 2 diyabetiklerin %47.9'unda ve iyi kontrollü tip 2 DM hastalarının %27.9'unda mikrovasküler komplikasyon varlığı saptandı (p=0.027). Alt grup analizinde ise retinopati, nefropati ve nöropati sıklığı açısından iyi ve kötü kontrollü diyabetikler arasında anlamlı fark izlenmedi. Kötü kontrollü tip 2 diyabet hastalarının %17.7'sinde makrovasküler komplikasyon varlığı saptanırken, iyi kontrollü tip 2 diyabet grubunda bu oran %14 olarak tespit edildi ve gruplar arasında istatistiksel anlamlı fark izlenmedi. İyi kontrollü ve kötü kontrollü diyabetiklerde diyet uyumu sırasıyla %58.1 ve %34.4 olarak saptandı (p=0.027). Kötü kontrollü diyabetik bireylerde oksidatif sistemdeki oksidan– antioksidan dengesinde oksidasyon lehine bozulma olup mikrovasküler komplikasyon gelişiminde oksidatif stresin rolü olduğu düşünülmektedir. Tip 2 DM hastalarında TOS düzeyleri mikrovasküler komplikasyon ve morbidite için prediktif bir test olarak kullanılabilir. TAS düzeyi 1.37 mmol Trolox Eq/L'nin üzerinde olduğunda %74 sensitivite ve %53 spesifite ile iyi diyabetik kontrolü öngörmektedir. TOS düzeyi ise 3.97 ?mol H2O2 Eq/L'nin üzerinde olduğunda %60 sensitivite ve %53 spesifite ile kötü diyabetik kontrolü öngörmektedir. Anahtar Kelimeler: Antioksidan, Diyabet komplikasyonları, HbA1c, Mikrovasküler Komplikasyonlar, Oksidant, Tip 2 Diabetes Mellitus
Diabetes is regarded as one of the most important health problems of the century. The fact that the number of people with diabetes increases day by day and that diabetes-related health problems affect public health and country economies seriously supports this idea. The balance between free oxygen radicals and antioxidant system plays an important role in the development of diabetes and its complications. Dr. Erel developed a total antioxidant status (TAS) kit and a total oxidant status (TOS) kit to detect overall antioxidant levels with a new calorimetric measurement technique. In this study, we aimed to compare TAS and TOS levels and metabolic parameters in patients with well-controlled type 2 diabetes with metabolic parameters and TAS and TOS levels in patients with poorly controlled type 2 diabetes. Poorly and well-controlled patients who were admitted to the internal diseases outpatient clinics of our university between March 2019 and September 2019 with diagnosis of type 2 diabetes were included in the study. Demographic data and anthropometric measurements, blood pressure and pulse data, TAS-TOS results, metabolic parameters, kidney and liver function tests, whole blood and anemia parameters, presence of diabetes microvascular and macrovascular complications, treatment compliance, diet and exercise habits were recorded. Data of well and poorly controlled type 2 diabetic patients were compared. A total of 139 patients, 96 poor controlled diabets and 43 well controlled diabets, were included in the study. There was no difference between the two groups in terms of demographic data and anthropometric measurements. In the poorly controlled type 2 diabetes group, the median HbA1c was 9.1% and fasting blood glucose was 169 mg / dL, while in the well-controlled type 2 diabetes group, the median was HbA1c 6.4% and the fasting blood glucose was 113 mg / dL, and there was a significant difference between the groups in terms of glycemia control (p<0.001 for HbA1c; p <0.001 for fasting blood glucose). In our study, TOS levels were found to be significantly higher (p = 0.002) and TAS levels were significantly lower in patients with poorly controlled type 2 diabetes compared to well-controlled type 2 diabetics (p <0.001). Microvascular complications were found in 47.9% of poorly controlled type 2 diabetics and 27.9% of well-controlled type 2 DM patients (p = 0.027). In the subgroup analysis, no significant difference was observed between good and badly controlled diabetics in terms of the frequency of retinopathy, nephropathy and neuropathy. While 17.7% of poorly controlled type 2 diabetes patients had macrovascular complications, this rate was found to be 14% in the well-controlled type 2 diabetes group and there was no statistically significant difference between the groups. Diet compliance was found to be 58.1% and 34.4%, respectively, in well-controlled and poorly controlled diabetics (p = 0.027). In poorly controlled diabetic individuals, the oxidant-antioxidant balance in the oxidative system is impaired in favor of oxidation and it is thought that oxidative stress plays a role in the development of microvascular complications. TOS levels can be used as a predictive test for microvascular complications and morbidity in type 2 DM patients. When TAS level is above 1.37 mmol Trolox Eq / L, it predicts good diabetic control with 74% sensitivity and 53% specificity. When TOS level is above 3.97 ?mol H2O2 Eq / L, it predicts bad diabetic control with 60% sensitivity and 53% specificity. Keywords: Antioxidants, Complications of Diabetes Mellitus, HbA1c, Oxidants, Type 2 Diabetes Mellitus
Diabetes is regarded as one of the most important health problems of the century. The fact that the number of people with diabetes increases day by day and that diabetes-related health problems affect public health and country economies seriously supports this idea. The balance between free oxygen radicals and antioxidant system plays an important role in the development of diabetes and its complications. Dr. Erel developed a total antioxidant status (TAS) kit and a total oxidant status (TOS) kit to detect overall antioxidant levels with a new calorimetric measurement technique. In this study, we aimed to compare TAS and TOS levels and metabolic parameters in patients with well-controlled type 2 diabetes with metabolic parameters and TAS and TOS levels in patients with poorly controlled type 2 diabetes. Poorly and well-controlled patients who were admitted to the internal diseases outpatient clinics of our university between March 2019 and September 2019 with diagnosis of type 2 diabetes were included in the study. Demographic data and anthropometric measurements, blood pressure and pulse data, TAS-TOS results, metabolic parameters, kidney and liver function tests, whole blood and anemia parameters, presence of diabetes microvascular and macrovascular complications, treatment compliance, diet and exercise habits were recorded. Data of well and poorly controlled type 2 diabetic patients were compared. A total of 139 patients, 96 poor controlled diabets and 43 well controlled diabets, were included in the study. There was no difference between the two groups in terms of demographic data and anthropometric measurements. In the poorly controlled type 2 diabetes group, the median HbA1c was 9.1% and fasting blood glucose was 169 mg / dL, while in the well-controlled type 2 diabetes group, the median was HbA1c 6.4% and the fasting blood glucose was 113 mg / dL, and there was a significant difference between the groups in terms of glycemia control (p<0.001 for HbA1c; p <0.001 for fasting blood glucose). In our study, TOS levels were found to be significantly higher (p = 0.002) and TAS levels were significantly lower in patients with poorly controlled type 2 diabetes compared to well-controlled type 2 diabetics (p <0.001). Microvascular complications were found in 47.9% of poorly controlled type 2 diabetics and 27.9% of well-controlled type 2 DM patients (p = 0.027). In the subgroup analysis, no significant difference was observed between good and badly controlled diabetics in terms of the frequency of retinopathy, nephropathy and neuropathy. While 17.7% of poorly controlled type 2 diabetes patients had macrovascular complications, this rate was found to be 14% in the well-controlled type 2 diabetes group and there was no statistically significant difference between the groups. Diet compliance was found to be 58.1% and 34.4%, respectively, in well-controlled and poorly controlled diabetics (p = 0.027). In poorly controlled diabetic individuals, the oxidant-antioxidant balance in the oxidative system is impaired in favor of oxidation and it is thought that oxidative stress plays a role in the development of microvascular complications. TOS levels can be used as a predictive test for microvascular complications and morbidity in type 2 DM patients. When TAS level is above 1.37 mmol Trolox Eq / L, it predicts good diabetic control with 74% sensitivity and 53% specificity. When TOS level is above 3.97 ?mol H2O2 Eq / L, it predicts bad diabetic control with 60% sensitivity and 53% specificity. Keywords: Antioxidants, Complications of Diabetes Mellitus, HbA1c, Oxidants, Type 2 Diabetes Mellitus
Açıklama
Tıp Fakültesi, İç Hastalıkları Ana Bilim Dalı
Anahtar Kelimeler
İç Hastalıkları, Internal diseases
