Evaluation of the blood glucose regulation and the metabolic control status of the diabetic patients who was followed in endocrinology clinic

Introduction: Diabetes mellitus (DM) is a common and chronic disease and due to its complications, progressive pattern and high cost of the treatment it is concerning the whole society. The delay in the diagnosis and treatment reduces patients? quality of life, causes labor and economic loss and also leads to irreversible sequelae and shortening of the survival. The main goal in diabetes is to delay and prevent subsequent complications by increasing the life quality of the patients. To be successful in the treatment of diabetes, as well as the new drugs and technological developments, the recognition of the target population and identification of the clinical and demographic characteristics are also important. Our aim in this study was to create demographic information of our clinic in DM patients and by using these data is to determine and organize the patients education, follow-up and treatment priorities.Material-Method: 500 diabetic patients those admitted to endocrinology clinic of Duzce University Faculty of Medicine between January 2010-December 2010 and who had diagnosed as diabetes for at least 6 months and routinely follow upped at intervals of 3-months were included in the study and their physical examination, laboratory, treatment datas were retrospectively reviewed. Patients; age, gender, height, weight, body mass index (BMI), diabetes type, duration of diabetes, antidiabetic treatment modalities, medication side effects, microvascular-macrovascular complications of diabetes, additional diseases other than diabetes were recorded. On the day of admission patients; fasting blood glucose (FBG), postprandial blood glucose (PBG), and glycated hemoglobin (HbA1c), creatinine, thyroid-stimulating hormone (TSH), albumin/creatinine ratio or 24-hour urine proteinuria, electrolytes (Na, K), uric acid and lipid parameters were recorded. For statistical analysis, independent Student's t test, one-way ANOVA (one-way analysis of variance) test, post hoc Tukey test, and likelihood chi-square test were used.Results: In research group, 39.6% of the patients were male and 60.4% were female, mean age was 56.6±11.8 years. Mean BMI was 31.7±6.9. While there was Type 1 DM in 14 (%2.8) of the patients, 484 (97.2%) of them had Type 2 DM. Mean disease duration of the patients was 9.3±7.3 years in Type 1 and 8.1±7.2 years in Type 2 DM. 20% of the patients were being treated with insulin, 26.5% of them with insulin and oral antidiabetic (OAD) and 53.5% of them with only OAD. There was a significant relationship between the form of the treatment and duration of the diabetes in patients (p<0.001). In OAD-treated patients, median duration of the diabetes was 5.1±5.0 years. It was found as when the duration of diabetes increased, the usage of insulin was also increased. When the late complications of diabetes were investigated; 31.9% retinopathy, 50.6% neuropathy, 37.1% nephropathy, in terms of atherosclerotic changes; 70.8% hypertension (HT), 69.8% hypercholesterolemia (HL) was detected. Complications were seen less in patients receiving OAD treatment (63.4%) whereas there was chronic complications of diabetes in %85 of the patients who were receiving insulin or insulin and OAD treatments. Complicaton rates were increasing with advancing age (p<0,001) and longer duration of diabetes (p<0,001). Metabolic control of 68% of the patients were assessed as poor, while 32% of them were assessed as well. The mean HbA1c value was 8.1±2.0. As the duration of diabetes prolonged, the rates of well metabolic controlled patients was decreased (P<0.001). Metabolic control of the insulin users was worse than those using other methods of treatment (p<0.001).Conclusion: These findings shows that metabolic control levels and follow-ups of diabetic individuals are generally poor. In diabetic individuals there is numerous medical and social factors that affect metabolic control so both of the patients and health personnel should give adequate consideration to this matter. To be successful in the treatment of diabetes, as well as the new drugs and technological developments, the recognition of the target population and identification of the clinical and demographic characteristics are also important.