Damci T, Kultursay H, Oguz A, Pehlivanoglu S, Tokgozoglu L
Department of Internal Medicine, Istanbul University Cerrahpasa Medical Faculty, Division of Endocrinology, Diabetes and Metabolism, Istanbul, Turkey.
Diabetes Metab. 2004 Sep;30(4):327-33. doi: 10.1016/s1262-3636(07)70124-6.
The present study is a snapshot of how diabetic patients are treated for diabetes and coexisting cardiovascular risk factors in Turkey. We also addressed the question of what percentage of these patients are treated appropriately according to the current guidelines. Next step will be to determine which pharmacological treatment strategies affect mortality and morbidity in these patients and whether there are regional differences in these outcomes.
To get a representative picture, Turkey was splitted into four parts with different ethnic and socioeconomic features then centers were randomized within each of these parts. Number of the centers in a region were calculated according to the population of that region. 305 physicians in 11 cities participated in data collection during a period of 3 months. Consecutive 2226 diabetic patients patients who were above 55 years of age were included. Detailed information was obtained about the demographic features and the cardiovascular risk factor and diabetes status of the patients together with relevant drug treatment. Laboratory analyses were done locally and recorded if performed during the last 3 months.
Most patients were treated with oral antidiabetic monotherapy regardless of diabetes duration, metabolic control and complication and cardiovascular risk factor status. There was a trend among physicians except for endocrinologists to underprescribe insulin. Monotherapy also was the main mode of treatment for hypertension. Angiotensin converting enzyme inhibitors were generally not used as first line treatment contrary to the recommendations and angiotensin converting enzyme inhibitors and angiotensin receptor blockers are not prescribed for renoprotection in microalbuminuric patients. Statins, fibrates, metformin and aspirin were largely underused.
The present study indicates that diabetic patients are undertreated in Turkey. Therefore every effort should be spent to implement current guidelines in diabetic patients in order to prevent macro and microvascular complications of diabetes.
本研究是关于土耳其糖尿病患者如何治疗糖尿病及并存的心血管危险因素的现状描述。我们还探讨了根据现行指南这些患者得到恰当治疗的比例问题。下一步将确定哪些药物治疗策略会影响这些患者的死亡率和发病率，以及这些结果是否存在地区差异。
为获得具有代表性的情况，土耳其按不同种族和社会经济特征划分为四个部分，然后在每个部分内随机选取中心。根据该地区人口计算每个地区的中心数量。11个城市的305名医生在3个月期间参与了数据收集。纳入了连续的2226名年龄在55岁以上的糖尿病患者。获取了患者的人口统计学特征、心血管危险因素、糖尿病状况以及相关药物治疗的详细信息。实验室分析在当地进行，并记录最近3个月内是否进行过。
大多数患者无论糖尿病病程、代谢控制情况、并发症及心血管危险因素状况如何，均接受口服抗糖尿病单药治疗。除内分泌科医生外，其他医生有胰岛素处方不足的趋势。单药治疗也是高血压的主要治疗方式。与建议相反，血管紧张素转换酶抑制剂一般未用作一线治疗，且血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂未用于微量白蛋白尿患者的肾脏保护。他汀类药物、贝特类药物、二甲双胍和阿司匹林大多未得到充分使用。
本研究表明，土耳其的糖尿病患者治疗不足。因此，应尽一切努力在糖尿病患者中实施现行指南，以预防糖尿病的大血管和微血管并发症。
