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Öğe Effect of vildagliptin add-on treatment to metformin on plasma asymmetric dimethylarginine in type 2 diabetes mellitus patients(Dove Medical Press, 2014) Çakırca, Mustafa; Karatoprak, Cumali; Zorlu, Mehmet; Kıskaç, Muharrem; Kanat, Mustafa; Çıkrıkçıoğlu, Mehmet Ali; Soysal, Pınar; Hurşitoğlu, Mehmet; Çamlı, Ahmet Adil; Erkoç, Reha; Abdul-Ghani, MuhammadAims: A close association has been demonstrated between increased cardiovascular risk and high asymmetric dimethylarginine (ADMA) levels in type 2 diabetes mellitus (DM) patients. We planned to measure serum ADMA levels in type 2 DM patients using vildagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor. Materials and methods: A total of 68 type 2 DM patients who were on metformin were enrolled in the study. Based on the glycemic levels of patients, vildagliptin was added on to treatment in 33 patients. Patients were followed for 6 months. Serum ADMA, C-reactive protein, and fibrinogen levels were compared in groups of patients using metformin or metformin + vildagliptin, after 6 months. Results: Serum ADMA levels were found to be significantly lower in the group using vildagliptin compared to the group using metformin + vildagliptin (P<0.001). However, serum C-reactive protein and fibrinogen levels were statistically similar in the two study groups (P=0.34 and P=0.23, respectively). Conclusion: Metformin + vildagliptin treatment was observed to lower serum ADMA levels in type 2 DM patients. Our findings notwithstanding, large-scale prospective randomized controlled studies are warranted to conclude that vildagliptin provides cardiovascular protection along with diabetes regulation.Öğe Evaluation of cardiac functions with tissue doppler ımaging in prediabetic subjects(Korean Soc Cardiology, 2013) Kanat, Mustafa; Vardı, Şeref; Arınç, Hüseyin; Gündüz, Hüseyin; Erdem, Alim; Karagöz, YalçınBackground and Objectives: The aim of the present study was to evaluate left ventricle systolic and diastolic function, using tissue Doppler echocardiography (TDE), in relation to blood glucose status in prediabetic patients who had no evidence of heart disease by conventional echocardiography (CE). Subjects and Methods: We included 60 patients (30 female, 30 male) and 20 healthy controls (10 male, 10 female). All participants were randomised into four groups according to their oral glucose tolerance test. Group-I consisted of those patients who had only impaired fasting glucose (IFG). group-II consisted of patients who had only impaired glucose tolerance (IGT) and group-III consisted of patients who had both IFG and IGT, that is so-called combined glucose intolerance. Group-IV included the healthy controls. All subjects underwent both CE and TDE. Results: No significant differences were found among the four groups in terms of CE. There was no significant difference between group-IV and group-I with respect to the early peak diastolic velocity (Ea) of medial mitral annulus (11.65 +/- 0.66 vs. 9.72 +/- 1.58, p>0.05), whereas a statistically significant difference was found between group-IV and group-II (11.65 +/- 0.66 vs. 9.06 +/- 1.07, p<0.001) and between group-IV and group-III (11.65 +/- 0.66 vs. 9.74 +/- 1.09, p<0.05). Conclusion: Diastolic myocardial dysfunction in prediabetic patients may be identified by quantitative TDE before the appearance of CE indices of myocardial dysfunction.Öğe Insulin vs GLP-1 analogues in poorly controlled Type 2 diabetic subjects on oral therapy: A meta-analysis(Editrice Kurtis S R L, 2013) Abdul-Ghani, Muhammed; Williams, Ken; Kanat, Mustafa; Altuntaş, Yüksel; DeFronzo, Ralph AlbaradoTo compare insulin and GLP-1 analogues therapy on glycemic control in poorly controlled Type 2 diabetes (T2DM) subjects failing on oral therapy. Methods: The electronic database PubMed was systematically searched for randomized controlled trial (RCT) with duration >16 weeks comparing the addition of insulin therapy vs glucagon-like peptide (GLP-1) analogues in poorly controlled T2DM subjects on oral therapy. Results: We identified 7 RCT with 2199 patients of whom 1119 were assigned to insulin therapy and 1080 received a GLP-1 analogue. Both insulin and GLP-1 analogues were effective in lowering glycated hemoglobin (HbA(1c)) with no statistically significant difference between the mean decreases in HbA(1c). However, insulin was more effective than GLP-1 analogues in lowering the fasting plasma glucose concentration, while GLP-1 agonists were more effective in lowering the postprandial glucose concentration. Insulin therapy was associated with weight gain while GLP-1 analogues consistently caused weight loss and the difference between the mean change in body weight between the two therapies was highly statistically significant. Despite a similar decrease in HbA(1c), the risk of hypoglycemia was 35% lower (p=0.001) with GLP-1 therapy compared to insulin. Compared to insulin, GLP-1 analogues caused a significant decrease in systolic blood pressure and were associated with greater rate of gastrointestinal adverse events. Conclusion/interpretation: In poorly controlled T2DM subjects on oral therapy, GLP-1 analogues and insulin are equally effective in lowering the HbA(1c). However, GLP-1 analogues have additional non-glycemic benefits and lower risk of hypoglycemia. Thus, GLP-1 analogues should be considered as a treatment option in this group of diabetic individuals.Öğe Intensive insulin titration with insulin glargine in insulin-naive type 2 diabetic patients in Turkey: Lantit study(Galenos Publishing, 2015) Tuncel, Ercan; Kanat, Mustafa; Algün, Ekrem; Gül Öz, Özen; Emral, RıfatPurpose: This open-label, single-arm, phase 4 study was designed to evaluate the efficacy of intensive insulin glargine titration in type 2 diabetes mellitus (T2DM) patients for 6 months to reach good glycaemic control. Material and Method: Two hundred-forty one insulin-naive T2DM patients were included. The primary efficacy variable was the glycaemic control (HbA1c level of <= 7%). The secondary variables were a fasting blood glucose (FBG) level of <100 mg/dL, the final dose of basal insulin, number of dose adjustments, time to dose titration in reaching target HbA1c level of <= 7%, weight gain and treatment satisfaction using the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Hypoglycemia, severe hypoglycemia and adverse events were also assessed. Results: The mean (+/-SD) HbA1c level of 8.8+/-0.6% at baseline decreased to 7.4+/-0.9% on day-90 (p<0.001) and to 7.3+/-0.9% on day-180 (p<0.001). The percentage of patients with HbA1c <=%7 was 36.9% on day-90 and 40% on day-180. The mean FBG of 186.3+/-52.5 mg/dL at baseline decreased to 111.5+/-36.6 mg/dL on day-90 (p<0.001) and to 114.1+/-34.8 mg/dL on day-180 (p<0.001). The mean insulin glargine dose on the last day of FBG measurement (day-89) was 32.7+/-15.5 IU and the mean number of titrations was 12.7+/-6.6. These values on day-179 were 36.8+/-19.4 IU and 5.8+/-5.7, respectively. The total DTSQ score (20.3+/-7.7) and scores for each item at baseline showed improvement on day-180 (p<0.001). The most frequently reported adverse reactions were hypoglycaemia (49.7%) and weight gain (9.5%). Serious hypoglycaemia cases reported during the first and the second 3-month periods were 11.2% and 13.3%, respectively. Discussion: In conclusion, the use of insulin glargine with intensive dose titration is effective and safe in T2DM patients.Öğe Strong association between insulin-mediated glucose uptake and the 2-hour, not the fasting plasma glucose concentration, in the normal glucose tolerance range(Endocrine Society, 2014) Winnier, Diedre; Norton, Luke; Kanat, Mustafa; Arya, Ruth; Fourcaudot, Marcel; Hansis-Diarte, Andrea; Tripathy, Devjit; DeFronzo, Ralph A.; Jenkinson, Christopher P.; Abdul-Ghani, MuhammadAim: The aim of this study was to examine the relationship between whole-body insulin-mediated glucose disposal and the fasting plasma glucose concentration in nondiabetic individuals. Research Design and Methods: Two hundred fifty-three nondiabetic subjects with normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance, and combined glucose intolerance received a 75-g oral glucose tolerance test and euglycemic hyperinsulinemic clamp. Total glucose disposal (TGD) during the insulin clamp was compared in IFG and NGT individuals and was related to fasting and 2-hour plasma glucose concentrations in each group. Results: TGD varied considerably between NGT and IFG individuals and displayed a strong inverse relationship with the 2-hour plasma glucose (PG; r = 0.40, P < .0001) but not with the fasting PG. When IFG and NGT individuals were stratified based on their 2-hour PG concentration, the increase in 2-hour PG was associated with a progressive decrease in TGD in both groups, and the TGD was comparable among NGT and IFG individuals. Conclusion: The present results indicate the following: 1) as in NGT, insulin-stimulated TGD varies considerably in IFG individuals; 2) the large variability in TGD in IFG and NGT individuals is related to the 2-hour PG concentration; and 3) after adjustment for the 2-hour proglucagon concentration, IFG subjects have comparable TGD with NGT individuals.Öğe The effect of feto-maternal blood type incompatibility on development of gestational diabetes mellitus(Societa Editrice Universo, 2014) Kanat, Mustafa; Bilir Göksügür, Sevil; Özlü, Tülay; Tunçkale, Aydın; Öztürk, B.; Yener Öztürk, Feyza; Altuntaş, Yüksel; Süleymanoğlu, Yaser; Atmaca, Hasan Tarık; Yolcu, Nazan; Gönenç, Işık; Delibaşı, Tuncay; Zuhur, Sayid Shafi; Dikbaş, O?uz; Aktaş, Gülali; Karagöz, Yalçın; Abdul-Ghani, Muhammad A.Objective. To assess the relation between fetal and maternal blood type (ABO, Rh) incompatibility and development of gestational diabetes mellitus (GDM). Materials and Methods. A total of 500 pregnant women underwent diagnostic test for GDM by a 100-g oral glucose tolerance test (OGTT) after an 8 to 12-h overnight fast participated in this study. OGTT was performed between the 24-28 weeks of gestation, but participants who were at high risk for GDM were tested after the first prenatal visit. In the postpartum period, maternal and infant blood types were determined. Presence of GDM was evaluated in terms of matched and unmatched fetal and maternal ABO and Rh blood types separately. Results. GDM was detected in 235 participants. Unmatched ABO blood types between the mother-infant pairs were present in 44.7% (n=105) of GDM (+) and 35.8 % (n=95) of GDM (-) patients. Incompatible feto-maternal ABO blood type was positively correlated with development of GDM which was marginally significant. (p=0.045; R=1.2;95% CL; 1.004-1.48). However, Rh feto-maternal blood type incompatibility was not related with development of GDM. Conclusions. Feto-maternal ABO blood type incompatibility may be a weak risk factor for the development of GDM.Öğe Treatment of prediabetes(Baishideng Publishing Group, 2015) Kanat, Mustafa; DeFronzo, Ralph; Abdul-Ghani, MuhammadProgression of normal glucose tolerance (NGT) to overt diabetes is mediated by a transition state called impaired glucose tolerance (IGT). Beta cell dysfunction and insulin resistance are the main defects in type 2 diabetes mellitus (type 2 DM) and even normoglycemic IGT patients manifest these defects. Beta cell dysfunction and insulin resistance also contribute to the progression of IGT to type 2 DM. Improving insulin sensitivity and/or preserving functions of beta-cells can be a rational way to normalize the GT and to control transition of IGT to type 2 DM. Loosing weight, for example, improves whole body insulin sensitivity and preserves beta-cell function and its inhibitory effect on progression of IGT to type 2 DM had been proven. But interventions aiming weight loss usually not applicable in real life. Pharmacotherapy is another option to gain better insulin sensitivity and to maintain beta-cell function. In this review, two potential treatment options (lifestyle modification and pharmacologic agents) that limits the IGT-type 2 DM conversion in prediabetic subjects are discussed.Öğe Treatment of prediabetes(World Scientific Publishing, 2014) Abdul-Ghani, Muhammad A.; Kanat, Mustafa; DeFronzo, Ralph Albarado[Abstract Not Available]
