ACTA ENDOCRINOLOGICA (BUC)

Objective. To determine the prevalence of overtreatment and hypoglycemia in Turkish type-2 diabetes patients and to identify the risk factors. Methods. Patients ≥ 65 years, having a minimum 5 years of type-2 diabetes, were included in the study. Patients’ body mass index, mean HbA1c level, disease onset and medications related with their co-morbidities were recorded. Over-treatment is defined as the use of non-metformin therapies despite having HbA1c levels < 7%. A history of hypoglycemia episodes in the last three months and patients’ home blood glucose measurements were recorded. Factors relating to hypoglycemia and over-treatment were analyzed. Results. After applying criteria, 755 patients were included in the study: 728 patients (96.4%) had at least one comorbidity. 257 patients (34%) were found to have HbA1c levels < 7%. 217 of them (84.4%) were using non-metformin therapies. 497 patients (65.8%) were using insulin. The overtreatment prevalence in the ≥ 65 years group was 28.7%. The over-treatment ratio in ≥ 80 years group was 28.2%. Hypoglycemia prevalence in the last three months was 23.3%. It was 22.7% for patients ≥ 80 years. Mean age, disease duration, body mass index, insulin usage and doses were found to be significantly different in over-treated patients compared to the others. Conclusions. This study showed that despite recent guidelines, there is still a considerable amount of overtreated geriatric patients who are at risk of hypoglycemia and related morbidity and mortality. Insulinization rate was high. Physicians should not avoid de-intensifying the treatment of geriatric patients who have multiple co-morbidities.

Background. Primary hyperparathyroidism and vitamin D deficiency are both associated with increased prevalence\r\nof anemia. Relationship of hemoglobin and parathyroid hormone in normal ranges were not investigated appropriately.\r\nMethods. We analysed laboratory data of 476 patients without primary hyperparathyroidism. The patients had concurrent measurements of calcium, phosphorus, alkaline phosphatase, parathyroid hormone, 25-OH vitamin D and hemoglobin.\r\nResults. Parathyroid hormone was negatively correlated with hemoglobin (p=0.01), the correlation persisted after\r\ncorrection for vitamin D levels (p=0.045), and in sub-group of normal (>20 ng/mL) 25-OH vitamin D levels (p=0.005). Parathyroid hormone was also correlated negatively with\r\nferritin (p=0.02), correlation persisted after being adjusted to vitamin D (p=0.021). In anemic patients, these with low ferritin (<12 ng/mL) had higher PTH levels than these with higher ferritin despite having similar calcium\r\nand vitamin D levels (p=0.014).\r\nConclusion. Interaction of parathyroid hormone and erythropoiesis seems to be present in normal ranges where\r\nerythropoietin may mediate key roles regulating both.