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Tip 2 Diyabetli Hastalarda Serum Resistin Düzeyleri İle Obezite ve İnsülin Direnci Arasındaki İlişki

Year 2017, Volume: 5 Issue: 3, 109 - 117, 27.12.2017

Abstract

 Amaç: Tip 2 diyabetes
mellitus (DM) hedef dokunun insüline dirençli olması ile karakterize olup
obezite ile yakın ilişkilidir. Resistin yağ dokusundan türeyen bir hormon olup
Tip 2 DM, obezite, insülin direnci ve inflamasyonla ilişkilendirilmektedir. Bu
çalışmamızın amacı Tip 2 DM , bozulmuş glukoz toleransı olan (IGT) ve normal
glukoz toleransı (NGT) olan gruplar arasındaki serum resistin seviyelerini
karşılaştırmak ve bu seviyelerin obezite ve insülin direnciyle ilişkisini
araştırmaktır.



Mateyal ve Metod:  Çalışma
gruplarımız  toplam 72 kişiden oluşmaktadır. Serum resistin
konsantrasyonlarını NGT(n=25), IGT(n=23) ve Tip 2 DM’lu grupların(n=24) glukoz,
insülin, HbA1c, BMI, HOMA ve bel/kalça oranı ile karşılaştırdık. Daha sonra 72
vaka beden kütle indeksine(BMI) ve HOMA-IR  skoruna göre alt gruplara
bölündü; obez olmayan BMI<25 kg/²(43 vaka), obez BMI>25kg/²(29 vaka),
HOMA-IR(+)(23 vaka) ve HOMA-IR(-)(49 vaka). Açlık serum resistin seviyesi ELISA
yöntemi ile ölçüldü. İnsülin direnci HOMA-IR formülüne göre hesaplandı. 



Bulgular: NGT, IGT
ve Tip 2 DM grupları arasında serum resistin seviyeleri bakımından istatistiksel
anlamlı farklılık yoktu(p>0,05). Obez olmayan gruba göre obez grupta daha
yüksek serum resistin seviyeleri görüldü(p<0,01). HOMA skoru NGT grubuna
göre IGT ve Tip 2 DM gruplarında daha yüksek bulundu(p<0,01). HOMA-IR(-)
grup ve HOMA-IR(+) grupları arasında resistin seviyeleri bakımından istatistiksel
anlamlı fark gözlenmedi(p>0,05). NGT grubunda resistin ile bel/kalça oranı
arasında , IGT grubunda serum resistini ile açlık kan glukozu, sistolik kan
basıncı, yaş arasında negatif korelasyon bulundu. (Sırasıyla; r=-0,45,p<0,05;
r=-0,59,p<0,05; r=-0,53,p<0,01; r=0,46; r=0,45, p<0,05).



Sonuç: Resistinin glukoz metabolizmasını
etkileyebileceğini, obezite ile ilişkili olabileceğini ancak insülin direnci ve
diyabeti dolaylı yollardan etkileyebileceğini düşünmekteyiz. 



Anahtar KelimelerDiyabetes
Mellitus, HOMA, obezite, resistin



Aim: Type 2
diabetes mellitus (DM) characterized by target-tissue resistance to insülin and
it is strongly linked to obesity. The adipocytes derived hormone resistin is
involved in tip 2 DM, obesity, insülin resistance and iflammation. The aim of
this study is to compare serum resistin levels between in normal glucose
tolerance group (NGT), impaired glucose tolerance group (IGT) and Type 2 DM
group and investigate correlations with obesity and insulin resistance.



Materials ve Methods: Firstly,
we compared serum concentrations of resistin with glucose,insülin,HbA1C, BMI,HOMA
and waist-to-hip ratio in subject with NGT(n=25), IGT(n=23) and type 2
DM(n=24).Later, according to the body mass index(BMI) and homeostasis model
assesment of insulin resistance(HOMA-IR) score 72 cases were divided into subgroups;
nonobese with BMI<25 kg/²(43 cases), the obese with BMI>25kg/²(29 cases),
HOMA-IR(+)(23 cases) and HOMA-IR(-)(49 cases). Fasting serum resistin level was
measured by ELISA. Insulin resistance was measured by the(HOMA-IR) formula.



Results: There was no statisfically difference in resistin levels
between NGT, IGT and Type 2 DM gorups(p>0,05). Compared with non obese
group, obese group showed higher serum resistin levels(p<0,01). HOMA score
was found significantly higher in the IGT and Type 2 DM groups than NGT
group(p<0,01). Between HOMA-IR(-) group and HOMA-IR(+) group no significant
difference was observed between in the levels of resistin(p>0,05). A
significant negative correlation observed between resistin and blood glucose
waist-to-hip ratio (r=0,45,p<0,05) in NGT group, between resistin and fasting
blood glucose, systolic blood pressure, age in IGT group
(respectively;r=-0,45,p<05;r=-0,59,p<05;r=-0,53,p<0,01;r=0,46;r=0,45,p<0,05). 



Conclusion: We concluded
that resistin may effect glucose metabolism, linked with obesity but indirectly
effect insülin resistance and diabetes.



Key Words: Diabetes
Mellitus, HOMA, obesity, resistin

References

  • American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2009 January; 32(Supplement 1). .
  • Gerich JE. The genetic basis of type 2 diabetes mellitus: impaired insulin secretion versus impaired insulin sensitivity. Endocr. Rev. 1998 Aug;19(4):491-503.
  • Kahn BB, Flier JS. Obesity and insulin resistance. J Clin Invest. 2000 Aug;106(4):473-81. .
  • Jung RT. Obesity and nutritional factors in the pathogenesis of non-insülin dependent diabetes mellitus. In: Textbook of diabetes. Volume 1. Second Edition. Pickup JC, Williams G, eds. Oxford: Blackwell Science Ltd. 19. 1-19. 23, 1997. .
  • Boden G, Shulman GI. Free fatty acids in obesity and type 2 diabetes: defining their role in the development of insulin resistance and beta-cell dysfunction. Eur J Clin Invest. 2002 Jun;32 Suppl 3:14-23. .
  • Patel L, Buckels AC, Kinghorn IJ, et al. Resistin is expressed in human macrophages and directly regulated by PPAR gamma activators. Biochem Biophys Res Commun 2003; 300: 472-6. .
  • Rajala MW, Obici S, Scherer PE & Rossetti L. Adipose-derived resistin and gut-derived resistin-like molecule-beta selectively impair insulin action on glucose production. Journal of Clinical Investigation 2003; 111: 225–230. .
  • Steppan CM, Bailey ST, Bhat S, Brown EJ, Banerjee RR, Wright CM, Patel HR, Ahima RS & Lazar MA. The hormone resistin links obesity to diabetes. Nature 2001; 409: 307–312. .
  • American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diab Care 2010; 33: P62–69. .
  • Steppan CM & Lazar MA. Resistin and obesity-associated insulin resistance. Trends in Endocrinology and Metabolism 2002; 13: 18-23. .
  • Steppan CM, Bailey ST, Bhat S, Brown EJ, Banerjee RR, Wright CM, Patel HR, Ahima RS & Lazar MA. The hormone resistin links obesity to diabetes. Nature 2001; 409: 307–312. .
  • Zhong Q, Lin CY, Clarke KJ, Kemppainen RJ, Schwartz DD, Judd RL. Endothelin-1 inhibits resistin secretion in 3T3-L1 adipocytes. Biochem Biophys Res Commun. 2002; 296: 383-387. .
  • Coello SD, Cabrera de LD, Almeida GA, Gonza´lez A. et al. association between serum resistin and insulin resistance in humans. Diabetes research and clinical practice 2008; 82: 256 – 261. .
  • Sentinelli F, Romeo S, Arca M, Filippi E, Leonetti F, Banchieri M, Di Mario U, Baroni MG. Human resistin gene, obesity, and type 2 diabetes: mutation analysis and population study. Diabetes 2002. 51: 860-862. .
  • Daghri NA, Chetty R, McTernan PG, Rubean KA, Attas OA, Jones AF and S Kumar. Serum resistin is associated with C-reactive protein and LDL cholesterol in type 2 diabetes and coronary artery disease in a Saudi population.. Cardiovascular Diabetology 2005; 4: 10.. .
  • McTernan PG, Fisher FM, Valsamakis G. et al. Resistin and type 2 diabetes: regulation of resistin expression by insulin and rosiglitazone and the effects of recombinant resistin on lipid and glucose metabolism in human differentiated adipocytes.. J. Clin. Endocrinol. Metab. 2003; 88: 6098–6106. .
  • Fujinami A, Obayashi H, Ohta K. et al. Enzyme-linke immunosorbent assay for circulating human resistin: resistin concentrations in normal subjects and patients with type 2 diabetes. Clin. Chim. Acta. 2004; 339, 57–63.. .
  • Youn BS, Kang-Yeol Yu KY, Park HJ, Lee NS, Min SS, Youn MY, at all. Plasma Resistin Concenratipns Measured by Enzyme Linked Immunosorbent Assay Using a Newly Developed Monoclonal Antibody Are Elevated in Individuals with Type 2 Diabetes Mellitus. The Journal of Clinical Endokrinology and Metabolism 2004; 89, 150-156. .
  • Degawa-Yamauchi M, Bovenkerk JE, Juliar BE, et al. Serum resistin (FIZZ3) protein is increased in obese humans. J. Clin. Endocrinol. Metab. 2003; 88: 5452–5455. .
  • Vendrell J, Broch M, Vilarrasa N, Molina A, Gomez JM, Gutierrez C, Simon I, Soler J, Richart C. Resistin, adiponectin, ghrelin, leptin, and proinflammatory cytokines: relationships in obesity. Obes Res. 2004; 12 (6) : 962-71. .
  • Schaffler A, Buchler C, Muller-Ladner U. Identification of variables influencing resistin serum levels in patients with type 1 and type 2 diabetes mellitus. Horm. Metab. Res. 2004; 36: 702–707. .
  • Savage DB, Sewter CP, Klenk ES, Segal DG, Vidal- Puig A, Considine RV, O’Rahilly S. Resistin / Fizz3 expression in relation to obesity and peroxisome proliferator-activated receptor-g action in humans. Diabetes 2001; 50: 2199-2202. .
  • Azuma K, Katsukawa F, Oguchi, et al. Correlation between serum resistin level and adiposity in obese individuals. Obes. Res. 2003; 11: 997–1001. .
  • Yannakoulia M, Yiannakouris N, Bluher S, Matalas AL, Klimis-Zacas D, Mantzoros CS. Body fat mass and macronutrient intake in relation to circulating soluble leptin receptor, free leptin index, adiponectin, and resistin concentrations in healthy humans. J Clin Endocrinol Metab. 2003; 88: 1730–6. .
  • Vozarova de CB, Degawa-Yamauchi M, Considine RV, Tataranni PA and Volarova de CB. High serum resistin is associated with an increase in adiposity but not a worsening of insulin resistance in Pima Indians. Diabetes 2004; 53: 1279–1284. .
  • Nagaev I, Smith U. Insulin resistance and type 2 diabetes are not related to resistin expression in human fat cells or skeletal muscle. Biochem Biophys Res Commun. 2001; 285: 561–564. .
  • Savage DB, Sewter CP, Klenk ES, Segal DG, Vidal- Puig A, Considine RV, O’Rahilly S. Resistin / Fizz3 expression in relation to obesity and peroxisome proliferator-activated receptor-g action in humans. Diabetes 2001; 50: 2199-2202. .
  • Osawa H, Yamada K, Onuma H, et al. The G/G genotype of a resistin single-nucleotide polymorphism at 420 increases type 2 diabetes Metabolism Clinical and Experimental 56 (2007) 693–698. .
  • McTernan PG, McTernan CL, Chetty R, et al. Increased resistin gene and protein expression in human abdominal adipose tissue J. Clin. Endocrinol. Metab. 2002; 87, 2407. .
  • Smith SR, Bai F, Charbonneau C, Janderova L, Argyropoulos G. A promoter genotype and oxidative stress potentially link resistin to human insulin resistance. Diabetes 2003; 52: 1611–1618. .
  • Silha JV, Krsek M, Skrha JV, et al. Plasma resistin, adiponectin and leptin levels in lean and obese subjects: correlations with insulin resistance. Eur J Endocrinol 2003; 149: 331-5. .
  • Tokuyamaa Y, Osawab H, Ishizukaa T, Onumab H, Matsuic K, Egashirac T, Makinob H, Kanatsukaa A. Serum resistin level is associated with insulin sensitivity in Japanese patients with type 2 diabetes mellitus. Metabolism Clinical and Experimental 2007; 56: 693– 698. .
  • Hui-Ling Lu, Hong-Wei Wang, Yu Wen, Mu-Xun Zhang, Han-Hua Lin. Roles of adipocyte derived hormone adiponectin and resistinin insulin resistance of type 2 diabetes. World J Gastroenterol 2006; 21; 12(11): 1747-1751. .
  • Utzschneider KM, Carr DB, Tong J, et al. Resistin is not associated with insulin sensitivity or the metabolic syndrome in humans. Diabetologia 2005; 48: 2330- 3. .
  • Janke J, Engeli S, Gorzelniak K, et al. Resistin gene expression in human adipocytes is not related to insulin resistance. Obes Res. 2002; 10: 1–5. .
  • Lee JH, Chan JL, Yiannakouris N, et al. Circulating resistin levels are not associated with obesity or insulin resistance in humans and are not regulated by fasting or leptin administration: cross-sectional and interventional studies in normal, insulin-resistant, and diabetic subjects. J Clin Endocrinol Metab. 2003; 88: 4848 –56. .
  • Janowska J, Markiewicz BZ, Glinianowicz MO. Relationship between serum resistin concentration and proinflammatory cytokines in obese women with impaired and normal glucose tolerance Metabolism Clinical and Experimental 2006; 55,1495-1499. .
  • Osawa H, Onuma H, Ochi M, et al. Resistin SNP-420 determines its monocyte mRNA and serum levels inducing type 2 diabetes. Biochem Biophys Res Commun 2005; 335: 596- 602. .
Year 2017, Volume: 5 Issue: 3, 109 - 117, 27.12.2017

Abstract

References

  • American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2009 January; 32(Supplement 1). .
  • Gerich JE. The genetic basis of type 2 diabetes mellitus: impaired insulin secretion versus impaired insulin sensitivity. Endocr. Rev. 1998 Aug;19(4):491-503.
  • Kahn BB, Flier JS. Obesity and insulin resistance. J Clin Invest. 2000 Aug;106(4):473-81. .
  • Jung RT. Obesity and nutritional factors in the pathogenesis of non-insülin dependent diabetes mellitus. In: Textbook of diabetes. Volume 1. Second Edition. Pickup JC, Williams G, eds. Oxford: Blackwell Science Ltd. 19. 1-19. 23, 1997. .
  • Boden G, Shulman GI. Free fatty acids in obesity and type 2 diabetes: defining their role in the development of insulin resistance and beta-cell dysfunction. Eur J Clin Invest. 2002 Jun;32 Suppl 3:14-23. .
  • Patel L, Buckels AC, Kinghorn IJ, et al. Resistin is expressed in human macrophages and directly regulated by PPAR gamma activators. Biochem Biophys Res Commun 2003; 300: 472-6. .
  • Rajala MW, Obici S, Scherer PE & Rossetti L. Adipose-derived resistin and gut-derived resistin-like molecule-beta selectively impair insulin action on glucose production. Journal of Clinical Investigation 2003; 111: 225–230. .
  • Steppan CM, Bailey ST, Bhat S, Brown EJ, Banerjee RR, Wright CM, Patel HR, Ahima RS & Lazar MA. The hormone resistin links obesity to diabetes. Nature 2001; 409: 307–312. .
  • American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diab Care 2010; 33: P62–69. .
  • Steppan CM & Lazar MA. Resistin and obesity-associated insulin resistance. Trends in Endocrinology and Metabolism 2002; 13: 18-23. .
  • Steppan CM, Bailey ST, Bhat S, Brown EJ, Banerjee RR, Wright CM, Patel HR, Ahima RS & Lazar MA. The hormone resistin links obesity to diabetes. Nature 2001; 409: 307–312. .
  • Zhong Q, Lin CY, Clarke KJ, Kemppainen RJ, Schwartz DD, Judd RL. Endothelin-1 inhibits resistin secretion in 3T3-L1 adipocytes. Biochem Biophys Res Commun. 2002; 296: 383-387. .
  • Coello SD, Cabrera de LD, Almeida GA, Gonza´lez A. et al. association between serum resistin and insulin resistance in humans. Diabetes research and clinical practice 2008; 82: 256 – 261. .
  • Sentinelli F, Romeo S, Arca M, Filippi E, Leonetti F, Banchieri M, Di Mario U, Baroni MG. Human resistin gene, obesity, and type 2 diabetes: mutation analysis and population study. Diabetes 2002. 51: 860-862. .
  • Daghri NA, Chetty R, McTernan PG, Rubean KA, Attas OA, Jones AF and S Kumar. Serum resistin is associated with C-reactive protein and LDL cholesterol in type 2 diabetes and coronary artery disease in a Saudi population.. Cardiovascular Diabetology 2005; 4: 10.. .
  • McTernan PG, Fisher FM, Valsamakis G. et al. Resistin and type 2 diabetes: regulation of resistin expression by insulin and rosiglitazone and the effects of recombinant resistin on lipid and glucose metabolism in human differentiated adipocytes.. J. Clin. Endocrinol. Metab. 2003; 88: 6098–6106. .
  • Fujinami A, Obayashi H, Ohta K. et al. Enzyme-linke immunosorbent assay for circulating human resistin: resistin concentrations in normal subjects and patients with type 2 diabetes. Clin. Chim. Acta. 2004; 339, 57–63.. .
  • Youn BS, Kang-Yeol Yu KY, Park HJ, Lee NS, Min SS, Youn MY, at all. Plasma Resistin Concenratipns Measured by Enzyme Linked Immunosorbent Assay Using a Newly Developed Monoclonal Antibody Are Elevated in Individuals with Type 2 Diabetes Mellitus. The Journal of Clinical Endokrinology and Metabolism 2004; 89, 150-156. .
  • Degawa-Yamauchi M, Bovenkerk JE, Juliar BE, et al. Serum resistin (FIZZ3) protein is increased in obese humans. J. Clin. Endocrinol. Metab. 2003; 88: 5452–5455. .
  • Vendrell J, Broch M, Vilarrasa N, Molina A, Gomez JM, Gutierrez C, Simon I, Soler J, Richart C. Resistin, adiponectin, ghrelin, leptin, and proinflammatory cytokines: relationships in obesity. Obes Res. 2004; 12 (6) : 962-71. .
  • Schaffler A, Buchler C, Muller-Ladner U. Identification of variables influencing resistin serum levels in patients with type 1 and type 2 diabetes mellitus. Horm. Metab. Res. 2004; 36: 702–707. .
  • Savage DB, Sewter CP, Klenk ES, Segal DG, Vidal- Puig A, Considine RV, O’Rahilly S. Resistin / Fizz3 expression in relation to obesity and peroxisome proliferator-activated receptor-g action in humans. Diabetes 2001; 50: 2199-2202. .
  • Azuma K, Katsukawa F, Oguchi, et al. Correlation between serum resistin level and adiposity in obese individuals. Obes. Res. 2003; 11: 997–1001. .
  • Yannakoulia M, Yiannakouris N, Bluher S, Matalas AL, Klimis-Zacas D, Mantzoros CS. Body fat mass and macronutrient intake in relation to circulating soluble leptin receptor, free leptin index, adiponectin, and resistin concentrations in healthy humans. J Clin Endocrinol Metab. 2003; 88: 1730–6. .
  • Vozarova de CB, Degawa-Yamauchi M, Considine RV, Tataranni PA and Volarova de CB. High serum resistin is associated with an increase in adiposity but not a worsening of insulin resistance in Pima Indians. Diabetes 2004; 53: 1279–1284. .
  • Nagaev I, Smith U. Insulin resistance and type 2 diabetes are not related to resistin expression in human fat cells or skeletal muscle. Biochem Biophys Res Commun. 2001; 285: 561–564. .
  • Savage DB, Sewter CP, Klenk ES, Segal DG, Vidal- Puig A, Considine RV, O’Rahilly S. Resistin / Fizz3 expression in relation to obesity and peroxisome proliferator-activated receptor-g action in humans. Diabetes 2001; 50: 2199-2202. .
  • Osawa H, Yamada K, Onuma H, et al. The G/G genotype of a resistin single-nucleotide polymorphism at 420 increases type 2 diabetes Metabolism Clinical and Experimental 56 (2007) 693–698. .
  • McTernan PG, McTernan CL, Chetty R, et al. Increased resistin gene and protein expression in human abdominal adipose tissue J. Clin. Endocrinol. Metab. 2002; 87, 2407. .
  • Smith SR, Bai F, Charbonneau C, Janderova L, Argyropoulos G. A promoter genotype and oxidative stress potentially link resistin to human insulin resistance. Diabetes 2003; 52: 1611–1618. .
  • Silha JV, Krsek M, Skrha JV, et al. Plasma resistin, adiponectin and leptin levels in lean and obese subjects: correlations with insulin resistance. Eur J Endocrinol 2003; 149: 331-5. .
  • Tokuyamaa Y, Osawab H, Ishizukaa T, Onumab H, Matsuic K, Egashirac T, Makinob H, Kanatsukaa A. Serum resistin level is associated with insulin sensitivity in Japanese patients with type 2 diabetes mellitus. Metabolism Clinical and Experimental 2007; 56: 693– 698. .
  • Hui-Ling Lu, Hong-Wei Wang, Yu Wen, Mu-Xun Zhang, Han-Hua Lin. Roles of adipocyte derived hormone adiponectin and resistinin insulin resistance of type 2 diabetes. World J Gastroenterol 2006; 21; 12(11): 1747-1751. .
  • Utzschneider KM, Carr DB, Tong J, et al. Resistin is not associated with insulin sensitivity or the metabolic syndrome in humans. Diabetologia 2005; 48: 2330- 3. .
  • Janke J, Engeli S, Gorzelniak K, et al. Resistin gene expression in human adipocytes is not related to insulin resistance. Obes Res. 2002; 10: 1–5. .
  • Lee JH, Chan JL, Yiannakouris N, et al. Circulating resistin levels are not associated with obesity or insulin resistance in humans and are not regulated by fasting or leptin administration: cross-sectional and interventional studies in normal, insulin-resistant, and diabetic subjects. J Clin Endocrinol Metab. 2003; 88: 4848 –56. .
  • Janowska J, Markiewicz BZ, Glinianowicz MO. Relationship between serum resistin concentration and proinflammatory cytokines in obese women with impaired and normal glucose tolerance Metabolism Clinical and Experimental 2006; 55,1495-1499. .
  • Osawa H, Onuma H, Ochi M, et al. Resistin SNP-420 determines its monocyte mRNA and serum levels inducing type 2 diabetes. Biochem Biophys Res Commun 2005; 335: 596- 602. .
There are 38 citations in total.

Details

Subjects Clinical Sciences
Journal Section Orginal Article
Authors

Ebru Yorulmaz Ertuğ

Mürvet Algemi This is me

Publication Date December 27, 2017
Published in Issue Year 2017 Volume: 5 Issue: 3

Cite

APA Yorulmaz Ertuğ, E., & Algemi, M. (2017). Tip 2 Diyabetli Hastalarda Serum Resistin Düzeyleri İle Obezite ve İnsülin Direnci Arasındaki İlişki. Namık Kemal Tıp Dergisi, 5(3), 109-117.
AMA Yorulmaz Ertuğ E, Algemi M. Tip 2 Diyabetli Hastalarda Serum Resistin Düzeyleri İle Obezite ve İnsülin Direnci Arasındaki İlişki. NKMJ. December 2017;5(3):109-117.
Chicago Yorulmaz Ertuğ, Ebru, and Mürvet Algemi. “Tip 2 Diyabetli Hastalarda Serum Resistin Düzeyleri İle Obezite Ve İnsülin Direnci Arasındaki İlişki”. Namık Kemal Tıp Dergisi 5, no. 3 (December 2017): 109-17.
EndNote Yorulmaz Ertuğ E, Algemi M (December 1, 2017) Tip 2 Diyabetli Hastalarda Serum Resistin Düzeyleri İle Obezite ve İnsülin Direnci Arasındaki İlişki. Namık Kemal Tıp Dergisi 5 3 109–117.
IEEE E. Yorulmaz Ertuğ and M. Algemi, “Tip 2 Diyabetli Hastalarda Serum Resistin Düzeyleri İle Obezite ve İnsülin Direnci Arasındaki İlişki”, NKMJ, vol. 5, no. 3, pp. 109–117, 2017.
ISNAD Yorulmaz Ertuğ, Ebru - Algemi, Mürvet. “Tip 2 Diyabetli Hastalarda Serum Resistin Düzeyleri İle Obezite Ve İnsülin Direnci Arasındaki İlişki”. Namık Kemal Tıp Dergisi 5/3 (December 2017), 109-117.
JAMA Yorulmaz Ertuğ E, Algemi M. Tip 2 Diyabetli Hastalarda Serum Resistin Düzeyleri İle Obezite ve İnsülin Direnci Arasındaki İlişki. NKMJ. 2017;5:109–117.
MLA Yorulmaz Ertuğ, Ebru and Mürvet Algemi. “Tip 2 Diyabetli Hastalarda Serum Resistin Düzeyleri İle Obezite Ve İnsülin Direnci Arasındaki İlişki”. Namık Kemal Tıp Dergisi, vol. 5, no. 3, 2017, pp. 109-17.
Vancouver Yorulmaz Ertuğ E, Algemi M. Tip 2 Diyabetli Hastalarda Serum Resistin Düzeyleri İle Obezite ve İnsülin Direnci Arasındaki İlişki. NKMJ. 2017;5(3):109-17.