Sezin Doğan Çakır

Hypoparathyroidism is a chronic endocrine disorder requiring lifelong management, with real-world data on the impact of follow-up setting on biochemical an

Summary: We assessed bone health in over 2500 adults with diabetes across Türkiye. T1DM patients had lower BMD, while T2DM patients showed higher fracture risk despite higher BMD. Several modifiable factors were linked to osteoporosis. These findings support personalized bone assessments in diabetic populations. Background: Diabetes mellitus (DM) is a recognized risk factor for bone fragility. While type 1 DM (T1DM) is typically associated with low bone mineral density (BMD), type 2 DM (T2DM) often presents with higher BMD despite increased fracture risk. Large-scale comparative studies remain limited. Objective: To evaluate bone health, including osteopenia, osteoporosis, and fracture risk, in adults with T1DM and T2DM. Methods: This multicenter, cross-sectional study included 2562 patients (224 with T1DM, 2338 with T2DM) from 27 centers across Türkiye. BMD was assessed using dual-energy X-ray absorptiometry (DXA) and fracture risk was estimated via the Turkish-adapted FRAX® algorithm in patients aged ≥ 40 years. Multinomial logistic regression was used to identify independent predictors of low BMD. Results: Osteoporosis prevalence was 5.5% in T1DM and 9.6% in T2DM (femoral neck T-score). Adjusted BMD was significantly lower in T1DM at all skeletal sites, while FRAX-based fracture risk and fall-related fractures were higher in T2DM. Independent predictors of osteoporosis included older age, female sex, lower BMI, reduced calcium levels, corticosteroid use, albuminuria, hypertension, and less frequent sodium-glucose cotransporter-2 (SGLT2) inhibitor use. T1DM was independently associated with osteopenia but not osteoporosis. Conclusion: This multicenter study demonstrates distinct patterns of BMD and fracture risk across diabetes subtypes and supports individualized bone health assessment in routine diabetes care.

SUMMARY OBJECTIVE: Fibrosis-4 (a liver fibrosis index) and triglyceride–glucose (an insulin resistance surrogate) indices may be markers associated with kidney stone risk. The aim of this study was to evaluate the association between triglyceride–glucose and fibrosis-4 indices and the presence of nephrolithiasis in adults. METHODS: This retrospective cross-sectional case–control study included 918 adults (785 with nephrolithiasis, 133 controls) evaluated between January 2016 and December 2023. Controls were consecutive patients from the same urology outpatient population who underwent abdominal imaging for non-stone-related urological indications, with no radiological evidence of nephrolithiasis. Triglyceride–glucose and fibrosis-4 indices were calculated using standard formulas. The triglyceride–glucose index was standardized (per 1 SD=0.23 units) prior to multivariable logistic regression including age, sex, and fibrosis-4. RESULTS: Triglyceride–glucose was significantly higher in stone formers (4.87±0.21 vs. 4.64±0.20; p<0.001). In multivariable analysis, triglyceride–glucose independently predicted nephrolithiasis (adjusted OR per 1 SD=3.52; 95%CI 2.48–5.00; p<0.001); male sex was also independently associated. Fibrosis-4 was not independently associated (p=0.809). Triglyceride–glucose area under the curve was 0.779 (95%CI 0.729–0.827), consistent across both sexes (interaction p=0.135). CONCLUSION: Each 1 SD increase in triglyceride–glucose was associated with a 3.5-fold increase in odds of nephrolithiasis, independent of age, sex, and fibrosis-4. Fibrosis-4 showed no independent utility. Prospective studies are needed to confirm these findings.

This study aimed to evaluate the clinical outcomes of switching from disposable insulin delivery pens to reusable insulin pens with a penfill cartridge system for the co-formulation of insulin degludec and insulin aspart (IDegAsp) in patients with type 2 diabetes (T2D) in Türkiye. We assessed the impact on glycemic control to evaluate the sustainability of this transition. A total of 226 adults with T2D who were initiating or switching to IDegAsp reusable cartridge insulin pens at a tertiary center in Türkiye were followed for 6 months. Data were retrospectively extracted from the medical records at baseline (prior to switching) and at follow-up visits after 3 and 6 months of IDegAsp Penfill reusable cartridges. Initiating the IDegAsp reusable cartridge insulin pen in patients who previously used basal-bolus, basal, or premixed insulin therapies with disposable insulin pens was associated with a significant reduction in mean glycated hemoglobin (HbA1c) [mean change -1.0% (95% confidence interval (CI) − 2.2 to − 0.20; p < 0.001)], [− 1.4% (95% CI − 2.3 to − 0.4; p < 0.001)], and [− 0.9% (CI − 1.7 to − 0.1; p < 0.001)]. Switching from IDegAsp disposable insulin pens to the reusable system demonstrated noninferior outcomes [− 0.08% (CI − 0.2 to 0.1; p = 0.629)]. The mean total daily insulin dose and body weight were also significantly lower in patients who were switched from basal-bolus insulin, basal insulin or premixed insulin therapies (p < 0.001 and p < 0.001, respectively). Initiating or switching to the IDegAsp reusable pen with the insulin cartridge system in a real-world population of people with T2D in Türkiye was associated with improved or maintained glycemic control.

Summary This study investigates the osteoporosis treatment gap and mortality following hip fractures in Turkey. We found that 83.1% of patients did not receive post-fracture osteoporosis treatment, with a 1-year mortality rate of 37%. Prior treatment, younger age, and parenteral medications were significant predictors of treatment adherence. These findings highlight the urgent need to address treatment gaps and improve patient outcomes. Objective This study aimed to evaluate the osteoporosis treatment gap, mortality rates, and predictors of mortality in hip fracture patients in a tertiary center in Turkey. Methods A retrospective analysis was conducted of 552 patients aged over 50 years who were hospitalized for hip fractures at Prof. Dr. Cemil Taşcıoglu City Hospital between January 2015 and November 2022. Data were collected from electronic medical records, including pre- and post-fracture osteoporosis treatment, treatment initiation times, bone mineral density (BMD) tests, and patient outcomes. Results The mean age of the cohort was 80.2 years, with a predominance of female patients (65.1%). Prior to the fracture, 90.8% of patients had not received osteoporosis treatment. After the fracture, 83.1% of patients did not receive any osteoporosis medications. Of those treated, 45 patients (8.6%) started treatment within 3 months. The 1-year mortality rate was 37%, with significant predictors including age, male gender, lack of prior osteoporosis treatment, delayed treatment initiation, and short treatment duration. Only 5.6% of patients had a BMD test within the first year after the fracture, which was associated with improved treatment adherence and lower mortality. Conclusions The study highlights a significant treatment gap for osteoporosis in hip fracture patients in Turkey. Prior treatment history, younger age, and use of parenteral therapies were strong predictors of adherence to post-fracture osteoporosis treatment. These findings emphasize the need for improved healthcare provider awareness, better treatment initiation protocols, and the implementation of Fracture Liaison Services.

Background/Purpose: Our aim was to investigate whether Hashimoto’s Thyroiditis (HT) effects the development of thyroid carcinoma or not. Methods: We examined 772 patients’ file between january 2000 and december 2010 retrospectively at Istanbul University Cerrahpasa Medical School Endocrinology and Metabolism Clinic, whom fine-needle aspiration biopsy (FNAB) were applied. We noted patient’s demographic findings, anti-thyroglobulin antibody (anti-TG) and anti-thyroperoxidase antibody (anti-TPO) levels, ultrasonography (US) and cytology reports. We compared findings of HT patients with nonhashimoto control group. Results: 393 patients with mean age 46.11 ± 12.53 of whom 39 male and 354 female with HT and thyroid nodules (HT group) were compared with 379 patients with mean age 47.5 ± 12.6 of whom 53 male and 326 female with nonautoimmune thyroid disease and nodules (control group). We found the prevalance of differentiated thyroid carcinoma 6.6% in the HT group and backwards 12.9% in the control group (p=0.03). There were not any distinguishing US findings between groups. Anti-TPO positivity was significantly higher in benign nodules (p=0.008). Conclusion: Our findings did not point out an increased risk of Hashimoto’s nodules in terms of differentiated thyroid carcinoma development.

The Medical Bulletin of Sisli Etfal Hospital

Context: The aims of the study are to compare characteristics of subacute thyroiditis (SAT) related to different etiologies, and to identify predictors of recurrence of SAT and incident hypothyroidism. Methods: This nationwide, multicenter, retrospective cohort study included 53 endocrinology centers in Turkey. The study participants were divided into either COVID-19–related SAT (Cov-SAT), SARS-CoV-2 vaccine–related SAT (Vac-SAT), or control SAT (Cont-SAT) groups. Results: Of the 811 patients, 258 (31.8%) were included in the Vac-SAT group, 98 (12.1%) in the Cov-SAT group, and 455 (56.1%) in the Cont-SAT group. No difference was found between the groups with regard to laboratory and imaging findings. SAT etiology was not an independent predictor of recurrence or hypothyroidism. In the entire cohort, steroid therapy requirement and younger age were statistically significant predictors for SAT recurrence. C-reactive protein measured during SAT onset, female sex, absence of antithyroid peroxidase (TPO) positivity, and absence of steroid therapy were statistically significant predictors of incident (early) hypothyroidism, irrespective of SAT etiology. On the other hand, probable predictors of established hypothyroidism differed from that of incident hypothyroidism. Conclusion: Since there is no difference in terms of follow-up parameters and outcomes, COVID-19– and SARS-CoV-2 vaccine–related SAT can be treated and followed up like classic SATs. Recurrence was determined by younger age and steroid therapy requirement. Steroid therapy independently predicts incident hypothyroidism that may sometimes be transient in overall SAT and is also associated with a lower risk of established hypothyroidism.

Bilgiye erişimin kolaylaştığı günümüzde, maalesef her birimiz zaman zaman; pratik, ayrıntıdan uzak ve hedefe yönelik bilgiye ulaşmakta zorlanmışızdır. Elinizdeki bu eser, sahada birebir vaka görüp aktif çalışan hekimlerimiz tarafından kaleme alınmış olup kolay, anlaşılır, ayrıntıdan uzak ve hedefe yönelik bilgileri vakalar üzerinden okuyucuya ulaştırmayı hedeflemektedir. Aile hekimleri, iç hastalıkları hekimleri, endokrinoloji alanında çalışan ya da tiroid hastalıkları ile ilgilenen tüm meslektaşlarımızın ilgiile okuyup faydalanabileceği bir kaynak oluşturulduğu kanaatindeyiz. Siz değerli meslektaşlarımızın geri bildirimleri ile bir sonraki baskı ve eserde huzurlarınıza daha öz güvenli çıkmayı umuyoruz