Diyabetik hasta profilimiz ve hemoglobin A1c ile hemogram testindeki inflamatuar belirteçlerin ilişkisi
Küçük Resim Yok
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Karabük Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu tez çalışmasında, hastanemize başvuran, diyabet tanısı olan ve diyabet ilaç raporu düzenlenmiş hasta verilerini incelemeyi amaçladık. Hastaların demografik özellikleri, diyabete eşlik eden hastalıklar, kullandıkları ilaçlar, glikolize hemoglobin A1c (HbA1c) düzeyleri ve bazı kan parametreleri retrospektif olarak değerlendirildi. HbA1c düzeyi ile inflamatuar parametreler olan nötrofil/lenfosit oranı (NLR), platelet/lenfosit oranı (PLR), ortalama platelet hacmi (MPV) ve eritrosit dağılım genişliği (RDW) arasında ilişki olup olmadığı değerlendirilerek, HbA1c ölçümüne göre daha basit ve maliyet etkin olan bu parametrelerin prediktif bir tanı testi olarak kullanılıp kullanılamayacağı araştırıldı. Gereç ve Yöntem: Karabük Üniversitesi Tıp Fakültesi Eğitim ve Araştırma Hastanesi iç hastalıkları ve aile hekimliği polikliniklerine 01.01.2019-31.03.2020 tarihleri arasında başvuran 2.252 diyabetik hasta verisi retrospektif olarak incelendi. Hasta seçimi, hastane otomasyon sistemi üzerinden Uluslararası Hastalık Sınıflandırması (ICD-10-İnternational Classification of Disease) kodları taranarak yapıldı. ICD-10 kodlamasına göre DM tanı kodu olan E10.0-E10.9, E11.0-E11.9 ile arama işlemi yapılarak tespit edildi Hastaların yaş ve cinsiyet gibi sosyo-demografik özellikleri, varsa ko-morbiditide durumu, diyabet tipi, almış oldukları tedavi tipleri; HbA1c, NLR, PLR, RDW, MPV incelendi. Diyabetik hasta verileri karşılaştırmalarında elde edilen sonuçlar yüzde (%) olarak ifade edildi. İnflamatuar parametreler için kestirim değeri belirlemede tanı tarama testleri olan duyarlılık, özgüllük, pozitif kestirim değeri (PPD), negatif kestirim değeri (NPD) ve ROC Curve analizi ile yapıldı. İstatistiksel anlamlılık düzeyi p<0,05 olarak ele alındı. Bulgular: Araştırmaya dahil edilen 2.252 diyabetik hastanın %99,68'i (n=2.245) Tip 2 diyabetli, yaş ortalamaları 62,01±11,23 yıl, %60'ı kadın cinsiyet ve HbA1c ortalamaları 8,53±1,95 idi. HbA1c ortalamaları <65 yaş hastalarda, erkeklerde ve bazal-bolus insülin tedavisi alanlarda daha yüksekti (sırasıyla p<0,001, p=0,021, p<0,001). Diyabete en sık eşlik eden hastalıklar; hipertansiyon, hiperlipidemi, hipotiroidi ve aterosklerotik kardiyovasküler hastalık (ASKVH) (sırasıyla %61,6, %59,7, %10,7, %10,6) idi. ASKVH oranları erkek hastalarda anlamlı derecede daha yüksek iken (p=0,028), hiperlipidemi ve hipotiroidi oranları ise kadınlarda daha yüksekti (sırasıyla p=0,013, p<0,001). ?65 yaş hastalarda hipertansiyon ve ASKVH oranları daha yüksekti (sırasıyla p<0,001, p<0,001). Hastaların kullandıkları tedavi tipleri sırasıyla; sadece OAD tedavisi, bazal-bolus insülin, OAD+bazal insülin, premiks insülin (sırasıyla %52,9, (%28, %14,3, %4,7) idi. Premiks insülin kullananlarda hipertansiyon oranları, diğer tedavi tiplerine göre daha yüksekti (p=0,014). Hiperlipidemi oranları premiks insülin tedavisi alanlarda, yalnızca OAD tedavisi ve OAD+bazal insülin tedavisi alanlara göre (p=0,010); ASKVH oranları ise premiks insülin tedavisi alanlarda, yalnızca OAD tedavisi alanlara göre daha yüksekti (p=0,006). ?65 yaş kadın hastalarda hemoglobin, platelet ve lenfosit ortalamaları daha düşük iken (p<0,001), RDW, NLR ve PLR değerleri ise daha yüksekti (sırasıyla p=0,007, p<0,001, p<0,001). ?65 yaş erkek hastalarda lökosit, hemoglobin, platelet ve lenfosit ortalamaları daha düşük iken (p<0,001), RDW, NLR ve PLR düzeyleri ise daha yüksekti (p<0,001). HbA1c ?6,5 olan olguların NLR ölçümleri anlamlı düzeyde düşüktü (p=0,005). NLR ?2,20 kesme değeri için; duyarlılık %64,70; özgüllük %46,50; PPD %63,40; NPD %36,60 idi. Eğri altında kalan alan 0,552 ve standart hatası 0,019 idi (p=0,005). HbA1c ?6,5 olan olguların PLR ölçümleri anlamlı düzeyde düşüktü (p=0,001). PLR ?105,25 kesme değeri için; duyarlılık %52,50; özgüllük %60,30; PPD %50,90; NPD %49,10 idi. Eğri altında kalan alan 0,562 ve standart hatası 0,019 olarak saptandı (p=0,001). HbA1c ?6,5 olan olguların RDW ölçümleri anlamlı düzeyde düşüktü (p=0,018). RDW ?13,95 kesme değeri için; duyarlılık %66,00; özgüllük %39,00; pozitif kestirim değeri %65,30; negatif kestirim değeri %34,70 idi. Eğri altında kalan alan 0,544 ve standart hata 0,018 olarak saptandı (p=0,018). HbA1c ?8'e göre değerlendirdiğimizde ise; NLR, PLR ve RDW ortalamalarının bu hastalarda anlamlı şekilde daha düşük olduğu saptandı (sırasıyla p=0,002, p<0,001, p<0,001). NLR ?2,20 kesme değeri için; duyarlılık %60,20; özgüllük %46,40; PPD %57,10; NPD %42,90 idi. Eğri altında kalan alan 0,538 ve standart hatası 0,012 olarak saptandı (p=0,002). PLR ?105,77 kesme değeri için; duyarlılık %56,0; özgüllük %54,0; PPD %51,60; NPD %48,40 idi. Eğri altında kalan alan 0,553 ve standart hatası 0,012 olarak saptandı (p<0,001). RDW ?13,55 kesme değeri için; duyarlılık %56,0; özgüllük %54,0; PPD %51,10; NPD %48,90 idi. Eğri altında kalan alan 0,553 ve standart hatası 0,012 olarak saptandı (p<0,001). Sonuç: Yeni geliştirilen antidiyabetik ilaç tedavilerine ve giderek artan sağlık hizmetlerine rağmen maalesef diyabetik hastalarda hedeflenen HbA1c düzeylerine ulaşılamamakta ve diyabete eşlik eden birçok ko-morbid hastalıklar sıklıkla görülmeye devam etmektedir. Çalışmamızda; yüksek HbA1c ile inflamatuar belirteçler olarak kullanılabilen NLR, PLR, RDW arasında istatistiksel anlamlılık saptanırken, bu parametrelerin hem HbA1C ?6,5, hem de HbA1c ?8 olan hastalara bir öngördürücü tanı testi olarak duyarlılık ve özgüllük oranlarının düşük olduğu saptandı. Anahtar Kelimeler: Diyabetes Mellitus, Diyabet Tedavi Tipleri, Diyabete Eşlik Eden Hastalıklar, Glikozile Hemoglobin A1c, Nötrofil/Lenfosit Oranı, Platelet/Lenfosit Oranı, Ortalama Platelet Hacmi, Eritrosit Dağılım Genişliği
Objective: In this thesis, we aimed to examine the data of patients who applied to our hospital, who were diagnosed with diabetes and whose diabetes medication report was issued. The demographic characteristics of the patients, diseases accompanying diabetes, the drugs they used, glycated hemoglobin A1c (HbA1c) levels and some blood parameters were evaluated retrospectively. By evaluating whether there is a relationship between HbA1c level and inflammatory parameters such as neutrophil / lymphocyte ratio (NLR), platelet / lymphocyte ratio (PLR), mean platelet volume (MPV) and erythrocyte distribution width (RDW), it is simpler and more cost-effective than HbA1c measurement. Whether these parameters can be used as a predictive diagnostic test was investigated. Materials and Method: Data of 2,252 diabetic patients admitted to the internal diseases and family medicine outpatient clinics of Karabük University Faculty of Medicine Training and Research Hospital between 01.01.2019 and 31.03.2020 were retrospectively analyzed. Patient selection was made by scanning the International Classification of Disease codes via the hospital automation system. According to the ICD-10 coding, the DM diagnosis code E10.0-E10.9 was detected by searching with E11.0-E11.9. Sociodemographic characteristics of the patients such as age and gender, condition of comorbidity, if any, type of diabetes, treatment types they received; HbA1c, NLR, PLR, RDW, MPV parameters were examined. The results obtained in the diabetic patient data comparisons were expressed as a percentage (%). In determining the predictive value for inflammatory parameters, diagnostic screening tests were performed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPD) and ROC Curve analysis. Statistical significance level was taken as p<0.05. Results: Of the 2,252 diabetic patients included in the study, %99.68 (n = 2.245) had Type 2 diabetes, their mean age was 62.01 ± 11.23 years, %60 were female, and their HbA1c mean was 8.53 ± 1.95. The mean HbA1c was higher in patients <65 years of age, men and those receiving basal-bolus insulin therapy (p<0.001, p=0.021, p<0.001, respectively). The most common diseases accompanying diabetes; hypertension, hyperlipidemia, hypothyroidism, and atherosclerotic cardiovascular disease (ASHVD) (%61.6, %59.7, %10.7, %10.6, respectively). While the ASHVD rates were significantly higher in male patients (p=0.028), the rates of hyperlipidemia and hypothyroidism were higher in women (p=0.013, p<0.001, respectively). Hypertension and ASHVH rates were higher in patients 65 years old (p<0.001, p<0.001, respectively). The types of treatment used by the patients, respectively; only OAD treatment, basal-bolus insulin, OAD+basal insulin, premixed insulin (%52.9, %28, %14.3, %4.7, respectively). Hypertension rates were higher in premixed insulin users compared to other treatment types. The rates of hyperlipidemia were higher than those who received premixed insulin treatment compared to those who received only OAD treatment and OAD+basal insulin therapy (p=0.010); ASHVH rates were higher than those who received premix insulin treatment and those who received only OAD treatment (p=0.006). While the mean hemoglobin, platelet and lymphocyte were lower (p<0.001), RDW, NLR and TLR values were higher in female patients 65 years (p=0.007, p<0.001, p<0.001, respectively). While the mean leukocyte, hemoglobin, platelet and lymphocyte was lower (p <0.001), RDW, NLR and PLR levels were higher (p<0.001). NLR measurements of cases with HbA1c ?6.5 were significantly lower (p=0.005) For the cut-off value of NLR 2.20; sensitivity %64.70; specificity %46.50; PPD %63.40; The NPD was %36.60. The area under the curve was 0.552 and its standard error was 0.019 (p=0.005). PLR measurements of cases with HbA1c ?6.5 were significantly lower (p=0.001). For PLR ?105.25 cut-off value; sensitivity %52.50; specificity %60.30; PPD %50.90; The NPD was %49.10. The area under the curve was 0.562 and its standard error was 0.019 (p=0.001). RDW measurements of the cases with HbA1c ?6.5 were significantly lower (p = 0.018). For the cut-off value of RDW ?13.95; sensitivity %66.00; specificity %39.00; positive predictive value %65.30; the negative predictive value was %34.70. The area under the curve was 0.544 and the standard error was 0.018 (p = 0.018). When we evaluate according to HbA1c ?8; It was found that the mean NLR, PLR and RDW were significantly lower in these patients (p=0.002, p<0.001, p<0.001, respectively). For the cut-off value of NLR ?2,20; sensitivity %60.20; specificity %46.40; PPD %57.10; The NPD was %42.90. The area under the curve was 0.538 and its standard error was 0.012 (p=0.002). For PLR ?105.77 cut-off value; sensitivity %56.0; specificity %54.0; PPD %51.60; The NPD was %48.40. The area under the curve was 0.553 and its standard error was 0.012 (p<0.001). For the cut-off value of RDW ?13,55; sensitivity %56.0; specificity %54.0; PPD %51.10; The NPD was %48.90. The area under the curve was 0.553 and its standard error was 0.012 (p<0.001). Conclusion: Despite the newly developed antidiabetic drug treatments and increasing health services, unfortunately, the targeted HbA1c levels cannot be reached in diabetic patients and many co-morbid diseases accompanying diabetes continue to be seen frequently. In our study; While statistical significance was found between high HbA1c and NLR, PLR, and RDW, which can be used as inflammatory markers, it was found that these parameters had low sensitivity and specificity as a predictive diagnostic test for patients with both HbA1C ?6.5 and HbA1c ?8. Keywords: Diabetes Mellitus, Diabetes Treatment Types, Diabetes Associated Diseases, Glycosylated Hemoglobin A1c, Neutrophil / Lymphocyte Ratio, Platelet / Lymphocyte Ratio, Average Platelet Volume, Erythrocyte Distribution Width
Objective: In this thesis, we aimed to examine the data of patients who applied to our hospital, who were diagnosed with diabetes and whose diabetes medication report was issued. The demographic characteristics of the patients, diseases accompanying diabetes, the drugs they used, glycated hemoglobin A1c (HbA1c) levels and some blood parameters were evaluated retrospectively. By evaluating whether there is a relationship between HbA1c level and inflammatory parameters such as neutrophil / lymphocyte ratio (NLR), platelet / lymphocyte ratio (PLR), mean platelet volume (MPV) and erythrocyte distribution width (RDW), it is simpler and more cost-effective than HbA1c measurement. Whether these parameters can be used as a predictive diagnostic test was investigated. Materials and Method: Data of 2,252 diabetic patients admitted to the internal diseases and family medicine outpatient clinics of Karabük University Faculty of Medicine Training and Research Hospital between 01.01.2019 and 31.03.2020 were retrospectively analyzed. Patient selection was made by scanning the International Classification of Disease codes via the hospital automation system. According to the ICD-10 coding, the DM diagnosis code E10.0-E10.9 was detected by searching with E11.0-E11.9. Sociodemographic characteristics of the patients such as age and gender, condition of comorbidity, if any, type of diabetes, treatment types they received; HbA1c, NLR, PLR, RDW, MPV parameters were examined. The results obtained in the diabetic patient data comparisons were expressed as a percentage (%). In determining the predictive value for inflammatory parameters, diagnostic screening tests were performed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPD) and ROC Curve analysis. Statistical significance level was taken as p<0.05. Results: Of the 2,252 diabetic patients included in the study, %99.68 (n = 2.245) had Type 2 diabetes, their mean age was 62.01 ± 11.23 years, %60 were female, and their HbA1c mean was 8.53 ± 1.95. The mean HbA1c was higher in patients <65 years of age, men and those receiving basal-bolus insulin therapy (p<0.001, p=0.021, p<0.001, respectively). The most common diseases accompanying diabetes; hypertension, hyperlipidemia, hypothyroidism, and atherosclerotic cardiovascular disease (ASHVD) (%61.6, %59.7, %10.7, %10.6, respectively). While the ASHVD rates were significantly higher in male patients (p=0.028), the rates of hyperlipidemia and hypothyroidism were higher in women (p=0.013, p<0.001, respectively). Hypertension and ASHVH rates were higher in patients 65 years old (p<0.001, p<0.001, respectively). The types of treatment used by the patients, respectively; only OAD treatment, basal-bolus insulin, OAD+basal insulin, premixed insulin (%52.9, %28, %14.3, %4.7, respectively). Hypertension rates were higher in premixed insulin users compared to other treatment types. The rates of hyperlipidemia were higher than those who received premixed insulin treatment compared to those who received only OAD treatment and OAD+basal insulin therapy (p=0.010); ASHVH rates were higher than those who received premix insulin treatment and those who received only OAD treatment (p=0.006). While the mean hemoglobin, platelet and lymphocyte were lower (p<0.001), RDW, NLR and TLR values were higher in female patients 65 years (p=0.007, p<0.001, p<0.001, respectively). While the mean leukocyte, hemoglobin, platelet and lymphocyte was lower (p <0.001), RDW, NLR and PLR levels were higher (p<0.001). NLR measurements of cases with HbA1c ?6.5 were significantly lower (p=0.005) For the cut-off value of NLR 2.20; sensitivity %64.70; specificity %46.50; PPD %63.40; The NPD was %36.60. The area under the curve was 0.552 and its standard error was 0.019 (p=0.005). PLR measurements of cases with HbA1c ?6.5 were significantly lower (p=0.001). For PLR ?105.25 cut-off value; sensitivity %52.50; specificity %60.30; PPD %50.90; The NPD was %49.10. The area under the curve was 0.562 and its standard error was 0.019 (p=0.001). RDW measurements of the cases with HbA1c ?6.5 were significantly lower (p = 0.018). For the cut-off value of RDW ?13.95; sensitivity %66.00; specificity %39.00; positive predictive value %65.30; the negative predictive value was %34.70. The area under the curve was 0.544 and the standard error was 0.018 (p = 0.018). When we evaluate according to HbA1c ?8; It was found that the mean NLR, PLR and RDW were significantly lower in these patients (p=0.002, p<0.001, p<0.001, respectively). For the cut-off value of NLR ?2,20; sensitivity %60.20; specificity %46.40; PPD %57.10; The NPD was %42.90. The area under the curve was 0.538 and its standard error was 0.012 (p=0.002). For PLR ?105.77 cut-off value; sensitivity %56.0; specificity %54.0; PPD %51.60; The NPD was %48.40. The area under the curve was 0.553 and its standard error was 0.012 (p<0.001). For the cut-off value of RDW ?13,55; sensitivity %56.0; specificity %54.0; PPD %51.10; The NPD was %48.90. The area under the curve was 0.553 and its standard error was 0.012 (p<0.001). Conclusion: Despite the newly developed antidiabetic drug treatments and increasing health services, unfortunately, the targeted HbA1c levels cannot be reached in diabetic patients and many co-morbid diseases accompanying diabetes continue to be seen frequently. In our study; While statistical significance was found between high HbA1c and NLR, PLR, and RDW, which can be used as inflammatory markers, it was found that these parameters had low sensitivity and specificity as a predictive diagnostic test for patients with both HbA1C ?6.5 and HbA1c ?8. Keywords: Diabetes Mellitus, Diabetes Treatment Types, Diabetes Associated Diseases, Glycosylated Hemoglobin A1c, Neutrophil / Lymphocyte Ratio, Platelet / Lymphocyte Ratio, Average Platelet Volume, Erythrocyte Distribution Width
Açıklama
Tıp Fakültesi, Aile Hekimliği Ana Bilim Dalı, Aile Hekimliği Bilim Dalı
Anahtar Kelimeler
İç Hastalıkları, Internal diseases
