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    Hyperbaric oxygen treatment augments the efficacy of a losartan regime in an experimental nephrotic syndrome model
    (2006) Yilmaz M.I.; Korkmaz A.; Kaya A.; Sonmez A.; Caglar K.; Topal T.; Eyileten T.; Yenicesu M.; Acikel C.; Oter S.; Yaman H.; Aktug H.; Oguz Y.; Vural A.; Ikizler T.A.
    Background/Aims: Proteinuria is associated with oxidant stress and inflammation. Hyperbaric oxygen (HBO) treatment has anti-inflammatory and anti-oxidant effects. The aim of the study was to investigate the benefits of HBO treatment on an experimental nephrotic syndrome model. Methods: 50 male Sprague-Dawley rats weighing 255 ± 39 g were housed. Forty rats were injected 6 mg/kg adriamycin into tail veins under anesthesia to induce nephrosis, while 10 rats were spared as sham control. After the stabilization of proteinuria at the sixth week, the rats were treated for 6 weeks by losartan (n = 10, 30 mg/kg/day), HBO (n = 10, 2.8 atmosphere absolute, 90 min/day), HBO + losartan (n = 10) and vehicle (n = 10). Protein carbonyl (PCO), superoxide dismutase (SOD) and glutathione peroxidase (GPx) were analyzed from tissue specimens. Biochemical markers were studied from venous samples and 24-hour urine was collected for proteinuria. The surviving animals at 12 weeks (vehicle group (n = 6), HBO (n = 6), losartan (n = 8), HBO + losartan (n = 10) were sacrificed. Glomerular sclerosis, tubulointerstitial and blood vessel changes were determined by semiquantitative scoring. Results: The PCO levels increased (p < 0.001), and the GPx and SOD levels decreased (p < 0.001 for both) in the nephrotic rats. In losartan and HBO groups GPx levels increased (p = 0.001, p = 0.002 respectively), but PCO and SOD levels did not change. The combination of HBO with losartan significantly increased the GPx and SOD levels (p = 0.001 for both) and decreased PCO levels (p = 0.005). HBO but not losartan significantly reduced proteinuria (p < 0.001). The combination of HBO and losartan reduced proteinuria better than the single losartan regime (p < 0.001). The effect of the combination was also noticed on the histological examination of the kidneys. The activities, appetites, weight gains, and improvement of edema were better in the HBO combined with losartan regime. Conclusions: These results indicate that the addition of HBO therapy to a conventional regime, angiotensin receptor blockers, has significant benefits in the management of proteinuria. Future clinical studies are needed to elucidate the role of HBO and other antioxidant strategies in the treatment of proteinuria. Copyright © 2006 S. Karger AG.
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    Turkish nationwide survEy of glycemic and other Metabolic parameters of patients with Diabetes mellitus (TEMD study)
    (Elsevier Ireland Ltd, 2018) Sonmez A.; Haymana C.; Bayram F.; Salman S.; Dizdar O.S.; Gurkan E.; Kargili Carlıoglu A.; Barcin C.; Sabuncu T.; Satman I.; Guldiken S.; Ayturk S.; Yilmaz M.; Asik M.; Dinccag N.; Cakmak R.; Turker F.; Idiz C.; Hacisahinogullari H.; Bagdemir E.; Yildiz B.; Yumuk V.D.; Haliloglu O.; Sancak S.; Ozsari L.; Cagiltay E.; Deyneli O.; Imre E.; Gonen S.; Boysan S.N.; Altuntas Y.; Ozturk F.Y.; Mert M.; Piskinpasa H.; Aydin H.; Imamoglu S.; Ersoy C.; Gul O.O.; Kucuksarac Kiyici S.; Cetinarslan B.; Selek A.; Dogru T.; Kirik A.; Kebapci N.; Efe B.; Kaya A.; Cordan I.; Baldane S.; Kirac C.O.; Demirci I.; Capa Z.; Cesur M.; Yetkin I.; Corapcioglu D.; Canlar S.; Bulent Yildiz O.; Sendur S.N.; Cakir B.; Ozdemir D.; Corakci A.; Kutlu M.; Bascil Tutuncu N.; Bozkus Y.; Cakal E.; Demirbas B.; Ertek S.; Altay M.; Dagdeviren M.; Abedi A.H.; Cetinkalp S.; Ozisik H.; Oruk G.G.; Yener S.; Saydam B.O.; Guney E.; Unubol M.; Yaylali G.F.; Topsakal S.; Hekimsoy Z.; Akbaba G.; Aslan I.; Balci M.K.; Dalkiran S.; Akbay E.; Gul K.; Agbaht K.; Yilmaz M.O.; Bozkirli E.; Tetiker B.T.; Cetinkaya Altuntas S.; Atmaca A.; Durmuş E.T.; Mete T.; Kutluturk F.; Kucukler F.K.; Dikbas O.; Akin S.; Nuhoglu I.; Ersoz H.O.; Bayraktaroglu T.; Sisman P.; Sahin I.; Cetin S.; Capoglu I.; Akbas E.M.; Ucler R.; Eren M.A.; Tuzcu A.K.; Pekkolay Z.; Ozkaya M.; Araz M.; on behalf of the TEMD Study Group
    Aims: Turkey has the highest prevalence of diabetes in Europe. It is therefore essential to know the overall cardiovascular risk and reveal the predictors of metabolic control in Turkish adults with diabetes mellitus. Methods: A nationwide, multicenter survey consecutively enrolled patients who were under follow up for at least a year. Optimal control was defined as HbA1c < 7%, home arterial blood pressure (ABP) < 135/85 mmHg, or LDL-C < 100 mg/dL. Achieving all parameters indicated triple metabolic control. Results: HbA1c levels of patients (n = 5211) were 8.6 ± 1.9% (71 ± 22 mmol/mol) and 7.7 ± 1.7% (61 ± 19 mmol/mol), in Type 1 and Type 2 diabetes, respectively. Glycemic control was achieved in 15.3% and 40.2%, and triple metabolic control was achieved in 5.5% and 10.1%, respectively. Only 1.5% of patients met all the criteria of being non-obese, non-smoker, exercising, and under triple metabolic control. Low education level was a significant predictor of poor glycemic control in both groups. Conclusions: Few patients with Type 2, and even fewer with Type 1 diabetes have optimal metabolic control in Turkey. TEMD study will provide evidence-based information to policy makers to focus more on the quality and sustainability of diabetes care in order to reduce the national burden of the disease. © 2018 Elsevier B.V.
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    Utilization of statins and LDL-cholesterol target attainment in Turkish patients with type 2 diabetes - a nationwide cross-sectional study (TEMD dyslipidemia study)
    (BioMed Central Ltd, 2020) Bayram F.; Sonmez A.; Haymana C.; Sabuncu T.; Dizdar O.S.; Gurkan E.; Carlioglu A.K.
    Background: Attaining acceptable levels of LDL Cholesterol (LDL-C) significantly improves cardiovascular (CV) outcomes in patients with type 2 diabetes mellitus (T2DM). The LDL-C target attainment and the characteristics of patients attaining these targets were investigated in this study. Furthermore, the reasons for not choosing statins and the physicians’ attitudes on the treatment of diabetic dyslipidemia were also examined. Methods: A nationwide, cross-sectional survey was conducted in tertiary centers for diabetes management. Adult patients with T2DM, who were under follow-up for at least a year in outpatient clinics, were consecutively enrolled for the study. LDL-C goals were defined as below 70 mg/dL for patients with macrovascular complications or diabetic nephropathy, and below 100 mg/dL for other patients. Data about lipid-lowering medications were self-reported. Results: A total of 4504 patients (female: 58.6%) were enrolled for the study. The mean HbA1c and diabetes duration was 7.73 ± 1.74% and 10.9 ± 7.5 years, respectively. The need for statin treatment was 94.9% (n = 4262); however, only 42.4% (n = 1807) of these patients were under treatment, and only 24.8% (n = 448) of these patients achieved LDL-C targets. The main reason for statin discontinuation was negative media coverage (87.5%), while only a minority of patients (12.5%) mentioned side effects. Physicians initiated lipid-lowering therapy in only 20.3% of patients with high LDL-C levels. It was observed that the female gender was a significant independent predictor of not attaining LDL-C goals (OR: 0.70, 95% CI: 0.59–0.83). Conclusions: Less than 50 % of patients with T2DM who need statins were under treatment, and only a quarter of them attained their LDL-C targets. There exists a significant gap between the guideline recommendations and the real-world evidence in the treatment of dyslipidemia in T2DM. © 2020, The Author(s).