Wos İndeksli Yayınlar Koleksiyonu

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Author: search.filters.author.Kirnap, Nazli

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    The Screening of Comorbid Depressive Disorders and Associated Risk Factors in Adult Patients with Type 2 Diabetes
    (2020) Demirci, Ibrahim; Haymana, Cem; Sonmez, Alper; Bolu, Abdullah; Kirnap, Nazli; Demir, Orhan; Meric, Coskun; Oysul, Guven; Aydogdu, Aydogan; Ersoz Gulcelik, Nese; Azal, Omer
    Objective: Elevated depressive symptoms and disorders affect one in five patients with diabetes. Current guidelines recommend screening depression in the diabetic population. Turkey has the highest (13.7%) prevalence of diabetes in Europe. However, there are limited data about the prevalence of depressive disorders among diabetic patients in Turkey. We aim to investigate the prevalence of a comorbid depressive disorder in Type 2 diabetic patients who were referred to the Endocrinology outpatient unit of a tertiary hospital. Material and Methods: All the Type 2 diabetic patients admitted to our endocrinology department were consecutively included in the study. Their sociodemographics, concomitant diseases and medications, macro and microvascular complications, lifestyle and personal habits, and treatment regimens were obtained by a specifically designed questionnaire. Laboratory data were obtained from the hospital records. The Patient Health Questionnaire-9 (PHQ-9), a depression screening tool, was used as a screening method for depression. Patients with a score of 10 or above determined high risk for depressive disorder according to PHQ-9. The scores were re-evaluated by a psychiatrist to minimize the false negative and positive results. Result: A total of 460 patients with Type 2 diabetic were enrolled in this crosssectional study. 18.9% (n=87) of the participants were found to have depressive disorders according to the psychiatric evaluation done after the PHQ-9 questionnaire. Patients with depressive disorders were predominantly female (69.0% vs. 55.5%; p=0.022), younger (57.2 +/- 10.5 vs. 60.0 +/- 9.5; p=0.014), had higher HbAlc (8.51 +/- 2.51 vs. 7.98 +/- 2.05; p=0.042), total cholesterol (205.6 +/- 44.2 vs. 194.2 +/- 46.0; p=0.045), LDL-cholesterol (123.1 +/- 37.8 vs. 113.1 +/- 35.4; p=0.026) and non-HDL-cholesterol (158.5 +/- 41.61 vs. 146.6 +/- 42.7; p=0.024). These patients had frequent neuropathy (37.3% vs. 19.0%, p=0.001), they were less likely to perform exerdse (31.8% vs. 53.1%; p<0.001) while smoke in excess (31.4% vs. 14.3%; p<0.001). The analysis showed that female gender (OR=4.4; 95% CI=1.6-12.8; p=0.005) and smoking (OR=7.6; 95% CI=2.8-20.5, p<0.001) are independent determinants of a depressive disorder. Conclusion: Approximately one-fifth of diabetic patients had a depressive disorder, and their metabolic parameters were worse than those without a depressive disorder. Therefore, to assess a diabetic patient from all aspects, screening for depressive disorder should be made an indispensable part of the evaluation process.
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    Short-Term Effect of Hypergastrinemia Following Esomeprazole Treatment On Well-Controlled Type 2 Diabetes Mellitus: A Prospective Study
    (2020) Bozkus, Yusuf; Mousa, Umut; Iyidir, Ozlem T.; Kirnap, Nazli; Demir, Canan C.; Nar, Asli; Tutuncu, Neslihan B.; 0000-0002-1816-3903; 0000-0002-6976-6659; 0000-0002-8078-9376; 0000-0001-5305-6807; 0000-0003-0998-8388; 31995024; ABG-5027-2020; AAA-5419-2021; AAK-4857-2021; I-1735-2018; K-7904-2019; AAA-2743-2021
    Objective: Proton pump inhibitor (PPI) drugs reduce gastric acid secretion and lead to an increase in serum gastrin levels. Many preclinical and some clinical researches have established some positive effects of gastrin or PPI therapy on glucose regulation. The aim of this study was to prospectively investigate the short term effects of esomeprazole on glycaemic control in patients with type 2 diabetes mellitus. In addition, the presence of an association between this effect and gastrin levels was evaluated. Methods: Thirty-two subjects with type 2 diabetes mellitus were enrolled and grouped as intervention (n=16) and control (n=16). The participants in the intervention group were prescribed 40 mg of esomeprazole treatment for three months. At the beginning of the study and at the 3rd month, HbA1c level (%) and gastrin levels (pmol/L) of participants were assessed. Then, the groups were compared in terms of their baseline and 3rd month values. Results: In the intervention group, the mean gastrin level increased significantly from 34.3 +/- 14.4 pmol/L to 87.4 +/- 43.6 pmol/L (p<0.001). The mean HbA1c level was similar to the pre-treatment level (6.3 +/- 0.7% vs. 6.4 +/- 0.9%, p=0.441). There were no statistically significant differences in all parameters of the control group. The majority of individuals were on metformin monotherapy (65.6 %). The subgroup analysis of metformin monotherapy revealed that, in intervention group, there was a significant increase in gastrin levels (39.9 +/- 12.6 vs. 95.5 +/- 52.5, p=0.026), but the HbA1c levels did not change (6.0 +/- 0.4 % vs. 5.9 +/- 0.6 %, p=0.288); and in control group, gastrin levels did not change (37.5 +/- 26.7 vs. 36.1 +/- 23.3, p=0.367), but there was an increase in HbA1c levels (6.1 +/- 0.50 vs. 6.4 +/- 0.60, p=0.01). Conclusion: Our study demonstrates that esomeprazole has no extra benefit for the controlled diabetic patient in three months. However, in only the metformin-treated subgroup, esomeprazole may prevent the rise in HbA1c level.