To evaluate the prevalence and types of potentially inappropriate prescriptions (PIP) in hospitalized older adults and to study whether PIP was a causative factor for index hospitalization, using the Turkish Inappropriate Medication Use in oldEr adults (TIME) criteria. This multicenter, cross-sectional study included 405 inpatients aged ≥60 years from 13 tertiary hospital departments in Turkiye between January 2020 and April 2021. PIP were assessed using TIME criteria, which include both potentially inappropriate medications, PIM (TIME-to-STOP) and potential prescribing omissions, PPO (TIME-to-START). Following the completion of medical history taking, physical examination, and comprehensive geriatric assessment (CGA), managing physicians evaluated each criterion individually. Based on clinical adjudication, they determined whether any PIM or PPO predefined in the TIME criteria could plausibly have contributed to the hospitalization. The prevalence of PIP was 82.5

This nationwide study assessed clinical features of osteoporosis in Turkish adults with diabetes. Osteoporosis prevalence was 9.36

Depression is a common but underrecognized comorbidity in individuals with diabetes and is associated with adverse clinical outcomes. This nationwide study aimed to determine the prevalence of clinically relevant depression (CRD) among adults with type 1 and type 2 diabetes in Türkiye and to identify clinical and metabolic factors independently associated with CRD. This cross-sectional analysis was conducted within the Turkish nationwide survEy of glycemic and other Metabolic parameters of patients with Diabetes mellitus-2 (TEMD-2), a multicenter study including adults followed in tertiary endocrinology centers across Türkiye. CRD was defined as a Patient Health Questionnaire-9 score ≥ 10 and/or current antidepressant use. A total of 5.266 patients were included. The prevalence of CRD was similar in type 1 and type 2 diabetes (29.4

AIM:Five years after the first "Turkish nationwide survEy of glycemic and other Metabolic parameters of patients with type 2 Diabetes" (TEMD-1), attainment of glycemic, arterial blood pressure (ABP), and LDL-cholesterol (LDL-C) goals was re-investigated in patients with type 2 diabetes mellitus (T2DM), with an additional focus on therapeutic inertia. METHODS:This cross-sectional study consecutively enrolled patients from 70 tertiary endocrine centers across Türkiye (November 2022-January 2023). Metabolic targets were HbA1c <7% (<53 mmol/mol), home ABP <135/85 mmHg, and risk-stratified LDL-C <55, <70, or <100 mg/dL (<1.4, <1.8, or <2.6 mmol/L). Therapeutic inertia was defined as failure to intensify treatment at enrollment. RESULTS:Among the 4956 participants (mean age: 58.9 ± 10.0 years, women: 59.8%), HbA1c, ABP, LDL-C and triple metabolic control target attainment rates were 36.7%, 71.1%, 8.7%, and 2.8%, respectively. Glycemic control rate was found lower than the previous survey (40.0% vs. 36.7%, p < 0.001), while LDL-C control rate improved (7.0% vs. 8.7%, p = 0.002). Patients with established cardiovascular disease (CVD) showed worse outcomes, with triple metabolic control rate of 1.6%. The rate of severely uncontrolled diabetes (HbA1c >9%/75 mmol/mol) was 23.6%. Therapeutic inertia was observed by 33.5%, persisting uniformly across subgroups. Younger age, male sex, longer diabetes duration, lower socioeconomic status, and microvascular complications were independently associated with poor glycemic control. CONCLUSIONS:Metabolic control remains suboptimal in Turkish T2DM patients, and one-third of patients with severe hyperglycemia showed therapeutic inertia. Systematic interventions and intensified strategies are urgently needed to improve diabetes outcomes and treatment inertia (ClinicalTrials.gov number NCT06347445).

Introduction: Türkiye has the highest obesity prevalence in Europe. Obesity not only causes type 2 diabetes mellitus (T2DM) but also impairs glycemic control in patients with T2DM. There is insufficient information about the demographic and clinical differences between individuals with T2DM who are living with or without obesity. The second TEMD survey across Türkiye investigated the latest overweight and obesity prevalence in patients with T2DM. The present study evaluated the 5-year changes in the prevalence, factors associated with an obesity diagnosis, and the association between obesity and metabolic control. METHODS:Patients under follow-up in tertiary units specialized for diabetes care were consecutively enrolled. The sociodemographic, anthropometric, and clinical variables were recorded. Metabolic targets were defined as hemoglobin A1c <7%, home arterial blood pressure <135/85 mm Hg, or low-density lipoprotein cholesterol <100 mg/dL or <70 mg/dL or <55 mg/dL according to the risk factors or complications of patients. Metabolic target attainment rates were investigated across normal-weight, overweight, and obesity body mass index (BMI) classes. RESULTS:The TEMD Obesity Study enrolled 4,935 patients with T2DM (age 58.9 ± 10.1 years; women 59.8%). The prevalence of overweight and obesity was 33.4% and 55.1%, respectively. Obesity was more frequent in women with T2DM than men (66.2% vs. 38.1%; p ≤ 0.001). From 2017 to 2022, the obesity rate decreased from 59.0% to 55.1%, while the overweight rate increased from 31.0% to 33.4%. As BMI class increased, the achievement of three metabolic targets decreased while the incidence of microvascular complications rose. Significant associations were found between obesity and sociodemographic characteristics (age, sex, education level) and lifestyle measures (diet, exercise, smoking) in multivariable logistic regression analysis. CONCLUSION:The TEMD Obesity study showed a decrease in obesity rates among patients with T2DM between 2017 and 2022. Also, the findings suggest that obesity poses an important barrier to the achievement of metabolic goals. .

OBJECTIVE:To investigate the Mitochondrial Open Reading Frame of the 12S rRNA type-c (MOTS-c) peptide levels in individuals with obesity compared to those with a normal body mass index and to examine the association of MOTS-c levels with markers of insulin resistance, endothelial function, and inflammation. METHODS:In this study 85 individuals were enrolled, including 48 with a body mass index ≥ 30 kg/m2 and 37 with a body mass index between 18.5 and 24.9 kg/m2. Individuals with smoking, pregnancy, type 2 diabetes mellitus and other chronic conditions were excluded. Blood samples were collected after at least 8 hours of fasting to measure serum MOTS-c, insulin, high-sensitivity C-reactive protein, and asymmetric dimethylarginine levels. Statistical analyses included t-tests, Mann-Whitney U tests, Chi-squared tests, correlation analyses, and multiple regression analyses. RESULTS:We found no significant difference in serum MOTS-c levels between individuals with obesity and those with normal body mass index (14.33 ± 3.76 pg/mL versus 13.67 ± 3.44 pg/mL; p = 0.395). Serum MOTS-c levels showed a significant positive correlation with the HOMA-IR index (p < 0.05) but did not correlate with high-sensitivity C-reactive protein or asymmetric dimethylarginine levels. Multiple regression analysis indicated that age and HOMA-IR were significant predictors of MOTS-c levels, with MOTS-c decreasing with age and increasing with higher insulin resistance. CONCLUSION:Serum MOTS-c levels were similar in individuals with obesity and those with normal weight. The study highlighted age and insulin resistance as significant determinants of MOTS-c levels.

Objective: Cushing's syndrome increases the risk of cardiovascular disease. The triglyceride-glucose (TyG) index has been linked to an increased risk of cardiometabolic disorders. Whether patients with non-functioning adrenal incidentaloma (NFAI) or cortisol-secreting adrenal incidentaloma (CSAI) have altered TyG index is unknown. Therefore, we aimed to investigate the TyG index between adrenal incidentaloma patients and controls. Materials and methods: This cross-sectional study retrospectively included patients with NFAI, CSAI and healthy controls admitted to a tertiary endocrinology service. Subjects receiving hormone replacement, or having cancer, diabetes mellitus, alcoholism, psychiatric disorders, hepatic and/or renal insufficiency or morbid obesity were excluded. TyG index was calculated using the following formula: (Ln [fasting triglyceride (mg/dL) x fasting glucose (mg/dL)]/2). The primary endpoint was the difference in TyG index between patients with NFAI, CSAI and healthy controls. Results: A total of 142 patients with incidentaloma [NFAI, n=95, age: 60.9 +/- 10.6 years, women: 75.8%; CSAI, n=47, age: 59.6 +/- 13.7 years, women: 63.8%] and 116 age and sex matched healthy controls (age: 59.8 +/- 13.4 years, women: 76.7%) were evaluated. Compared with healthy controls, patients with overall incidentaloma, NFAI and CSAI had increased TyG index (6.39 +/- 1.87 vs. 8.85 +/- 0.52, 8.76 +/- 0.25, and 8.81 +/- 0.51, respectively, P<0.001 for all). There was no difference in TyG index between patients with NFAI and CSAI (8.76 +/- 0.25 vs. 8.81 +/- 0.51), and with possible autonomous cortisol secretion, autonomous cortisol secretion and Cushing's syndrome (8.80 +/- 0.54, 8.86 +/- 0.52 and 9.31 +/- 0.37). Conclusion: This study showed increased TyG index in patients with NFAI or CSAI, emphasizing the importance of cardiometabolic risk assessment in patients with adrenal incidentaloma even if it is non-functioning.

The relationship between sedentary lifestyle and chronic diseases is well known. This study examined the prevalence and factors associated with reduced physical activity (PA) among internal medicine inpatients on admission. In this single-center, cross-sectional study, inpatients aged 50 years or older were prospectively enrolled at a tertiary care facility in Ankara, Türkiye. PA was assessed using the International Physical Activity Questionnaire (IPAQ). Care and performance indicators, quality of life (EQ-5D 3L), nutritional status, timed up-and-go test, muscle strength, and cognitive status were assessed. Participants were classified into 3 groups of PA levels as low, moderate, and high. Study end points were the prevalence of low PA level and associated factors. Of the 240 participants (mean age: 62.7 ± 8.0 years; women: 50

Background and aims: Familial hypercholesterolemia (FH) is the most common cause of premature atherosclerotic cardiovascular disease (ASCVD). Turkiye is among the countries with the highest rate of ASCVD. However, no population-based study has been published so far on the prevalence of FH, demographic and clinical characteristics, burden of ASCVD, treatment compliance, and attainment of low-density lipoprotein cholesterol (LDL-C) targets. Methods: We performed a study using the Turkish Ministry of Health's national electronic health records involving 83,063,515 citizens as of December 2021 dating back 2016. Adults fulfilling the diagnostic criteria of definite or probable FH according to the Dutch Lipid Network Criteria (DLNC), and children and adolescents fulfilling the criteria of probable FH according to the European Atherosclerosis Society (EAS) Consensus Panel report formed the study population (n = 157,790). The primary endpoint was the prevalence of FH.Results: Probable or definite FH was detected in 0.63% (1 in 158) of the adults and 0.61% (1 in 164) of the total population. The proportion of adults with LDL-C levels >4.9 mmol/L (190 mg/dL) was 4.56% (1 in 22). The prevalence of FH among children and adolescents was 0.37% (1 in 270). Less than one-third of the children and adolescents, and two-thirds of young adults (aged 18-29) with FH were already diagnosed with dyslipidaemia. The proportion of adults and children and adolescents on lipid-lowering treatment (LLT) was 32.1% and 1.5%, respectively. The overall discontinuation rate of LLT was 65.8% among adults and 77.9% among children and adolescents. Almost no subjects on LLT were found to attain the target LDL-C levels.Conclusions: This nationwide study showed a very high prevalence of FH in Turkiye. Patients with FH are diagnosed late and treated sub-optimally. Whether these findings may explain the high rates of premature ASCVD in Turkiye needs further investigation. These results denote the urgent need for country-wide initiatives for early diagnosis and effective management of FH patients.

Aims:The evaluation of swallowing in the palliative care (PC) unit (PCU) is an important indicator of care. In this study, we investigated how an on-admission swallowing test in the PCU guides the course of the feeding route.Methods:This single-center, retrospective study included PC patients who underwent bedside swallowing evaluation. The main exclusion criteria were gastrointestinal failure requiring permanent parenteral nutrition, no swallowing test upon admission, and a length of stay shorter than four days. The primary endpoint was the proportion of patients with dysphagia who transitioned to oral feeding.Results:The study included 63 patients [age, median interquartile range: 80.0 (14) years (37 to 94 years); males: 54.0%]. Thirty-six (57.1%) of 63 admissions had dysphagia, whereas 27 (42.9%) patients had no dysphagia. The route of feeding was modified in 50.8% of the samples during their PCU stay. The proportion of patients who returned to oral feeding was 30.2% (n=19), whereas 6.3% (n=4) and 12.7% (n=8) of the sample underwent nasoenteral tube and percutaneous endoscopic gastrostomy (PEG) placement, respectively. Among the 32 patients who were on tube feeding on admission, 12 (37.5%) returned to oral feeding during their PCU stay. Seven (58.4%) of these subjects who regained oral feeding were on nasoenteral tube feeding and 5 (41.6%) were on PEG feeding on admission.Conclusions:This study showed a high rate of dysphagia on admission to the PCU. On the other hand, safe and adequate oral feeding could be re-initiated in almost one-third of patients with dysphagia on admission.

Background: Although distinct disorders, peripheral vascular disease (PVD) and dementia are both associated with a progressive decline in activities of daily living in elderly patients. Objective: This study aimed to compare the functional performance scores between elderly patients with and without dementia and with or without PVD. Methods: Patients with Alzheimer’s disease, vascular dementia, and mixed type dementia and controls were prospectively enrolled. Functional performance scores for basic activities of daily living (BADL) and instrumental activities of daily living (IADL) were evaluated using the Barthel scale and Lawton scale, respectively. PVD was diagnosed using the ankle brachial index (ABI). Results: Controls without PVD were age- and sex-matched with 57 patients with both dementia and PVD and with 69 patients without dementia. The patients with PVD in both groups had lower mean BALD scores. Adjusting for age, clinical dementia rating, and depression, PVD was associated with a higher likelihood of being in the quartiles of lower BADL scores in those with dementia (p=0.020). Adjusting for age, sex, Mini-Mental State Examination (MMSE) score, depression, and comorbidity and drug counts among the patients without dementia, a significant association was observed with PVD and a higher likelihood of being in the quartiles of lower BADL scores (p=0.044). PVD was related to a higher likelihood of being in the quartiles of lower IADL scores in the non-dementia subjects (p=0.001) after adjusting for age, depression, MMSE, education, and comorbidity count. Conclusion: PVD presence determined the poorer status of BADL in demented individuals but not of the level of IADL. It is still unclear whether modifying PVD health risks and undergoing ABI screening may help demented people become more independent.

The aim of this study was to explore the prevalence of geriatric syndromes and comorbid conditions, as well as their interrelationships, in individuals aged 90 years and over.

Mycobacterium tuberculosis (TB) is an infectious agent that can affect several organ systems and can cause various symptoms. The most common presentation is pulmonary TB. The incidence of extrapulmonary TB has become much more common worldwide due to the more frequent use of long-term immunosuppressive treatment for various indications. Examples include but are not limited to human immunodeficiency virus infection, organ transplantation, and rheumatic, hematologic, gastrointestinal, and dermatologic inflammatory conditions. Osteoarticular involvement is the third most common presentation of TB after the lung and lymph nodes, accounting for approximately 10-20% of all cases of extrapulmonary disease. The joint involvement is generally monoarticular and progresses insidiously. Skeletal TB mostly involves weight-bearing joints such as the hip and knee. Wrist involvement is rarely encountered and accounts for only 1% of skeletal TB. Herein, we describe a rare involvement of musculoskeletal TB in a renal transplant recipient.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

To which extent the pre-existing hypothyroidism or hyperthyroidism has an impact on coronavirus infection 2019 (COVID-19) outcomes remains unclear. The objective of this study was to evaluate COVID-19 morbidity and mortality in patients with pre-existing thyroid dysfunction. A retrospective cohort of patients with a polymerase chain reaction (PCR)-confirmed COVID-19 infection (n=14 966) from March 11 to May 30, 2020, was established using the database of the Turkish Ministry of Health. We compared the morbidity and mortality rates of COVID-19 patients with pre-existing hypothyroidism (n=8813) and hyperthyroidism (n=1822) to those patients with normal thyroid function (n=4331). Univariate and multivariate regression analyses were performed to identify the factors associated with mortality. Mortality rates were higher in patients with hyperthyroidism (7.7%) and hypothyroidism (4.4%) than those with normal thyroid function (3.4%) (p<0.001 and p=0.008, respectively). Pre-existing hyperthyroidism was significantly associated with an increased risk of mortality (OR 1.54; 95% CI, 1.02-2.33; p=0.042) along with advanced age, male gender, lymphopenia and chronic kidney disease (p<0.001 for all). Although a potential trend was noted, the association between pre-existing hypothyroidism and mortality was not significant (OR 1.36; 95% CI, 0.99-1.86; p=0.055). In conclusion, this study showed an association between pre-existing hyperthyroidism with higher COVID-19 mortality. A potential trend towards increased mortality was also observed for hypothyroidism. The risk was more pronounced in patients with hyperthyroidism.

Objective: Pressure ulcers (PU) are common in patients admitted to palliative care clinics (PCC). Pregressive nutritional deficiency, incontinence, and limitation of movement increase the risk of new PU formation. Purpose: To examine the risk of PU in patients hospitalized in PCC andthe rate of wounds on admission. Materials and Methods: We retrospectively analyzed patients hospitalized between 2017 and 2019 in a PCC integrated into a tertiary health institution. Patients with demographic and clinical data, data on the region, number, and stage of PU, and Norton and Braden pressure risk scores were enrolled. Patients with scores 11 on the Norton scale and 18 on the Braden scale were considered to be at higher risk for PU. Results: The final analysis included 566 patients [mean age: 68 years, male: 328 (58%)]. On admission, PU was recorded in 181 patients (32%) (sacrum: 80%). According to the Norton scale, 269 (47.5%) of all cases were under the risk of PU and 48.7% (n=131) of them already had PU. According to the Braden scale, 475 (83.9%) patients were at risk of PU, and 37.5% (n=178) of them already had PU. Among subjects with a low Norton score (n=297), 16% (n=50) already had PUs. Among subjects with PUs, the Norton score was not high 27.6%. Only 3.3% (n=3) of 91 patients whose Braden score was not low already had a PU. The sensitivity and specificity of the Norton score in the prediction of PU were 48.9% and 83.2%, respectively. The sensitivity and specificity of the Braden score in the prediction of PU were 66.9% and 99.0%, respectively. Conclusion: Physical PU examination on admission to PCC and during follow-up can identify a significant number of cases. The utility of Norton and Braden scores to estimate the occurrence of PUs may be limited in the palliative care setting or patients.

Objective: This study aims to assess the sensitivity and specificity of ankle-brachial index (ABI) measurements in diagnosing peripheral artery disease (PAD) among a cohort of Turkish subjects, with angiography serving as the reference standard. Material and Methods: In this single-center, cross-sectional and observational study, subjects who had an aorta and lower extremity arterial imaging by angiography subsequently underwent an ABI measurement. Anthropometric measurements, cardiovascular risk factors, and blood biochemistry data were recorded. Sensitivity and specificity analyses were performed for a low ankle-brachial index (ABI ≤ 0.9), with angiography as the reference standard. Results: A total of 57 patients (age: 59.1±15.9, male/female: 47/10) were included. Diabetes mellitus, coronary artery disease and cerebrovascular disease were present in 40.4%, 42.1% and 15.8% of the participants, respectively. Three or more cardiovascular risk factors were present in 54.4%. The angiographic diagnostic method was computed tomography angiography in 57.9%, digital subtraction angiography in 38.6%, and magnetic resonance angiography in 3.5% of the subjects. The presence of PAD on angiography was documented in 55 of 57 participants. The calculated mean ABI value was 0.6±0.2 in the overall group, and a low ABI (≤0.9) was found by 82.5% (n = 47). Compared to angiography, the low ankle-brachial index (ABI) test demonstrated a sensitivity of 83.6% and a specificity of 50%. The positive predictive value of 97.9% was calculated. When an ABI≤0.95 was used as the diagnostic threshold, the sensitivity of the ABI test increased to 90.9%. Conclusion: Our study confirms the reliability of ABI measurements as a diagnostic method for lower extremity peripheral artery disease (PAD) when compared to angiographic techniques, the gold standard. Establishing a higher cut-off value (≤0.95) may enhance the diagnostic performance of the test in Turkish patients.

OBJECTIVE:Mitochondrial open reading frame of the 12s ribosomal RNA type-c (MOTS-c) is a novel identified mitochondrial signal transmission peptide that plays an important role in glucose, amino acid and lipid metabolism. In this study, we aimed to investigate the relationship of circulating MOTS-c level with noninvasive scores of fibrosis and the components of metabolic syndrome (MetS) in patients with metabolic dysfunction-associated fatty liver disease (MAFLD).PATIENTS AND METHODS:This was a single-center cross-sectional study, and the participants were divided into two groups based on their liver ultrasound results: the fatty liver group and the healthy control group. The MOTS-c level was measured by the ELISA method. Non-alcoholic fatty liver disease fibrosis score (NFS) and fibrosis 4 (FIB-4) were used to determine the level of liver fibrosis. Statistical analyses were performed using Statistical Package for Social Science 15.0 package program.RESULTS:One hundred fifty patients (male, n=57) with MAFLD [median age 41.0 (14) years] and 84 healthy controls (male, n=34) [median age 36.0 (22) years] were included in this study. Patients with MAFLD had significantly lower MOTS-c levels than the healthy controls (p=0.009). The MOTS-c level was significantly lower in subjects with MetS (n=48) compared to those without MetS (n=186) (p=0.01). In the total population (n=234), MOTS-c levels negatively correlated with the presence of MAFLD, NFS, FIB-4, and components of MetS.CONCLUSIONS:Individuals diagnosed with MetS and MAFLD tend to have lower levels of MOTS-c. Additionally, these lower levels are inversely correlated with both the components of MetS and noninvasive fibrosis scores. MAFLD negatively correlated to the MetS components and noninvasive scores of fibrosis.

To the Editor, In a recent issue of the Journal of Diabetes Investigation, Tanaka et al. reported valuable findings regarding the relationship of metabolic dysfunction-associated fatty liver disease (MAFLD) and fatty liver index (FLI) with fatty acid binding protein 4 (FABP4) in middle-aged and older adults. This study expanded the overall understanding of the association of hepatosteatosis with altered cytokine production and the independent predictors ofMAFLD. However, we would like to address some issues that need clarification. We appreciate the efforts of the authors to comprehensively control for some potential confounders. Nevertheless, the physical activity level and renal function that could influence the adjusted analyses were not taken into consideration. Exercise confers a clear benefit on preventing or delaying the development of chronic diseases. The beneficial effect of exercise occurs in part through changes in the adipose tissue, namely by promoting anti-inflammatory cytokines and reducing proinflammatory cytokines. A follow-up study showed that the circulating FABP concentrations decreased after 3 months of exercise therapy with improving body composition and metabolic parameters in obese women. Another point we would like to discuss is the relationship of serum FABP4 level with renal function. A prospective study of participants with type 2 diabetes mellitus showed that an elevated serum FABP level was a predictor for adverse renal outcomes over a median follow-up of 5 years. The serum FABP4 level was significantly elevated in parallel with a reduced estimated glomerular filtration rate in patients with chronic kidney disease. The FABP4 levels were also shown to be highly dependent on kidney function in an experimental model. In addition, elevated urinary FABP4 was significantly associated with the progression of renal dysfunction. As noted in the current article, the mean age of the participants was 65 – 15 years, suggesting that the study consisted of a significant number of older subjects. The prevalence of chronic kidney disease is significantly increased in older adults with advancing age and may be encountered earlier in subjects with MAFLD. In conclusion, the authors have demonstrated a relationship between MAFLD and serum FABP4 level through rigorous research. However, the conclusions would be wiser if the authors could provide further adjusted data on physical activity and renal function. Consideration of confounders that have clinical impacts may also be helpful in the development of novel therapeutic actions.