Covid-19 pandemi sürecinin diabetes mellitus olgularında hastalık yönetimi, glisemik kontrol, lipit profili ve vücut kompozisyonu üzerine etkisinin değerlendirilmesi
Evaluation of the effect of the Covid-19 pandemic process on disease management, glicemic control, lipid profile and body composition in diabetes mellitus cases
- Tez No: 796968
- Danışmanlar: DR. ÖĞR. ÜYESİ BİLGEHAN AÇIKGÖZ
- Tez Türü: Tıpta Uzmanlık
- Konular: Halk Sağlığı, Public Health
- Anahtar Kelimeler: COVID-19, Type 2 Diabetes mellitus, locdown, pandemic
- Yıl: 2023
- Dil: Türkçe
- Üniversite: Zonguldak Bülent Ecevit Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Halk Sağlığı Ana Bilim Dalı
- Bilim Dalı: Halk Sağlığı Bilim Dalı
- Sayfa Sayısı: 82
Özet
Amaç: Bu çalışmanın amacı COVID-19 pandemi sürecinin tip 2 diabetes mellitus tanılı bireylerin hastalık kontrolü, glisemik regülasyonu, lipit profili ve vücut kompozisyon analizi parametreleri üzerindeki etkisini incelemektir. Gereç ve Yöntem: Çalışmamız Zonguldak Bülent Ecevit Üniversitesi Obezite ve Diyabet Uygulama ve Araştırma Merkezi diyabet polikliniğinde takipli 142 Tip 2 diabetes mellitus tanılı hasta ile gerçekleştirilmiştir. Türkiye'de ilk vakanın görüldüğü 10 Mart 2020 pandemi başlangıcı kabul edilerek bu tarihten önceki 6 aylık dönemde ve pandemi kısıtlamalarının kaldırıldığı 1 Temmuz 2021 tarihinden sonraki 3 aylık dönemde kontrole gelmiş bireyler dahil edilmiştir. Hastaların pandemi öncesi ve sonrası açlık plazma glukozu (APG) , Glikolize Hemoglobin A1c (HbA1c) , yüksek yoğunluklu lipoprotein (HDL), düşük yoğunluklu lipoprotein (LDL), total kolesterol, trigliserid, spot idrarda mikroalbumin ve mikroalbumin/kreatinin, tGFR ile plazma üre düzeyi gibi laboratuar parametreleri ile ağırlık, vücut kitle indeksi (VKİ), yağ kütlesi, kas kütlesi, kemik kütlesi, mineral kütlesi, protein kütlesi, total vücut sıvısı ve yağsız kütle gibi vücut kompozisyon analizi parametreleri incelenerek karşılaştırılmıştır. Ayrıca hastalara telefon aracılığıyla ulaşılarak pandemi sürecinde hastalık yönetimi ve sağlık hizmelerine ulaşım konusunda yaşadıkları zorlukları belirlemek amacıyla bir anket uygulanmıştır. Bulgular: Katılımcıların yaş ortalaması 56,3 ± 9,5 yıldır ve %57,7'si (n₌82) kadındır. Ortanca diyabet süresi 8,5 yıldır. Pandemi öncesi döneme göre pandemi sonrası HbA1c değeri ortanca %7,2'den %7,15'e, açlık plazma glukozu ortanca 138 mg/dL'den 129,5 mg/dL'ye gerilemiş, HDL kolesterol ortanca 45 mg/dL iken değişim gözlenmemiştir. LDL kolesterol ortanca 114 mg/dL'den 106 mg/dL'ye gerilemiş; trigliserid ortanca 160 mg/dL'den 180,5 mg/dL'ye yükselmiş; total kolesterol ortanca 192 mg/dL'den 186,5 mg/dL'ye; spot idrar kreatinin ortanca 89,6 mg/dL'den 84,7 mg/dL'ye; spot idrar mikroalbumin ortanca 9 mg/L'den 8,3 mg/L'ye; spot idrar mikroalbumin/kreatinin ortanca 9,1 mg/gr'dan 8,4 mg/gr'a gerilemiş ancak bu farklar istatistiksel olarak anlamlı bulunmamıştır. tGFR değeri ortanca 96,5 ml/dk/1.72 m²'den 95 ml/dk/1.72 m²'ye gerilemiş; üre değeri ortanca 29 mg/dL'den 32 mg/dL'ye yükselmiş; bu değişimler istatistiksel olarak anlamlı bulunmuştur. (p
Özet (Çeviri)
Aim: The aim of this study is to examine the effect of the COVID-19 pandemic process on disease control, glycemic regulation,lipid profile and body composition analysis parameters of individuals diagnosed with type 2 diabetes mellitus. Materials and Metods: Our study was performed with 142 patients diagnosed with Type 2 diabetes mellitus, who were followed up in the diabetes outpatient clinic of Zonguldak Bülent Ecevit University Obesity and Diabetes Application and Research Center. When the first case was seen in Turkey, was accepted as the beginning of the pandemic when the pandemic restrictions were lifted, was accepted as the end of the pandemic. İndividuals who came to the control in the 6-month period before March 2020 and in the 3-month period after July 2021 were included. The data of the patients were compared in before the pandemic and after the pandemic. Fasting plasma glucose (APG), glycosylated hemoglobin A1c (HbA1c), high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol, triglyceride, microalbumin and microalbumin/creatinine in spot urine, tGFR, plasma urea, weight, body mass index (BMI), fat mass, muscle mass, bone mass, mineral mass, protein mass, total body fluid and lean mass were evaluated. In addition, patients were contacted via telephone and a questionnaire was applied to determine the difficulties they experienced in disease management and access to health services during the pandemic process. Results: The mean age of the participants was 56,3±9,5 years and %57,7 (n ¬₌ 82) were female. Median duration of diabetes was 8,5 years. Compared to the pre-pandemic period, post-pandemic median HbA1c value decreased from %7,2 to % 7,15, median fasting plasma glucose decreased from 138 mg/dL to 129,5 mg/dL, median HDL cholesterol was 45 mg/dL, no change was observed; median LDL cholesterol decreased from 114 mg/dL to 106 mg/dL; median triglyceride increased from 160 mg/dL to 180,5 mg/dL; median total cholesterol decreased from 192 mg/dL to 186,5 mg/dL; median spot urinary creatinine decreased from 89,6 mg/dL to 84,7 mg/dL; median spot urinary microalbumin decreased from 9 mg/L to 8,3 mg/L; median spot urinary microalbumin/creatinine decreased 9,1 mg/gr to 8,4 mg/gr; however, these changes were not statistically significant. Median tGFR decreased from 96,5 ml/min/1.72 m² to 95 ml/min/1.72 m²; median plasma urea increased from 29 mg/dL to 32 mg/dL; these changes were found to be statistically significant. ( p < 0,001) The pre-pandemic body composition analysis parameters of the patients were compared with post-pandemic. Median weight decreased from 85,3 kg to 84,1 kg; median BMİ decreased from 32,1 kg/m² to 31,6 kg/m²; median degree of obesity decreased from %44,1 to %38,7; median bone mass decreased from 3 kg to 2,9 kg; median protein mass decreased from 12,7 kg to 12,5 kg; median mineral mass decreased from 3,8 kg to 3,7 kg; extracellular water mass increased from 18,1 kg'dan 18,2 kg; mean muscle mass decreased from 55,5 kg to 54,8; mean lean mass decreased from 58,4 kg to 57,7 kg and these changes were statistically significant. ( p < 0,001) Median intracellular water mass decreased from 23,6 kg to 23,4 kg; mean total body water mass decreased from 41,7 kg to 41,4 kg; mean body fat percentage was %32,5 and did not change; median fat mass decreased from 27 kg to 26,2 kg, but these changes were not statistically significant. Compared to the pre-pandemic period, 49 (34,5%) patients had a decrease in diet compiance and 60 (42,3%) patients showed a decrease physical activity. Statistically significant increases were observed in HbA1c, FPG, total cholesterol and triglyceride values of these individuals who had a decrease in physical activity and diet compliance. Besides, HbA1c and FPG values showed a statistically significant decrease in individuals who had a increase in physical activity and diet compliance. Conclusion: During the pandemic process, the disease management of individuals has been adversely affected. Blood sugar monitoring at home has decreased, diet habits have changed and physical activity has decreased. Diabetes follow-ups have been delayed due to the fear of the epidemic, and the frequency of outpatient check-ups has decreased. The glycemic regulation of individuals with reduced diet and physical activity compliance is impaired. Loss of bone and muscle mass of the patients suggested that they were at risk for osteosarcopenia. It was thought that special precautions should be taken for these patients in terms of the risks that diabetes patients are exposed to in extraordinary situations such as pandemics.
Benzer Tezler
- Covid-19 pandemisi sürecinde tip 2 diyabet hastalarının mobil sağlık hizmeti ile takip edilmelerinin sonuçları
The results of moni̇tori̇ng type 2 diabetes patients with mobile health service during the covid-19 pandemic process
KÜBRA GİZEM NACAK
Tıpta Uzmanlık
Türkçe
2020
İç HastalıklarıSağlık Bilimleri Üniversitesiİç Hastalıkları Ana Bilim Dalı
PROF. DR. SEMA BASAT
- COVID-19 (SARS-CoV-2) pandemisi sürecinde olguların akciğer bulgularının radyolojik değerlendirmesi
Radiological assessment of lung findings of cases during the COVID-19 (SARS-CoV-2) pandemic
ŞEYMA ÖZEN
Tıpta Uzmanlık
Türkçe
2021
Radyoloji ve Nükleer TıpAfyonkarahisar Sağlık Bilimleri ÜniversitesiRadyoloji Ana Bilim Dalı
PROF. DR. AYLİN YÜCEL
- COVID-19 nedeniyle yatırılarak tedavi edilen hastaların demografik ve klinik özelliklerinin prognoz ile ilişkisinin değerlendirilmesi
Evaluation of the demographic and clinical characteristics of hospitalized COVID-19 patients in relation to prognosis
SERDANUR ÖZDEMİR
Tıpta Uzmanlık
Türkçe
2021
Göğüs HastalıklarıRecep Tayyip Erdoğan ÜniversitesiGöğüs Hastalıkları Ana Bilim Dalı
DR. ÖĞR. ÜYESİ BİLGE YILMAZ KARA
- Tip2 diyabetik hastalarda COVİD-19 pandemi sürecinin diyabetes mellitus tedavi ve izlemine etkileri
The effects of the COVİD-19 pandemic process on the treatment and follow-up of diabetes mellitus in TYPE 2 diabetic patients
ERDEM KARAHAN
Tıpta Uzmanlık
Türkçe
2023
İç HastalıklarıSağlık Bilimleri Üniversitesiİç Hastalıkları Ana Bilim Dalı
PROF. DR. ARİF YÖNEM
UZMAN İSMAİL ENGİN
- COVID–19 pandemi sürecinin glisemik kontrol üzerine etkileri
The effects of the COVID–19 pandemic process on glicemic control
AHMET CAN ESEN
Tıpta Uzmanlık
Türkçe
2022
İç HastalıklarıSağlık Bilimleri Üniversitesiİç Hastalıkları Ana Bilim Dalı
PROF. DR. ESİN BEYAN