TİP 2 DİYABETLİ HASTALARIN TEDAVİSİNDE KILAVUZLARA NE KADAR UYGUN HAREKET EDİYORUZ?

Yıl 2021, , 369 - 375, 31.07.2021

İlkim Toprak , Özlem Kandemir Alibakan Mehmet Alptekin Acar Betül Köstek İpek Bilge Aslan Uğur Yılmaz , Hasan Eruzun , Yücel Arman , Tufan Tükek

https://doi.org/10.26650/IUITFD.2021.828573

Öz

Amaç: Biz bu çalışma ile, Tip 2 diabetes mellitusta (DM) güncel tedavi yaklaşımları ve hedeflere yönelik hekimlerin farkındalığını artırmak için retrospektif olarak kılavuzlara uygunluğu araştırmayı hedefledik. Gereç ve Yöntem: Çalışmamız retrospektif, kesitsel, analitik bir çalışma olarak tasarlandı. Ocak 2018-Ocak 2019 tarihleri arasında Tip 2 DM nedeniyle tedavi alan hastalar, randomize olarak tespit edildi. Hastaların son bir yıllık takiplerindeki laboratuvar değerleri, eşlik eden hastalıkları ve kullandıkları ilaçlar kaydedildi. Bulgular: Çalışmaya toplam 1154 hasta dahil edilmiştir. Üç ayda bir düzenli kontrole gelenler ile gelmeyenler karşılaştırıldığında, başlangıç hemoglobin A1c (HbA1c) değerleri arasında istatistiksel olarak anlamlı bir fark saptanmaz iken (%7,83±%1,94 ve %7,99±%1,97), bir yılın sonunda, düzenli kontrole gelenlerin HbA1c değerleri kontrole gelmeyenlere göre istatistiksel olarak anlamlı olacak şekilde daha düşüktü (%7,18±%1,85 ve %7,91±%1,96). Toplam 1154 hastanın, 887’si (%76,8) düzenli olarak metformin kullanmaktaydı. Hastalarımızın 149’unda, başlangıç HbA1c düzeyi %10’un üzerinde idi ve bu hastaların 120’sine (%80,5) insülin tedavisi hemen başlanmıştı. Sonuç: Tip 2 diyabetli hastalarda takip sıklığı, metformin ve insülin tedavisinin düzenlenmesi konusunda genel olarak kılavuzlara uyumun iyi olduğu ancak yeni anti-diyabetik ilaç grupları olan GLP-1 reseptörü agonisti veya SGLT2 inhibitörlerinin kullanım oranlarının düşük olduğu ve statin tedavisi ile hedeflenen sonuçlara ulaşılamayan dislipidemik hastalarda ikincil tedavi eklenmesi oranlarının çok düşük olduğu saptanmıştır.

Anahtar Kelimeler

Diyabet tedavisi, kılavuzlar, diyabet, insülin

HOW DO WE FOLLOW THE GUIDELINES IN THE TREATMENT OF PATIENTS WITH TYPE 2 DIABETES?

Öz

Objective: We aimed to retrospectively investigate compliance with guidelines in order to increase the awareness of physicians towards current treatment approaches and goals in Type 2 diabetes mellitus (DM). Material and Method: Our study was designed as a retrospective, cross-sectional, analytical study. Patients who received treatment for Type 2 DM between January 2018 and January 2019 were randomly identified. Laboratory values, accompanying diseases, and medications used by the patients in their last one-year follow-up were recorded. Results: A total of 1,154 patients were included in the study. When the patients who came for regular check-ups every three months and those who did not were compared, there was no statistically significant difference between the initial hemoglobin A1c (HbA1c) and the final values (7.83%±1.94% and %7.99%±1.97%). At the end of one year, HbA1c values were statistically significantly lower than those of patients who did not come for control (7.18%±1,.5% and 7.91%±1.96%). 887 (76.8%) of a total of 1154 patients were using metformin regularly. In 149 of our patients, the initial HbA1c level was above 10% and insulin treatment was started immediately in 120 (80.5%) of these patients. Conclusion: In patients with Type 2 Diabetes, the frequency of follow-up and regulation of metformin and insulin treatment is generally good, but the use of GLP-1 receptor agonists or SGLT2 inhibitors, which are new anti-diabetic drug groups, is low. The herate of adding secondary therapy in dyslipidemic patients who do not achieve the targeted results with statin therapy has been found to be very low.

Anahtar Kelimeler

Treatment of diabetes, guidelines, diabetes, insulin

Kaynakça

• 1. Kleinberger JW, Pollin TI. Personalized medicine in diabetes mellitus: current opportunities and future prospects. Ann N Y Acad Sci 2015;1346(1):45-56. [CrossRef]
• 2. Schmidt AM. Highlighting Diabetes Mellitus: The Epidemic Continues. Arterioscler Thromb Vasc Biol 2018;38(1):e1-8. [CrossRef]
• 3. American Diabetes Association. Standards of Medical Care in Diabetes-2019 Abridged for Primary Care Providers. Clin Diabetes 2019;37(1):11-34. [CrossRef]
• 4. World Health Organization. WHO Fact Sheets on Palliative Care. http://www.who.int/news-room/fact-sheets/detail/ palliative-care
• 5. Kanter JE, Bornfeldt KE. Impact of Diabetes Mellitus. ArteriosclerThrombVasc Biol 2016;36(6):1049-53. [CrossRef]
• 6. Türkiye Endokrinoloji ve Metabolizma Derneği Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu-2020 14. Baskı (Çevrimiçi Yayın): 25 Haziran 2020 (Güncellenmiş Baskı). (Erişim Tarihi: 01.07.2020, http:// temd. org.tr/admin/uploads/tbl_kilavuz/20200625154506- 2020tbl_ kilavuz86bf012d90.pdf
• 7. Sekimoto M, Ii M. Supplier-Induced Demand for Chronic Disease Care in Japan: Multilevel Analysis of the Association between Physician Density and Physician-Patient Encounter Frequency. Value Health Reg Issues 2015;6:103-10. [CrossRef]
• 8. Anjana RM, Shanthirani CS, Unnikrishnan R, Mugilan P, Amutha A, Nair HD, et al. Regularity of follow-up, glycemic burden, and risk of microvascular complications in patients with type 2 diabetes: a 9-year follow-up study. Acta Diabetol 2015;52(3):601-9. [CrossRef]
• 9. Javorsky E, Robinson A, Boer Kimball A. Evidence-based guidelines to determine follow-up intervals: a call for action. Am J Manag Care 2014;20(1):17-9.
• 10. Hu M, Zhou Z, Zeng F, Sun Z. Effects of frequency of followup on quality of life of type 2 diabetes patients on oral hypoglycemics. Diabetes Technol Ther 2012;14(9):777-82. [CrossRef] 11. American Diabetes Association, Standards of Medical Care in Diabetes-2016: Summary of Revisions. Diabetes Care 2016;39(Suppl 1):S4-5. [CrossRef]
• 12. Bolen S, Tseng E, Hutfless S, Segal JB, Suarez-Cuervo C, Berger Z, et al. Diabetes Medications for Adults With Type 2 Diabetes: An Update, Comparative Effectiveness Reviews 173. Rockville (MD): Agency for Healthcare Research and Quality (US), 2016 Apr. Report No.: 16-EHC013-EF.
• 13. Tuot DS, Lin F, Shlipak MG, Grubbs V, Hsu CY, Yee J, et al. CDC CKD Surveillance Team. Potential Impact of Prescribing Metformin According to eGFR Rather Than Serum Creatinine. Diabetes Care 2015;38(11):2059-67. [CrossRef]
• 14. Inzucchi SE, Lipska KJ, Mayo H, Bailey CJ, McGuire DK. Metformin in patients with type 2 diabetes and kidney disease: a systematic review. JAMA 2014;312(24):2668-75. [CrossRef]