Tip 2 Diyabet Hastalarında Makrovasküler Komplikasyonların HbA1c Düzeyi, Diyabet Süresi ve Obezite ile İlişkisi: Retrospektif Bir Analiz

Öz

Amaç: Bu çalışmanın amacı, tip 2 diyabetes mellitus (T2DM) hastalarında glisemik kontrol (HbA₁c), diyabet süresi ve vücut kitle indeksi (VKİ) ile makrovasküler ve mikrovasküler komplikasyonlar (MACV ve MICV) arasındaki ilişkiyi değerlendirmektir. Gereç ve Yöntemler: Bu retrospektif kesitsel çalışmada, İstanbul Eğitim ve Araştırma Hastanesi Diyabet Polikliniği’nde takip edilen 902 tip 2 diyabetes mellitus hastasının başlangıç verileri incelendi. Katılımcılar HbA₁c düzeyine (<%8 / ≥%8), diyabet süresine (≤5 yıl / >5 yıl) ve VKİ’ne (<25 / 25–29.9 / ≥30 kg/m²) göre sınıflandırıldı. Gruplar arasındaki farklar, makrovasküler (hipertansiyon [HT], iskemik kalp hastalığı [İKH], serebrovasküler hastalık [SVH], periferik arter hastalığı [PAH]) ve mikrovasküler (nefropati, retinopati, nöropati) komplikasyonlar açısından analiz edildi. İstatistiksel analizlerde Ki-kare testi kullanıldı ve anlamlılık düzeyi p<0.05 olarak kabul edildi. Bulgular: HbA₁c ≥%8 olan bireylerde (n=603), makrovasküler komplikasyon sıklığı %79.1 (n=477), HT %71.6 (n=432) ve İKH %26.0 (n=157) olup, HbA₁c <%8 grubuna göre anlamlı derecede yüksekti (p<0.01). Diyabet süresi >5 yıl olan grupta (n=472) tüm makrovasküler komplikasyon oranları belirgin şekilde artmıştı (p<0.01). VKİ arttıkça MACV (p<0.01), HT (p<0.01), SVH (p=0.005) ve PAH (p=0.017) sıklıkları da yükseldi; ancak İKH ile anlamlı ilişki saptanmadı (p=0.116). Mikrovasküler bulgular açısından, HbA₁c ≥%8 ve diyabet süresi >5 yıl olan bireylerde nöropati (p<0.001) ve nefropati (p=0.003) oranları anlamlı olarak yüksekti; retinopati açısından ise HbA₁c ile anlamlı fark izlenmedi (p>0.05). VKİ ile mikrovasküler komplikasyonlar arasında da anlamlı bir ilişki bulunmadı (p>0.05). Sonuç: Yüksek HbA₁c düzeyi, uzun diyabet süresi ve artmış VKİ, tip 2 diyabetes mellitus hastalarında makrovasküler ve mikrovasküler komplikasyon riskini anlamlı biçimde artırmaktadır. Bu parametrelerin erken dönemde optimize edilmesi, kardiyovasküler ve mikrovasküler morbiditeyi azaltmada kritik bir strateji olabilir.

Anahtar Kelimeler

• Tip 2 diyabet
• HbA₁c
• vücut kitle indeksi
• vasküler komplikasyon
• diyabet süresi

The relationship between macrovascular complications, HbA1c levels, diabetes duration, and obesity in patients with type 2 diabetes: a retrospective analysis

Öz

Aim: The aim of this study was to evaluate the relationship between glycemic control (HbA₁c), duration of diabetes, and body mass index (BMI) and macrovascular and microvascular complications (MACV and MICV) in patients with type 2 diabetes mellitus (T2DM). Material and Methods: In this retrospective cross-sectional study, baseline data from 902 individuals diagnosed with type 2 diabetes mellitus (T2DM) at the Diabetes Outpatient Clinic of Istanbul Training and Research Hospital were evaluated. Participants were classified based on HbA₁c level (<8% / ≥8%), duration of diabetes (≤5 years / >5 years), and BMI (<25 / 25-29.9 / ≥30 kg/m²). Differences between groups were analyzed in terms of macrovascular (hypertension [HT], ischemic heart disease [IHD], cerebrovascular disease [CVD], peripheral arterial disease [PAD]) and microvascular (nephropathy, retinopathy, neuropathy) complications. The Chi-square test was used for statistical analyses, with a significance level of p<0.05. Results: In individuals with HbA₁c ≥8% (n=603), the frequency of macrovascular complications was 79.1% (n=477), HT 71.6% (n=432), and IHD 26.0% (n=157)-all significantly higher compared with those with HbA₁c <8% (p<0.01). All macrovascular complication rates were markedly increased in the group with diabetes duration >5 years (n=472; p<0.01). As BMI increased, the frequencies of MACV (p<0.01), HT (p<0.01), CVD (p=0.005), and PAD (p=0.017) also rose, while no significant relationship was found with IHD (p=0.116). Regarding microvascular findings, the rates of neuropathy (p<0.001) and nephropathy (p=0.003) were significantly elevated in individuals with HbA₁c ≥8% and diabetes duration >5 years, whereas the difference in retinopathy was not significant for HbA₁c (p=0.082). No significant association was observed between BMI and microvascular complications (p=0.952). Conclusion: High HbA₁c, longer diabetes duration, and increased BMI significantly raise the risk of both macrovascular and microvascular complications in individuals with T2DM. Early optimization of these parameters may serve as a crucial strategy to reduce cardiovascular and microvascular morbidity.

Anahtar Kelimeler

• type 2 diabetes
• HbA₁c
• body mass index
• vascular complications
• duration of diabetes

Kaynakça

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