OBJECTIVE:Type 2 diabetes mellitus is a chronic metabolic disorder characterized by insulin resistance and β-cell dysfunction, often coexisting with obesity. Obesity increases adipose tissue inflammation and oxidative stress, which may impair mitochondrial function and muscle metabolism. The aim of this study was to investigate the effects of obesity severity on oxidative stress biomarkers, exercise-related biomarkers, physical activity level, and sleep quality in individuals with type 2 diabetes mellitus. METHODS:This prospective observational study included 80 individuals aged 20-80 diagnosed with type 2 diabetes mellitus. Participants' body mass index, physical activity assessed by the International Physical Activity Questionnaire-Short Form, and sleep quality assessed by the Pittsburgh Sleep Quality Index were recorded. Serum samples were analyzed for oxidative stress biomarkers (total antioxidant status, total oxidant status, malondialdehyde, and superoxide dismutase) and exercise-related biomarkers (irisin, Fibronectin Type III Domain-Containing Protein 5, Adenosine Monophosphate-Activated Protein Kinase, and leptin) using enzyme-linked immunosorbent assay methods. RESULTS:There were significant differences in irisin, Fibronectin Type III Domain-Containing Protein 5, Adenosine Monophosphate-Activated Protein Kinase, leptin, malondialdehyde, superoxide dismutase, total antioxidant status, and total oxidant status values according to body mass index levels (p<0.001). Overweight participants had higher irisin, Adenosine Monophosphate-Activated Protein Kinase, and Fibronectin Type III Domain-Containing Protein 5 levels, while leptin, malondialdehyde, and total oxidant status levels increased with obesity severity. Physical activity levels decreased as body mass index increased (p=0.016). No significant differences were observed in self-reported sleep quality parameters assessed by the Pittsburgh Sleep Quality Index across body mass index groups (p>0.05). CONCLUSION:Increasing obesity severity in individuals with type 2 diabetes mellitus is associated with elevated oxidative stress and decreased antioxidant defense, along with lower levels of exercise-related metabolic biomarkers. These findings highlight the importance of promoting regular physical activity and interventions targeting the irisin/Adenosine Monophosphate-Activated Protein Kinase pathway to reduce oxidative stress and improve metabolic health in obese diabetic individuals.

Objective: This study investigated the association between HbA1c levels and hematological parameters in patients with type 2 diabetes mellitus to determine their potential as markers of glycemic regulation. Methods: This retrospective cross-sectional study included 498 patients with Type 2 diabetes mellitus attending the Endocrinology Outpatient Clinic of Selcuk University Faculty of Medicine between January 2023 and December 2024, along with 500 healthy adults as controls. Demographic data (age and sex) and laboratory results were retrospectively analyzed. Results: HbA1c levels showed positive correlations with age (r = 0.558, p < 0.001), WBC (r = 0.237, p < 0.001), RDW (r = 0.128, p < 0.001), and NLR (r = 0.068, p = 0.040). An inverse association was detected between HbA1c levels and MCV (r = -0.238, p < 0.001). There were no statistically meaningful associations identified between HbA1c levels and MPV, PLT, or Hgb (p > 0.05). Among individuals with type 2 diabetes, WBC, RDW and NLR were notably elevated, whereas MCV was significantly reduced in comparison to the control group (p < 0.05). Conclusion: The observed associations between HbA1c and selected hematological parameters indicate that complete blood count-given its affordability and accessibility-may serve as a supportive tool for the assessment of glycemic status in patients with Type 2 diabetes mellitus. Parameters such as MCV, RDW, and NLR could act as potential biomarkers for glycemic control and early complication detection. However, these findings require validation through large-scale, multicenter, prospective studies.

INTRODUCTION:Our study aimed to compare the short- and particularly long-term type 2 diabetes mellitus (T2DM) remission prediction abilities of ABCD, individualised metabolic surgery (IMS), DiaRem2, Ad-DiaRem and DiaBetter scoring systems in Turkish adult type 2 diabetic morbidly obese patients who underwent bariatric surgery. PATIENTS AND METHODS:Our study was planned as a retrospective cohort study. A total of 137 patients with T2DM, including 78 sleeve gastrectomy (SG) and 59 Roux-en-Y gastric bypass (RYGB) patients, were included in the 1 st -year evaluation after bariatric surgery, and a total of 115 patients with T2DM, including 64 SG and 51 RYGB patients, were included in the evaluation at the end of the 5 th year. RESULTS:In the 1 st year after bariatric surgery, area under the ROC curve (AUC) values for diabetes remission scores were 0.863 for Ad-DiaRem, 0.896 for DiaBetter, 0.840 for DiaRem2, 0.727 for ABCD and 0.836 for IMS. At 5 years after bariatric surgery, the AUC values for diabetes remission were 0.834 for Ad-DiaRem, 0.888 for DiaBetter, 0.794 for DiaRem2, 0.730 for ABCD and 0.878 for IMS. CONCLUSIONS:According to our study, the DiaBetter score provided a better AUC value than the other scores both in the short and long term but showed similar predictive performance to Ad-DiaRem in the short term and IMS in the long term. We believe that DiaBetter and Ad-DiaRem scores might be more appropriate for short-term assessment and DiaBetter and IMS scores for long-term remission assessment.

Aim: This study aimed to investigate the rate of carpal tunnel syndrome (CTS) and polyneuropathy in patients with new-diagnosed hypothyroidism and the relationship between median nerve conduction and the cross-sectional area of the median nerve by ultrasonography. Material and Methods: It was a prospective, cross-sectional and case-control study. This study included thirty-five new-diagnosed hypothyroidism cases and thirty-five healthy controls. Bilateral sensory and motor nerve potentials were noted in the lower and upper extremities. The cross-sectional area of the median nerve was examined at the entrance of the CT with the axial plan by ultrasonography. The relationship between the cross-sectional areas of the median nerve and nerve conduction parameters was investigated. Results: CTS was determined electrophysiologically in 8 (22.9%) patients. The control group had no CTS. There was no significant electrophysiological finding to support polyneuropathy in the patients. The cross-sectional areas of the median nerve were higher in the patient group but did not reach statistically significant (p>0.05). There was a positive correlation between the right and left cross-sectional area of median nerves and body mass index (BMI) (p<0.05). Conclusion: The rate of CTS is high in patients with newly diagnosed hypothyroidism. There is a positive correlation between cross-sectional nerve areas and BMI. There was no significant correlation between nerve conductions and median nerve ultrasonographic cross-sectional areas.

Abstract Introduction: Although pregnancy is a physiological condition, the secretion of diabetogenic hormones such as growth hormone, corticotropin-releasing hormone, placental lactogen hormone, prolactin and progesterone from the placenta could lead to insulin resistance (IR). In Metabolic Syndrome, obesity and Type1&2 diabetes, a shift in the kynurenine pathway (KP) towards IDO activation is observed. The activation of the IDO leads to the activation of the Aryl hydrocarbon receptor (AhR) and Interleukin-6 (IL-6) also, which may also induce some effects like insulin resistance, β-cell disfunction and increased gluconeogenesis. We hypothesized that the overactivation of IDO and some KP enzymes would be observed in GDM patients, in a similar manner to metabolic syndrome, prediabetes, and diabetes patients. Methods: 50 patients and 50 controls, who applied to the Endocrinology outpatient clinic of Selcuk University Faculty of Medicine were included. Serum triptophan metabolite levels were measured with liquid chromatography tandem mass spectrometry. Results: Tryptophan and KYNA values was found to be lower in the patient group diagnosed with GDM (p<0.001 and p<0.001, respectively). The levels of KYN, 3-OH AA, 3-OH-KYN and KTR were significantly higher in the patient group compared to the control group (p=0.008, p<0.001, p=0.05 and p<0.001, respectively). Conclusions: Understanding the changes that occur in this pathway in GDM patients may provide insight into the development of the disease. Also these tests could be used as supplementary tests in gestational diabetes, which could assist in diagnosis and patient follow-up.

OBJECTIVE Thyroid cancer is the most common endocrine neoplasm. About 10% develop invasive disease and 5% lymph node (LN) metastasis. An alternative immunoscore system to the tumor node metastasis (TNM) classification has been developed to predict the prognosis of solid tumors. The aim of this study is to investigate the potential roles of CD3+, CD8+ T lymphocyte infiltration and programmed death-ligand 1 (PD-L1) expression in immunoscore, the prognostic value of Immunoscore for Papillary thyroid cancer and its support for TNM classification.METHODS A total of 164 patients diagnosed with papillary thyroid cancer were included in our study. Immunoscore was evaluated by immunohistochemistry according to CD3+ and CD8+ T lymphocyte density at the tumor center and at the tumor margin. Immunoscore values were calculated. PD-L1 was evaluated by immunohistochemistry according to its density at the tumor center and at the tumor margin. The relationships between the parameters studied were evaluated statistically.RESULTS The presence of PD-L1 at the tumor centers in CD8+ T lymphocytes height was also significantly higher (p<0.001). There was no significant relationship between PD-L1 expression at the tumor center and LN metastasis and tumor size ( p>0.999 and p=0.226, respectively). In the presence of PD-L1 expression at the tumor margin, LN metastasis (p<0.001) and tumor size (p=0.029) were higher. PD-L1 expression at the tumor margin was significantly associated with overall survival (p<0.001).CONCLUSION In particular, immunoscore value can be a good prognostic marker and its significant association with conditions associated with poor prognosis, such as PD-L1 expression, suggests that it may be a parameter that can be used and guided in stage scoring.

Objective: This study was aimed to compare serum galectin-3 (Gal-3) levels in gestational diabetes mellitus (GDM) and healthy pregnant women and to evaluate the relationship between insulin resistance parameters and serum Gal-3 levels. Materials and Methods: Fifty-nine pregnant women who were screened for GDM with oral glucose tolerance tests (OGTT) at the 24th–28th gestational weeks were included in the study. According to the results of OGTT, 34 pregnant women were included in the GDM group and 25 pregnant women were included in the control group. Results: Serum Gal-3 value was found to be similar in the GDM and control group (P < 0.471). However, there was a significant positive association between Gal-3 and fasting insulin (r = 0.509, P < 0.001) and homeostasis model assessment of insulin resistance (HOMA-IR) (r = 0.479, P < 0.001) in the whole pregnancies, and between Gal-3 levels and fasting insulin (r = 0.608, P < 0.001), HOMA-IR (r = 0.609, P < 0.001), and OGTT 60 min glucose (r = 0.444, P = 0.016) in the GDM patients. Conclusions: There was no difference in the last trimester serum Gal-3 levels between GDM and healthy pregnant women. However, a significant positive correlation was determined between Gal-3 and fasting insulin, HOMA-IR, and OGTT 60 min glucose values in the GDM group, and fasting insulin and HOMA-IR values in whole pregnancies. The results of our study support previous data reporting the relationship between Gal-3 and GDM through insulin resistance.

The SLC30A8 gene encodes zinc transporter-8 (ZnT8), highly expressed in insulin-secreting pancreatic beta cells, and may contribute to insulin processing and secretion. The SNP 13266634C/T (R325W change) in the SLC30A8 gene has been associated with type 2 diabetes (T2D) development. Genome-wide association studies and subsequent population studies including Europeans and Asians have demonstrated that the rare allele T (Trp325) of SNP 13266634 in the SLC30A8 gene is protective against T2D. We aimed to investigate whether the SNP rs13266634C/T is associated with T2D and its phenotypes in Turkey, which geographically connects Asia and Europe. In our study, 650 nonobese individuals (366 T2D and 284 healthy individuals) were enrolled. Target SNP was genotyped by real-time PCR using the LightSNiP Genotyping Assay System. The frequency of the T allele was lower in the T2D group than in the healthy control group (14.6

Objective. This study was aimed to evaluate the prevalence of Cushing's syndrome and the diagnostic performance of the 1 mg dexamethasone suppression test in class 3 obese patients. Methods. Anthropometric measurements and other laboratory data, including 1 mg dexamethasone suppression test of 753 class 3 obese patients, who applied to the Endocrinology and Metabolism Outpatient Clinic for the pre-bariatric surgery evaluation between 2011 and 2020, were evaluated retrospectively. Results. An abnormal response to the 1 mg dexamethasone suppression test (cortisol ≥1.8 mcg/dl) was observed in 24 patients and the presence of Cushing's syndrome was confirmed by additional tests in 6 patients. The prevalence of abnormal dexamethasone suppression test was 3.18% and the prevalence of Cushing's syndrome 0.79%. The specificity value was determined as 97.5% for 1 mg dexamethasone suppression test with cortisol threshold value ≥1.8 mcg/dl. Conclusions. The prevalence of Cushing's syndrome was found to be low in class 3 obese patients and 1 mg of dexamethasone suppression test had a very sufficient performance for Cushing's syndrome screening in this patient group.

Objectives: Inflammation-induced overexpression of cytokines can lead to cell death by caspase-dependent or independent signaling pathways.Numerous natural products are used to suppress/re-modulate inflammation.Phenolic monoterpene Thymol is widely used in cosmetics and medical purposes.It has been shown that thymol regulates the anti-inflammatory, antioxidant, and anti-apoptotic responses in LPS-induced in vitro and in vivo models.However, there is still a need to investigate the molecular mechanism of inflammation and the detailed regulatory roles of thymol on inflammation-dependent signal mechanisms.In the present study, the possible protective effects of thymol on inflammation-mediated lysosomal stress in the LPS-induced acute kidney inflammation model were investigated on HEK293 cells. Materials-Methods:To mimic the inflammation in HEK293 cells, LPS was applied to the cells for 24 hours.Following, cells were treated with various doses of thymol and total protein was isolated from the cells.Inflammation-associated IL-6, TNF-⍺, Nf-κB and phospho-Nf-κB protein levels, autophagy-related Beclin-1, Atg5, p62/SQSTM1 and LC3-I/II, ubiquitin proteosome system-associated polyubiquitin, cell deathassociated caspase-3 and PARP-1 protein levels were examined by immunoblotting. Results:We find that LPS-induced acute inflammation caused the suppressing of autophagic flux and reducing degradation of polyubiquitinated proteins.Thymol treatment markedly reversed the suppression of autophagy and stacking of poly-ubiquitinated protein by LPS.Also, LPS-induced acute inflammation did not cause caspase activation, it caused an increase in lysosomal stress-related PARP-1 cleavage pattern and thymol administration efficiently reduced PARP-1 cleavage. Conclusions:Our results suggested that LPS-induced acute inflammation triggers blockage of autophagic flux and thymol has a protective role against LPS-induced lysosomal stress.

Objective In this study, the objective was to evaluate the cardiovascular and metabolic effects in men with male pattern alopecia beginning before 30 years of age. Methods Total of 81 people (41 androgenetic alopecia (AGA) and 40 healthy individuals) were included in the study. Twenty-four-hour ambulatory blood pressure (ABP) measurement, high sensitive C-reactive protein (hsCRP), galectin-3 were studied. Hamilton-Norwood scale (HNS) was used to determine the AGA types of the cases. Results The mean age in the AGA and control groups was 30.3 +/- 7.5 and 30.8 +/- 6.0, respectively. Twenty-four-hour ABP measurements, hsCRP, and galectin-3 were similar in both groups. There was a positive correlation between HNS grade with age, BMI, triglyceride levels and fasting blood glucose levels in individuals with AGA. Similarly, there was a positive correlation between HNS grade with daytime pulse wave velocity and night-time reflection magnitude. A significant positive correlation was determined between hsCRP with BMI and waist circumference, and between galectin-3 with BMI, waist circumference, hip circumference, HOMA-IR in individuals with AGA. Conclusions This study shows that AGA patients are similar to the normal population in terms of insulin resistance or metabolic syndrome components. However, hsCRP and galectin-3 appear to be associated with cardiovascular disease risk factors in individuals with AGA.

Introduction: This study aims to compare the predictive capacity of ABCD, DiaRem2, Ad-DiaRem, and DiaBetter scoring systems for type 2 diabetes mellitus (T2DM) remission in Turkish adult morbidly obese patients who underwent SG. Methods: This retrospective cohort study included 80 patients who underwent sleeve gastrectomy (SG) operation who were diagnosed with T2DM preoperatively, and had at least one-year follow-up after surgery. Because bariatric surgery is performed on patients with class III obesity (BMI ≥ 40 kg/m2) or class II obesity (BMI ≥ 35 kg/m2) with obesity releated comorbid conditions in our hospital, our study cohort consisted of these patients. Results: The diagnostic performance of the DiaBetter, DiaRem2, Ad-DiaRem and ABCD for identifying diabetes remission, assessed by the AUC was 0.882 (95% CI, 0.807-0.958, p < 0.001), 0.862 (95% CI, 0.779-0.945, p < 0.001), 0.849 (95% CI, 0.766-0.932, p < 0.001) and 0.726 (95% CI, 0.601-0.851, p = 0.002), respectively. The AUCs of the Ad-Diarem, DiaBetter and DiaRem2 were statistically higher than AUC of the ABCD (all p-value < 0.001). Besides, there was no statistically significant difference in AUCs of the Ad-Diarem, DiaBetter and DiaRem scores (all p-value > 0.05). Conclusion: Ad-Dairem, DiaBetter and DaiRem scoring systems were found to provide a successful prediction for diabetes remission in sleeve gastrectomy patients. It was observed that the predictive power of the ABCD scoring system was lower than the other systems. We think that the use of scoring systems for diabetes remission, which have a simple use, will become widespread.

Amaç: Tip 2 diyabet (T2D), diyabetin en sık görülen türüdür ve tüm dünyada olduğu gibi ülkemizde de ciddi bir halk sağlığı sorunu haline gelmiştir. İnsülin sekresyonunun azalması ve/veya insülin direnci (İR) gelişimi, T2D patogenezinde yer alan iki ana bozukluktur. Kromozom 3p25'te yer alan peroksizom proliferatör aktive reseptör gama (PPARG) geni tarafından kodlanan ve esas olarak adipositlerde eksprese edilen PPARG2, glikoz ve lipid metabolizmasının düzenlenmesinde yer alan çok sayıda anahtar geni düzenler. Fonksiyonel önemi dolayısıyla, T2D gelişimi ile ilişkisi ilk rapor edilen aday gen PPARG2 (Pro12Ala varyantı)’dir. Çalışmamızda, PPARG genindeki Pro12Ala'nın IR gelişimi ve T2D riski üzerine etkilerini Konya bölgesinde yaşayan 387 (181 non-obez/ 206 obez) T2D ve 264 (137 non-obez/127 obez) sağlıklı birey olmak üzere toplam 650 kişide değerlendirmeyi amaçladık. Yöntem: Bireylerden alınan kan örneklerinden, T2D ilişkili biyokimyasal parametreler analiz edildi ve sonrasında HOMA-IR (HOMA indeksi) hesaplandı. HOMAIR indeksi 2.5'ten yüksek olan kişiler insüline dirençli olarak kabul edildi. İzole edilen DNA örneklerinde, Pro12Ala genotiplendirmesi RT-PCR tekniği ile yapıldı. İstatistiksel analiz için SPSS18.0 programı kullanıldı. P<0.05 istatistiksel olarak anlamlı kabul edildi. Bulgular: Obez hasta grubu dışında diğer hasta ve ve kontrol grupları Hardy-Weinberg dengesinde değildi (p<0.05). Dominant, resesif ve aditif modeller kurularak yapılan ilişkilendirme analizine göre Pro12Ala polimorfizminin T2D riski ve ilişkili biyokimyasal parametreler üzerine bir etkisi bulunmadı (p>0.05). Sonuç: Hastalığın poligenik doğası ve çevresel faktörlerin karmaşıklığı, genlerin T2D patogenezindeki etkisinin anlaşılmasını zorlaştırmaktadır. Bu nedenle, PPARG'nin hastalığın genetik zeminindeki olası rolünü ortaya çıkarmak için daha büyük popülasyonlarda daha fazla çalışmaya ihtiyaç vardır. Çalışma Türk toplumunda PPARG ve T2D ilişkisi bakımından sunulan ilk rapordur.

AIM OF THE STUDY:To determine the parenchymal vascularity of the thyroid gland with color superb microvascular imaging in patients with Graves' disease, and compare the vascularization index values with healthy subjects. MATERIALS AND METHODS:The thyroid glands of 37 patients whose laboratory and clinical findings were consistent with Graves' disease, and 40 asymptomatic subjects with normal laboratory values, were examined using color superb microvascular imaging. Measurements of the vascularization index were performed with a free region of interest which was drawn along the outer margin of the gland on the color superb microvascular imaging mode. The vascularization index values obtained in the Graves' disease and control groups were compared. A correlation analysis was performed between the vascularization index values and laboratory and grayscale US parameters. RESULTS:The median vascularization index value of the thyroid parenchyma in patients with Graves' disease was significantly higher than in the asymptomatic group [median (min-max); 12 (2.3-32.1) vs 5.04 (1.1-10.8), p <0.001]. When the cutoff value of the vascularization index is determined as 6.3, Graves' disease can be diagnosed with 83.8% sensitivity and 70% specificity. CONCLUSIONS:The vascularization index obtained with color superb microvascular imaging can be a quantitative indicator of parenchymal vascularity in the diagnosis of Graves' disease, and serve as a supportive tool.

Within 2 minutes intravenous anti-lung serum (ALS) into guinea pig induces a respiratory failure that is fatal within 30 min. The relationship between surfactant, alveolar-capillary permeability and respiratory failure was studied. Within two minutes ALS induced a leak in the alveolar-capillary barrier. Within 30 minutes 28.3% (controls, given normal rabbit serum: 0.7%) of iv 131I-albumin, and 0.5% (controls 0.02%) of iv surfactant phospholipid tracer were recovered in bronchoalveolar lavage. Furthermore, 57% (controls 32%) of the endotracheally administered surfactant phospholipid became associated with lung tissue and only less than 0.5% left the lung. The distribution of proteins and phospholipids between the in vivo small volume bronchoalveolar lavages and the ex vivo bronchoalveolar lavages were dissimilar: 84% (controls 20%) of intravenously injected, lavageable 131I-albumin and 23% (controls 18%) of total lavageable phospholipid were recovered in the in vivo small volume bronchoalveolar lavages. ALS also decreased lavageable surfactant phospholipid by 41%. After ALS the minimum surface tension increased. The supernatant of the lavage increased the minimum surface tension of normal surfactant. In addition, the sediment fraction of the lavage had slow surface adsorption, and a marked reduction in 35,000 and 10,000 MW peptides. Exogenous surfactant ameliorated the ALS-induced respiratory failure. We propose that inhibition, altered intrapulmonary distribution, and dissociation of protein and phospholipid components of surfactant are important in early pathogenesis of acute respiratory failure.

Type 2 diabetes (T2D) is a complicated public health problem in Turkey as well as worldwide. Genome-wide approaches have been guiding in very challenging situations, such as the elucidation of genetic variations underlying complex diseases such as T2D. Despite intensive studies worldwide, few studies have determined the genetic susceptibility to T2D in Turkish populations. In this study, we investigated the effect of genes that are strongly associated with T2D in genome-wide association (GWA) studies, including MTNR1B, CDKAL1, THADA, ADAMTS9 and ENPP1, on T2D and its characteristic traits in a Turkish population. In 824 nonobese individuals (454 T2D patients and 370 healthy individuals), prominent variants of these GWA genes were genotyped by real-time PCR using the LightSNiP Genotyping Assay System. The SNP rs1387153 C/T, which is located 28 kb upstream of the MTNR1B gene, was significantly associated with T2D and fasting blood glucose levels (P < 0.05). The intronic SNP rs10830963 C/G in the MTNR1B gene was not associated with T2D, but it was associated with fasting blood glucose, HbA1C and LDL levels (P < 0.05). The other important GWA loci investigated in our study were not found to be associated with T2D or its traits. Only the SNP rs1044498 (A/C variation) in the ENPP1 gene was determined to be related to fasting blood glucose (P < 0.05). Our study suggests, consistent with the literature, that the MTNR1B locus, which has a prominent role in glucose regulation, is associated with T2D development by affecting blood glucose levels in our population.

Purpose: In patients with uncontrolled type 2 diabetes mellitus (T2DM) on insulin therapy, increasing the insulin doses is most commonly preferred as the first choice to achieve glycaemic control. We evaluated the efficacy of initiating exenatide combination with oral antidiabetics (OAD) instead of insulin therapy. Materials and Methods: We examined all 61 uncontrolled T2DM patients had greater than 2 ng/ml C-peptide levels and were switched from insulin and metformin therapy to exenatide combination with OAD in the period of 2015 - 2017. For examination, the patients were divided into 3 groups according to their insulin regimen as basal insulin alone, biphasic insulin and basal-bolus insulin groups. The fasting blood glucose (FBG), HbA1c and C-peptide levels of the patients were recorded before and at the 6th month of treatment. Results: After the 6th month of the exenatide-based treatment, results show that the HbA1c levels were significantly lower than which had been evaluated before this treatment. By the end of the study, 14 of the 61 patients treated with exenatide and OAD achieved to decrease the HbA1c levels under 7.0%. FBG also decreased with the exenatide and OAD treatment. Conclusion: We demonstrated that in order to achieve glycaemic control, exenatide-based therapy could be a better therapeutic option than increasing insulin doses with insulin and metformin treatment in patients who have uncontrolled T2DM with insulin regimens.

Objective: Lipohypertrophy (LH) is one of the most common treatment-related cutaneous complications of injectable therapies. Although the etiology of LH cannot be clarified, it may be due to the lipogenic effect of insulin or recurrent tissue trauma caused by injections. In this respect, we aimed to evaluate the relationship between vitamin D level and LH. Material and Methods: Patients with Type 2 diabetes mellitus aged 18 years or older, who were under insulin and/or exenatide treatment for at least one year were included in this study. The injection sites of the patients were examined by inspection and palpation method. Patients were categorized into two groups according to vitamin D levels as below and above 20 ng/mL. Results: A total of 140 patients, including 91 women and 49 men, aged between 20-78 years with a mean age of 54.53 +/- 13.89 were included in the study. LH was detected in 91 (65%) of 140 patients. This study demonstrated that there was a significant relationship between gender and LH. Statistically, the frequency of LH was higher in female patients (p=0.001). Further, a relationship between vitamin D levels and LH was also observed (p=0.006). Conclusion: Besides calcium metabolism, the effects of vitamin D on lipogenesis are also known. Vitamin D inhibits the differentiation of pre-adipocytes to mature adipocytes. This is the first study showing the relationship between vitamin D and LH in our knowledge.

Amaç: İnsülin tedavisi altındaki kontrolsüz tip 2 diyabetes mellitus hastalarında glisemik kontrolü sağlamak için en sık tercih edilen yöntem insülin dozlarını arttırmaktır. Bu çalışmada, bu grup hastalarda insülin tedavisi yerine eksenatid ile oral antidiyabetik (OAD) kombinasyonunun etkisini değerlendirdik.Gereç ve Yöntem: 2015-2017 arasında, C-peptid düzeyleri 2 ng/ml’nin üzerinde olan, insülin ve metformin tedavisi altında kontrolsüz seyrederken eksenatid ve OAD tedavisine geçilen 61 hasta çalışmaya alındı. Hastalar kullandıkları insulin rejimlerine göre, sadece bazal insülin, bifazik insülin ve bazal-bolus insülin grubu olarak 3 gruba ayrıldı. Hastaların tedavi değişikliği öncesi ve tedavinin 6. ayında açlık kan şekerleri, HbA1c ve C-peptid düzeylerine bakıldı.Bulgular: Eksenatid bazlı tedavinin 6. ayında HbA1c düzeylerinde tedavi değişikliği öncesine göre anlamlı azalma görüldü. Çalışmanın sonunda, eksenatid ve OAD tedavisi alan 61 hastanın 14’ünde HbA1c değeri %7’nin altına düştü. Eksenatid ve OAD tedavisiyle açlık kan şekerinde de azalma görüldü.Sonuç: Bu çalışmada insülin ve metformin tedavisi altındayken kontrolsüz seyreden T2DM hastlarında eksenatid bazlı tedaviye geçişin glisemik kontrolü sağlamakta insülin dozunu arttırmaktan daha iyi bir tedavi seçeneği olduğunu gösterdik.