Birinci basamak merkez laboratuvarı HbA1c verilerine göre Hatay’da glisemik kontrol durumu ve ilişkili faktörler

Year 2022, Volume: 20 Issue: 1, 26 - 36, 01.04.2022

Cansu Karabiber , Nazan Savaş

https://doi.org/10.20518/tjph.853697

Cited By: 1

Abstract

Amaç: HbA1c glisemik kontrolü, diyabetik komplikasyon riskini ve diabetik bakım kalitesini gösteren bir kan parametresidir. Bu çalışmada Hatay’da Aile Sağlığı Birimleri’nde (ASB) HbA1c tetkiki yapılan 18≤yaş bireylerde HbA1c durumu saptanarak, HbA1c’nin sosyodemografik özellikler, kan lipit profili ve böbrek fonksiyon belirteçleriyle arasındaki ilişkinin değerlendirilmesi amaçlanmıştır. Yöntem: Kesitsel nitelikteki araştırmada Hatay Birinci Basamak Merkez Laboratuvarı’nda Ekim-Aralık.2017 döneminde 18≤yaş bireylerin (n=22943) Hba1c, trigliserit, total kolesterol, yüksek dansiteli lipoprotein (HDL), düşük dansiteli lipoprotein (LDL), üre ve kreatinin verileri retrospektif değerlendirilmiştir. Değerlendirmede laboratuarın referans değerleri kullanılmış, HbA1c’nin ≥%6.5 olması kötü glisemik kontrol kabul edilmiştir. İstatistiksel analizlerde; HbA1c bağımlı değişken, ilçe, uyruk, cinsiyet, yaş ve diğer laboratuvar verileri bağımsız değişken olarak alınmış, tanımlayıcı istatistik, ki-kare ve Mann Whitney-U testleri kullanılmıştır. p<0.05 önemli kabul edilmiştir. Bulgular: HbA1c tetkiki yapılanların yaş ortalaması 47.1±15.7, %72.4’ü kadın, %99.2’si TC vatandaşı olup, %15.4’ünün HbA1c düzeyi ≥%6.5’dir. Kadınların %13.0’ının, erkeklerin %21.9’unun HbA1c düzeyi ≥%6.5’dir (p<0.001). TC vatandaşlarının %15.4’ünün, Suriyeli sığınmacıların %14.2’sinin HbA1c düzeyi ≥%6.5’dir (p=0.662). HbA1c düzeyi ≥%6.5 en fazla olan ilçeler; Kumlu(%37.1), Belen(%22.7) ve Payas’tır(%21.8). HbA1c ≥%6.5 olan bireylerin %54.5’inde Trigliserit ≥150 mg/dl, %46.7’sinde Total Kolesterol ≥200 mg/dl ve %36.3’ünde LDL ≥130 mg/dl, kadınların %91.2’sinin, erkeklerin %91.1’inin HDL düzeyi <65mg/dl’dir (p<0.001). HbA1c ≥%6.5 olan 18-64 yaş bireylerin %3.1’inin, 65≤ yaş bireylerin ise %3’ünün üre düzeyi ≥50 mg/dl, kadınların %10.7’sinin, erkeklerin %7.5’inin kreatinin düzeyi ≥0.9 mg/dl’dir. Sonuç: Hatay’da ASB’lerde 18≤yaş HbA1c bakılan her altı kişiden biri kötü glisemik kontrole sahiptir. Erkeklerde, ileri yaşlarda ve küçük ilçelerde yaşayanlarda glisemik kontrol daha kötüdür. Glisemik kontrolü kötü olan bireylerin kan lipit profili ve böbrek fonksiyon belirteçleri anormal sınırlar içindedir.

Keywords

HbA1c, glisemik kontrol, birinci basamak

Glycemic control status according to HbA1c data of primary care center laboratory and related factors in Hatay

Abstract

Objective: HbA1c is a blood parameter showing glycemic control, risk of diabetic complications and diabetic care quality. In this study, it was aimed to evaluate the relationship between sociodemographic characteristics, blood lipid profile and renal function markers by determining the HbA1c status in 18≤ year old individuals whose HbA1c was examined in Family Health Units (FHU) in Hatay. Methods: In a cross-sectional study, Hba1c, triglyceride, total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), urea and creatinine data were evaluated retrospectively in individuals aged 18≤ (n=22943) between October-December 2017 at the Hatay Primary Care Center Laboratory. Laboratory reference values were used in the evaluation and ≥6.5% HbA1c was accepted as bad glycemic control. In statistical analysis; HbA1c dependent variable, district, nationality, gender, age and other laboratory data were taken as independent variables. Descriptive statistics, chi-square and Mann Whitney-U tests were used. p<0.05 was considered as significant.Results: The average age of those who underwent HbA1c examination was 47.1±15.7, 72.4% were female, 99.2% were Turkish citizens, and 15.4% had an HbA1c level of ≥6.5%. The HbA1 clevel of 13.0% of women and 21.9% of men is ≥6.5% (p <0.001). The HbA1c level of 15.4% of Turkish citizens and 14.2% of Syrian refugees is ≥6.5% (p=0.662). Districts with the highest HbA1c level of ≥6.5%; It is Kumlu (37.1%), Belen (22.7%) and Payas (21.8%). Individuals with HbA1c ≥6.5% had levels of Triglycerides ≥150 mg/dl in 54.5%, of Total Cholesterol ≥200 mg/dl in 46.7% and of LDL ≥130 mg/dl in 36.3%; and 91.2% of women and 91.1% of men had HDL levels <65mg/dl (p <0.001). HbA1c was ≥6.5% of 3.1% 18-64 year-olds and 3% of 65≤ years-old had urea levels of ≥50mg /dl; and 10.7% of women and 7.5% of men had creatinine levels of ≥0.9 mg/dl. Conclusion: One out of every six people aged 18≤ HbA1c analyzed in FHU in Hatay has poor glycemic control. Glycemic control is worse in men, elderly people and those living in small districts. The blood lipid profile and kidney function indicators of individuals with poor glycemic control are in abnormal limits.

Keywords

HbA1c, glycemic control, primary healthcare

References

• Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL. Harrison İç Hastalıkları Prensipleri. 15.Baskı. Nobel Tıp Kitabevleri;2004. s.1382-1386, s.2109-2143.
• İliçin G, Biberoğlu K, Süleymanlar G, Ünal S. Temel İç Hastalıkları. 2.Baskı. Güneş Kitabevi;2003. s.2279-2332.
• Başkal N. Diyabetes Mellitusun Sınıflandırılması. In: Erdoğan G (ed). Koloğlu Endokrinoloji Temel ve Klinik. 2.Baskı. MN Medikal&Nobel Kitabevi; 2005.s. 342-349.
• International Diabetes Federation. IDF Diabetes Atlas, 9th edn. Brussels,Belgium: 2019. Available at: https://www.diabetesatlas.org.Accessed January 03,2021.
• Satman I, Yilmaz T, Sengül A et al. Population-based study of diabetes and risk characteristics in Turkey: results of the Turkish diabetes epidemiology study (TURDEP). Diabetes Care 2002;25(9):1551-1556.
• Satman I, Omer B, Tutuncu Y et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 2013;28(2):169-180.
• Koenig RJ, Peterson CM, Kilo C, Cerami A, Williamson JR. Hemoglobin A1c as an indicator of the degree of glucose intolerance in diabetes. Diabetes 1976;25(3):230-232.
• Weykamp C, John WG, Mosca A. A review of the challenge in measuring hemoglobin A1c. J Diabetes Sci Technol 2009;3(3):439-45.
• Herman WH, Fajans SS. Hemoglobin A1c for the diagnosis of diabetes: practical considerations. Pol Arch Med Wewn 2010;120(1-2):37-40.
• True MW. Circulating biomarkers of glycemia in diabetes management and implications for personalized medicine. J Diabetes Sci Technol 2009;3(4):743-747.
• American Diabetes Association. Standarts of medical care in diabetes-2009. Diabetes Care 2009;32(Suppl 1):S13-61.
• Rodbard HW, Blonde L, Braithwaite SS et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus. Endocr Pract 2007;13(Suppl 1):1-68.
• Olson DE, Rhee MK, Herrick K, Ziemer DC, Twombly JG, Phillips LS. Screening for diabetes and pre-diabetes with proposed A1c-based diagnostic criteria. Diabetes Care 2010; 33: 2184–2189.
• Zemlin AE, Matsha TE, Hassan MS, Erasmus RT. HbA1c of 6.5% to diagnose diabetes mellitus does it work for us? The Bellville South Africa Study. PLoS One 2011; 6: e22558.
• Wan Nazaimoon WM, Md Isa SH, Wan Mohamad WB, Khir AS, Kamaruddin NA, Kamarul IM, Mustafa N, Ismail IS, Ali O, Khalid BA. Prevalence of diabetes in Malaysia and usefulness of HbA1c as a diagnostic criterion. Diabet Med. 2013;30:825-828.
• Türkiye Endokrinoloji ve Metabolizma Derneği Diyabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzleme Klavuzu 2020. 14.Basım. ISBN 978-605-4011-40-7.
• Sabuncu T, Sönmez A, Bayram F et al. Li̇pi̇d Metaboli̇zma Bozuklukları Tanı ve Tedavi̇ Kılavuzu. 4. Baskı. Türkiye Endokrinoloji ve Metabolizma Derneği; 2017. ISBN: 978-605-4011-23-0.
• Behard S,Benderly M,Reicher-Reus H et al. For the Bezafibrate İnfarction Prevention (BIP) Study. Lipid profile and outcome of diabetic patiens with coronary artery dissease in the BIP Study Registry. Proceedings of the American Collage of Cardiology;1997 March;Anaheim,California
• Renders CM, Valk GD, de Sonnaville JJ, Twisk J, Kriegsman DM, Heine RJ, van Eijk JT, van der Wal G: Quality of care for patients with Type 2 diabetes mellitus--a long-term comparison of two quality improvement programmes in the Netherlands. Diabet Med 2003;20:846-852
• International Diabetes Federation. Managing type 2 in primary care. Erişim tarihi:02.11.2021 https://www.idf.org/our-activities/care-prevention/type-2-diabetes.html
• International Diabetes Federation. Clinical Practice Recommendations for managing Type 2 Diabetes in Primary Care, 2017. ISBN: 978-2-930229-85-0
• Murphy ME, Byrne M, Galvin R, Boland F, Fahey T, Smith SM. Improving risk factor management for patients with poorly controlled type 2 diabetes: a systematic review of healthcare interventions in primary care and community settings. BMJ Open. 2017;7(8):e015135. Published 2017 Aug 4.
• Choo PP, Md Din N, Azmi N, Bastion MLC. Review of the management of sight-threatening diabetic retinopathy during pregnancy. World J Diabetes 2021; 12(9): 1386-1400 [PMID: 34630896 Hatay İl Nüfusu. Available at: https://www.nufusu.com/il/2016/hatay-nufusu. Accessed July 29, 2020.
• Hatay Birinci Basamak Merkez Laboratuvarı Ocak-Aralık 2017 Referans Değerleri. Available at: http://hsl31.com/Default.aspx?ID=67. Accessed December 20,2017.
• Sönmez A, Haymana C, Bayram F, Salman S, Dizdar OS, Gürkan E, Kargılı A, Barcın C, Sabuncu T, Satman I, TEMD study group. Turkish nationwide survey of glycemic and other Metabolic parameters of patients with Diabetes mellitus (TEMD study). Diabetes Res Clin Pract 2018;146:138-147.
• Saaddine J, Campagna AF, Rolka D et al. Distribution of HbA1c levels for children and young adults in the U.S. Third National Health and Nutrition Examination Survey. Diabetes Care 2002;25(8);1326-30.
• Ulaş B, Pehlivan E. Üniversite öğrencilerinde hemoglobin A1c taraması ve olası yeme bozukluğu sıklığı. Medicine Science 2015;4(2):2196-209.
• Khan HA, Sobki SH, Khan SA. Association between glycaemic control and serum lipids profile in type 2 diabetic patients: HbA1c predicts dyslipidaemia. Clin Exp Med 2007;7(1):24–29.
• Klisic A, Kavaric N, Jovanovic M et al. Association between unfavorable lipid profile and glycemic control in patients with type 2 diabetes mellitus. J Res Med Sci 2017;22:122.
• Altay M, Aslan İ, Aydoğdu A et al. Dislipidemi Tanı ve Tedavi Kılavuzu. 5. Baskı. Türkiye Endokrinoloji ve Metabolizma Derneği; 2018. ISBN: 978-605-4011-30-8.
• Zimmet PZ, Alberti KG. The changing face of macrovascular disease in non insülin dependent diabetes mellitus: an epidemicin progress. Lancet 1997;350(Suppl 1):1-4.
• Özdoğan E, Özdoğan O, Güldal Altunoğlu E, Köksal AR. Tip 2 diyabet hastalarında kan lipid düzeylerinin Hba1c ve obezite ile ilişkisi.Şişli Etfal Hastanesi Tıp Bülteni 2015;49(4):248-54.
• Mahato RV, Gyawali P, Raut PP et al. Association between glycaemic control and serum lipid profile in type 2 diabetic patients: glycated haemoglobin as a dual biomarker. Biomed Res 2011;22(3):375-80.
• Betteridge DJ. Lipid disorders in type 2 diabetes. In: Pickup J, Williams G(eds). Diabetes 2nd ed. Blaxkwell Science,Victoria; 1997:2(55):1-31.
• O’Brien T, Nguyen TT, Harrison JM, Bailey KR, Dyck PJ, Kottke BA. Lipids and lipoprotein (a) lipoprotein levels and coronary artery disease in subjects with non-insulin dependent diabetes mellitus. Mayo Clin Proc 1994;69(5):430–435.
• Mullugeta Y, Chawla R, Kebede T, Worku Y. Dyslipidemia associated with poor glycemic control in type 2 diabetes mellitus and the protective effect of metformin supplementation. Indian J Clin Biochem 2012;27(4):363-9.
• Babikr WA, Alshahrani AS, Hamid HG, Abdelraheem AH, Shalayel MH. The correlation of HbA1c with body mass index and HDL-cholesterol in type 2 diabetic patients. Biomed Res 2016;27(4):1280-3.
• Satman İ, Salman S, Deyneli O et al. Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu. 10. Baskı. Türkiye Endokrinoloji ve Metabolizma Derneği; Mayıs 2018. ISBN: 978-605-4011-32-2.