Hasan Esat Yücel

Objective: To compare 6-month changes in anxiety and depression levels relative to metabolic trajectories between patients with type 2 diabetes newly initiated on insulin and an oral antidiabetic drug (OAD)–treated control group. Methods: This prospective, observational study included 100 patients with type 2 diabetes: an insulin group (n = 55; basal insulin added to OADs) and an OAD control group (n = 45). Psychological distress was assessed at baseline and 6 months using the Hospital Anxiety and Depression Scale (HADS) alongside HbA1c monitoring. Trajectories were analyzed using 2×2 repeated-measures ANOVA, and within-group changes via paired t tests. Standardized effect sizes (Cohen d) were calculated at 6 months. Results: At baseline, diabetes duration and HbA1c levels were higher in the insulin group, while anxiety scores were higher in the OAD group (P < .001 for all). At 6 months, mean (SD) HbA1c decreased significantly in the insulin group (from 9.51% [0.72%] to 7.49% [0.78%]; P < .001) but remained stable in the OAD group. Repeated-measures ANOVA showed significant time × group interactions for anxiety (F 1,98 = 69.16; P < .001) and depression (F 1,98 = 85.68; P < .001). Within the insulin group, mean (SD) scores increased significantly for anxiety (from 6.98 [2.00] to 11.25 [2.74]; P < .001) and depression (from 8.25 [2.05] to 12.36 [2.26]; P < .001). At 6 months, between-group differences reflected substantial clinical magnitudes favoring the control group for both anxiety (Cohen d = 1.14) and depression (Cohen d = 2.29). Conclusions: Insulin initiation was associated with increased anxiety and depression symptoms over 6 months despite improved glycemic control. These findings underscore the need to integrate structured psychosocial support into clinical care during insulin transition.

Introduction: Medical ozone therapy is increasingly used as a complementary therapeutic approach because of its potential anti-inflammatory, antioxidant, and immunomodulatory effects. However, the behavior of composite immune–inflammation indices, such as the Systemic Immune– Inflammation index (SII) and Neutrophil-to-Lymphocyte Ratio (NLR), after ozone exposure remains insufficiently studied. This study aimed to evaluate changes in composite immune–inflammation indices, along with conventional inflammatory and laboratory safety parameters following medical ozone therapy in routine outpatient practice. Materials and Methods: This uncontrolled retrospective before–after study included 265 patients who completed at least 10 sessions of medical ozone therapy and had paired laboratory measurements available before and after treatment. The study was conducted at the Traditional and Complementary Medicine outpatient clinic of Kirşehir Training and Research Hospital. Hematological parameters were used to calculate SII, NLR, SII/HDL, PLT/HDL, and AIP. Conventional inflammatory markers and biochemical safety parameters, including C-reactive Protein (CRP), AST, ALT, creatinine, eGFR, glucose, and HbA1c, were also analyzed. Pre- and post-treatment values were compared using the Wilcoxon signed-rank test, and effect sizes were calculated as r = Z / √N. Results: NLR and SII/HDL increased significantly after FDR correction, whereas the nominal increase in SII did not remain significant after adjustment for multiple comparisons. CRP levels significantly decreased after treatment. AST and ALT levels also decreased significantly, while creatinine, urea, glucose, and HbA1c remained stable. Although eGFR showed a statistically significant decrease, values remained within clinically acceptable ranges. Overall, the observed laboratory changes were modest and did not indicate clinically relevant organ dysfunction. Although several laboratory parameters changed significantly, the observed effect sizes were generally small. Discussion: The findings indicate modest laboratory changes following medical ozone therapy. The divergent behavior of cell-based inflammatory indices and conventional inflammatory markers warrants further investigation in prospective controlled studies. The increase in cell-based inflammatory indices together with the decrease in CRP and liver enzymes may reflect transient immune activation and redox-related adaptive regulation. Given the small effect sizes and the retrospective uncontrolled design, these findings should be interpreted cautiously, and their clinical significance requires confirmation in prospective controlled studies. Conclusion: Medical ozone therapy was associated with small but statistically significant laboratory changes in this uncontrolled retrospective cohort. Because of the retrospective design, absence of a control group, and generally small effect sizes, these findings should not be interpreted as evidence of clinical efficacy. Prospective controlled studies are required to determine the clinical relevance of these observations.

Background: Metabolic age (Met-Age), a bioelectrical impedance analysis (BIA)-derived index based on basal metabolic rate (BMR) and body composition, has been associated with cardiometabolic risk. However, its relationship with body mass index (BMI)-defined obesity severity in individuals with type 2 diabetes mellitus (T2DM) remains unclear. This study investigated the association between obesity severity and Met-Age and identified factors associated with Met-Age. Methods: In this retrospective observational study, 683 adults with T2DM were classified into five BMI categories: normal weight, overweight, and class I, II, and III obesity. Anthropometric, laboratory, and BIA-derived body composition data were analyzed using correlation and sex-stratified multivariable linear regression analyses. Results: Although chronological age did not differ significantly across groups, Met-Age increased progressively with increasing obesity severity (p < 0.001). The Jonckheere–Terpstra test confirmed a significant ordered increase in Met-Age across BMI categories. BMI, fat mass, and waist-to-height ratio (WHtR) also increased progressively with increasing obesity severity. In the multivariable regression analyses, chronological age and WHtR were positively associated with Met-Age in both sexes, whereas muscle mass showed a weak inverse association with Met-Age only in female participants. No significant correlations were found between Met-Age and fasting blood glucose (FBG) or hemoglobin A1c (HbA1c) levels (all p > 0.05). Conclusions: In individuals with T2DM, greater obesity severity was associated with higher BIA-derived Met-Age. WHtR was positively associated with Met-Age in both sexes, whereas muscle mass showed a weak inverse association among female participants. Met-Age may serve as a descriptive index reflecting body composition and metabolic characteristics; however, its incremental clinical value beyond BMI and WHtR remains unproven.

Aim: Bioelectrical impedance analysis (BIA) is a widely used, non-invasive technique that provides valuable information about phase angle (PhA) and hydration status, both of which are indicators of cellular health. In patients with chronic renal failure (CRF), fluid balance is often disrupted due to impaired kidney function. This study aimed to evaluate the effects of hemodialysis (HD) on segmental PhA values and body fluid distribution in patients with CRF.Material and Methods: Patients receiving HD for CRF were enrolled. Using a multi-frequency (5, 50, 250 kHz) BIA device, segmental PhA and body fluid composition were measured. Results: Post-dialysis measurements revealed a significant increase in phase angles across all examined segments. Concurrently, extracellular water (ECW), intracellular water (ICW) and total body water (TBW) volumes significantly decreased, whereas both ECW/TBW and ECW/ICW ratios increased.Conclusion: HD leads to significant shifts in body fluid compartments, resulting in reduced hydration status and increased segmental phase angles values.

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) prevalence data in Türkiye is limited. We aimed to determine the nationwide prevalence of MASLD and advanced hepatic fibrosis risk in subjects with cardiometabolic risk factors (CMRF). Despite recent international consensus redefining fatty liver disease terminology, no nationwide MASLD study has been reported in Türkiye. Methods: This cross-sectional study included 14,371 adults with ≥1 CMRF from 44 centers across 31 cities. MASLD was diagnosed using liver ultrasonography plus cardiometabolic criteria. Advanced fibrosis risk was assessed by fibrosis-4 (FIB-4) score (≥1.3 for ≤65 years; ≥2.0 for >65 years). Logistic regression was used to identify independent predictors of high FIB-4. Results: A total of 61.4% of participants were women, the mean age was 51.3 ± 14.4 years, and the mean BMI was 31.4 ± 6.0 kg/m². MASLD prevalence was 75.7% (n = 10,873), rising with the number of CMRFs (56.5% with one factor vs. 83.4% with all). The prevalence of high FIB-4 scores was 12.0% overall, being lower in MASLD patients than non-MASLD patients (11.2% vs. 14.4%, p < 0.001). FIB-4 scores decreased with increasing BMI (28.1% underweight vs. 8.7% class III obesity). Male sex, T2DM, and hypertension independently predicted high FIB-4 scores, while smoking, higher BMI, and MASLD were inversely associated. Conclusions: Three-quarters of Turkish adults with CMRF have MASLD. Standard FIB-4 thresholds may underestimate fibrosis risk in obese and smoking populations, underscoring the need for adjusted cut-offs or alternative tools. This study is the first to provide nationwide MASLD prevalence data in Türkiye.

Background: Metabolic age (met-age), a risk marker, may vary within the same chronological age group. Its association with chronological age, waist/height ratio, obesity degree, body mass index (BMI), and physical rating score (PRS)—risk factors for type 2 diabetes—remains unexplored. Methods: A total of 122 type 2 diabetes patients (50 males, 72 females) were analyzed. Bioimpedance measurements were taken using the Tanita MC-780MA, alongside anthropometric data. Variables were compared, and correlations with met-age were assessed. Results: The met-age–chronological age difference was higher in females with type 2 diabetes (p < 0.001). Females also had higher BMI, obesity degree, fat mass, and waist/height ratio (p < 0.05), but lower waist/hip ratio (p < 0.001). Males showed higher PRS, muscle mass, and fat-free mass (p < 0.001). Met-age positively correlated with chronological age and negatively with PRS in both sexes (p < 0.05). According to the linear regression model, in females, the met-age was influenced positively by chronological age and waist/height ratio and negatively by PRS (R² = 0.983). In males, it was positively influenced by chronological age, obesity grade, and BMI, but negatively by PRS (R² = 0.974). Conclusions: Met-age correlates with chronological age and PRS in type 2 diabetes patients. It increases with advancing age and lower PRS, with waist/height ratio impacting females and BMI/obesity degree affecting males.

Background:Metabolic age is an important risk marker that can be easily understood by patients in clinical practice. In this study, we aimed to investigate the association of metabolic age with chronological age and physical examination score in male and female patients with type 2 diabetes mellitus. Material and Method:Male (n:50) and female patients (n:72) with T2DM were included in the study. Anthropometric measurements were obtained with Tanita MC-780MA device, waist/hip and waist/height ratios were calculated, variables were compared between groups and correlation with met age was analyzed. Linear regression analysis was used to determine the factors affecting met age. Results:The difference between met-age and chronological age was significantly higher in female patients with T2DM (age difference: 6.0∓3.79 in female group, 3.38∓2.80 in male group) (p<0.001). BMI values, degree of obesity and fat mass were significantly higher in women (p<0.001), waist/hip ratios were lower (p<0.001) and waist/height ratios were higher (p=0.001). Physical examination score, muscle mass, lean mass and BMR were higher in men than in women (p<0.001).There was a significant positive association of met age with chronological age and a significant negative association with physical examination score in both sexes (p<0.05). According to the linear regression model, it was found that met age was positively affected by chronological age and waist/height ratio and negatively affected by physical examination score in the female group (R2 =0.983).In the male group, it was observed that it was positively affected by chronological age, obesity degree, body mass index (BMI) and negatively affected by physical examination score (R2 =0.974). Conclusions:Met age increases with increasing chronological age and decreasing physical examination score in male and female patients with T2DM.

Context center dot Growth/differentiation factor-15 (GDF-15) is a diagnostic and prognostic marker associated with inflammation, renal damage, and cardiovascular risk in type-2 diabetes mellitus. Researchers have proposed treatment targets that reduce GDF-15 levels. Objective center dot Our aim in this study is to investigate the effect of major autohemotherapy on GDF-15 levels and to evaluate it as a complementary therapy. Design center dot The research team designed a laboratory study to examine the effect of major hemotherapy on GDF-15 levels in patients with type-2 diabetes mellitus and healthy volunteers. Blood was drawn from the participants in a closed system, infused with ozone gas, and reinfused into the patients. Setting center dot The study was carried out from 15 August-5 October at Kirsehir Training and Research Hospital Traditional and Complementary Medicine Center, Turkey. Participants center dot The study was conducted prospectively, and two groups were formed, consisting of those with type-2 diabetes mellitus (n = 21) and healthy volunteers (n = 14). Outcome Measures center dot All participants received 10 sessions of major autohemotherapy at a concentration of 25-35 micrograms/milliliter twice a week. Before and after the application, GDF-15, fasting glucose, glycosylated hemoglobin, and lipid panel levels were studied and compared. Results center dot Age, GDF-15, fasting glucose, glycosylated hemoglobin, and triglyceride levels were found to be higher in the type-2 diabetes mellitus group compared to the healthy group, and high-density lipoprotein cholesterol levels were found to be lower. After major autohemotherapy, GDF-15 and low-density lipoprotein cholesterol decreased significantly in the type-2 diabetes mellitus group. No change was observed in the healthy group. Conclusions center dot As a new treatment strategy, major autohemotherapy reduces GDF-15 levels in type-2 diabetes mellitus and contributes to the therapeutic effects of ozone therapy.

Aim: The phase angle obtained from the maximum reactance (PA max) is a better potential indicator than the phase angles obtained from multiple frequencies. Our aim in this study is to investigate the correlation of PA max with fasting glucose and hemoglobin A1c in Type-2 Diabetes Mellitus (T2 DM). Material and Methods: The study was conducted prospectively, two groups were formed as T2 DM (n=75) and healthy controls (n=32) and their demographic variables were examined. Right hand, left hand, right leg, left leg, hand leg and leg leg segment measurements were taken with electrical impedance method and phase angle was obtained at maximum reactance. Correlations with fasting glucose, hemoglobin A1c and other variables were examined. Results: Fasting glucose, glycated hemoglobin A1c, age, body mass index, body fat percentage were found to be significantly higher in the T2 DM group compared with the healthy group. However, RH PA max, RL PA max, LL PA max, H_L PA max, and L_L PA max values were found to be significantly lower than in the healthy group. In T2 DM group, hemoglobin A1c was found significantly negative correlated with PA max in all segments, while fasting glucose is negatively correlated with all segments except LH Pamax. Conclusion: PA max is significantly reduced by the impaired glycemic index in T2 DM and is a potential marker reflecting metabolic status.

Aim: To investigate the correlation of GDF-15 with renal damage and dyslipidemia in Type-2 Diabetes Mellitus.Material and Method: The study was conducted prospectively with patients diagnosed with Type-2 Diabetes Mellitus. Two groups were formed as non-albuminuric (n:47) and albuminuric (n:24). Age, gender, comorbidities, GDF-15, glycemic index, lipid panel, GFR, urine albumin/creatin (ACR) and urine protein/creatin (PCR) ratios of the groups were compared and their correlations were examined.Results: GDF-15, age and hemoglobin A1c were found to be higher in the albuminuric group, and hemoglobin and hematocrit levels were found to be lower. A positive correlation of GDF-15 with urine ACR/PCR was observed in the albuminuric group. In the non-albuminuric group, was observed positive correlation with Triglyceride and negative correlation with HDL. Negative correlation of GDF-15 and GFR was detected in all participants.Conclusions: In type-2 DM, GDF-15 is positively correlated albuminuria and TRG elevation and negatively correlated with GFR and HDL