Department of Endocrinology and Metabolism, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey,
Department of Endocrinology and Metabolism, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
Obes Facts. 2019;12(2):167-178. doi: 10.1159/000496624. Epub 2019 Mar 20.
Obesity is the main obstacle for metabolic control in patients with type 2 diabetes. Turkey has the highest prevalence of obesity and type 2 diabetes in Europe. The effect of obesity on the metabolic control, and the macro- and microvascular complications of patients are not apparent.
This nationwide survey aimed to investigate the prevalence of overweight and obesity among patients with type 2 diabetes and to search for the impact of obesity on the metabolic control of these patients. We also investigated the independent associates of obesity in patients with type 2 diabetes.
We consecutively enrolled patients who were under follow-up for at least 1 year in 69 tertiary healthcare units in 37 cities. The demographic, anthropometric, and clinical data including medications were recorded. Patients were excluded if they were pregnant, younger than 18 years, had decompensated liver disease, psychiatric disorders interfering with cognition or compliance, had bariatric surgery, or were undergoing renal replacement therapy.
Only 10% of patients with type 2 diabetes (n = 4,648) had normal body mass indexes (BMI), while the others were affected by overweight (31%) or obesity (59%). Women had a significantly higher prevalence of obesity (53.4 vs. 40%) and severe obesity (16.6 vs. 3.3%). Significant associations were present between high BMI levels and lower education levels, intake of insulin, antihypertensives and statins, poor metabolic control, or the presence of microvascular complications. Age, gender, level of education, smoking, and physical inactivity were the independent associates of obesity in patients with type 2 diabetes.
The TEMD Obesity Study shows that obesity is a major determinant of the poor metabolic control in patients with type 2 diabetes. These results underline the importance of prevention and management of obesity to improve health care in patients with type 2 diabetes. Also, the results point out the independent sociodemographic and clinical associates of obesity, which should be the prior targets to overcome, in the national fight with obesity.
肥胖是 2 型糖尿病患者代谢控制的主要障碍。土耳其是欧洲肥胖和 2 型糖尿病患病率最高的国家。肥胖对患者代谢控制以及大血管和微血管并发症的影响尚不清楚。
本项全国性调查旨在研究 2 型糖尿病患者超重和肥胖的患病率，并探讨肥胖对这些患者代谢控制的影响。我们还研究了 2 型糖尿病患者肥胖的独立相关因素。
我们连续纳入了在 37 个城市的 69 个三级医疗机构中至少随访 1 年的患者。记录了患者的人口统计学、人体测量学和临床数据，包括药物治疗情况。排除标准为妊娠、年龄<18 岁、失代偿性肝病、精神疾病影响认知或依从性、接受过减重手术或正在进行肾脏替代治疗的患者。
仅有 10%（n=4648）的 2 型糖尿病患者体重指数正常，其余患者超重（31%）或肥胖（59%）。女性肥胖（53.4%比 40%）和重度肥胖（16.6%比 3.3%）的患病率明显更高。高 BMI 水平与较低的教育水平、胰岛素、降压药和他汀类药物的使用、代谢控制不良或微血管并发症的存在有关。年龄、性别、教育程度、吸烟和缺乏体力活动是 2 型糖尿病患者肥胖的独立相关因素。
TEMD 肥胖研究表明，肥胖是 2 型糖尿病患者代谢控制不良的主要决定因素。这些结果强调了预防和管理肥胖对于改善 2 型糖尿病患者的医疗保健的重要性。此外，研究结果还指出了肥胖的独立社会人口学和临床相关因素，这应该是国家肥胖防治工作的首要目标。
