Tip 2 diyabetes mellitus hastalarında SGLT-2 inhibitörü tedavisi ile serum klotho ve FGF-23 düzeylerindeki değişimin değerlendirilmesi
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Dosyalar
Tarih
2023
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Selçuk Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Çalışmanın amacı T2DM tanısı olan SGLT-2 inhibitörü başlanan hastaların başlangıç ve 6. Aydaki HbA1c, FGF-23 ve serum Klotho değişimleri ve arasında ilişki olup olmadığını incelemektir. Yöntem: Çalışmamıza T2DM tanısı olup Endokrinoloji Bilim Dalı polikliniğe başvuran ve çalışmaya dahil olma kriterlerine uyup SGLT-2 inhibitörü başlanan 81 hasta dahil edildi. Çalışmaya T2DM tanısı olup oral antidiyabetik veya insülin kullanan, 18 yaş üstü ve BKİ 45 kg/m2'nin altında olan, gönüllü olur formu imzalayan hastalar dâhil edildi. 18 yaşından küçük, gebelik durumu olan, malignitesi olan, son 3 ay içinde sistemik steroid alma hikayesi olan kişiler, aktif enfeksiyonu olan ve SGLT-2 inhibitörü kullanımı için kontrendikasyona sahip olan hastalar çalışmaya dâhil edilmedi. Rutin tetkiklerinden olan glikoz kreatinin, üre, ALT, AST, LDL, HDL, trigliserid, kolesterol, TSH, D vitamini, kalsiyum, fosfor, sodyum, potasyum, HbA1c, insülin, c-peptit, hemogram, spot idrarda mikroalbumin/kreatinin ve protein/kreatin, FGF-23 ve Klotho değerleri çalışıldı. Tedavinin başlangıcından 6 ay sonra kontrole çağırıldı. Başlangıç ve 6. aydaki HbA1c, FGF-23 ve Klotho düzeylerinin değişimi ve aralarındaki ilişki incelendi. Bulgular: Çalışmamıza katılan hastaların 48'i (%59.3) erkek, 33'ü (%40.7) kadın cinsiyette idi. Hastaların yaş ortalaması 59.13±10.02, BKİ ortalamaları ise 31.09±5.48 olarak tespit edildi. Çalışmaya dahil edilen hastaların 49 (%60.5)'unda hipertansiyon, 24 (%29.6)'ünde koroner arter hastalığı, 20 (%24.7)'sinde hiperlipidemi tanısı mevcut idi. Klotho ve FGF-23 düzeyleri ile KAH, albuminüri ve HT arasında istatistiksel açıdan anlamlı fark saptanmadı. Hastaların 6. ayda ölçülen Klotho ve FGF-23 düzeylerinin başlangıca göre istatistiksel olarak anlamlı yüksek olduğu tespit edildi. Hastaların HbA1c düzeylerinin 6. ayda başlangıç düzeylerine göre istatistiksel olarak anlamlı düşük olduğu saptandı. Hastaların başlangıç ve 6. ayda ölçülen Klotho, FGF-23 ve HbA1c düzeylerindeki değişimlerin arasında istatistiksel olarak anlamlı fark tespit edilmedi. Başlangıçtaki ve 6. aydaki HbA1c düzeyleri sabit tutularak yapılan parsiyel korelasyon analizinde; başlangıçta ve 6. ayda ölçülen Klotho ve FGF-23 düzeyleri arasında pozitif yönde mükemmel korelasyon tespit edildi. Sonuç: Çalışmamız T2DM tanısı olan ve tedavisine SGLT-2 inhibitörü eklenen hastaların başlangıç ve 6. aydaki HbA1c ile FGF-23 ve Klotho değişimi arasındaki ilişkiyi incelemek için yapılmıştır. SGLT-2 inhibitörü sonrası, Klotho ve FGF-23 düzeyi artmış, HbA1c değeri ise azalmıştır. Klotho, FGF-23 ve HbA1c düzeylerindeki değişimlerin arasında istatistiksel olarak anlamlı fark tespit edilmedi. Başlangıç ve 6. ayda HbA1c ve glukoz düzeyleri sabit tutularak yapılan parsiyel korelasyon analizinde Klotho ve FGF-23 düzeyleri arasında korelasyonun devam ettiği görüldü. Bu veriler göz önüne alındığında SGLT-2 inhibitörlerinin kan şekeri düşüşünden bağımsız bir etki ile FGF-23 ve Klotho seviyelerinin değişimlerine neden olduğu düşünüldü.
Objective: The aim of the study was to investigate the changes in HbA1c, FGF-23 and serum Klotho at baseline and at 6 months in patients with T2DM who were started on SGLT-2 inhibitors and whether there was a relationship between them. Methods: The study included 81 patients with T2DM who were admitted to the Endocrinology Department outpatient clinic, met the inclusion criteria and were started on SGLT-2 inhibitors. Patients with a diagnosis of T2DM who used oral antidiabetic or insulin, were over 18 years of age, had a BMI below 45 kg/m2 and signed a consent form were included in the study. Patients younger than 18 years of age, pregnant women, patients with malignancy, patients with a history of taking systemic steroids in the last 3 months, patients with active infection and patients with contraindications for the use of SGLT-2 inhibitors were excluded. Routine tests including glucose creatinine, urea, ALT, AST, LDL, HDL, triglyceride, cholesterol, TSH, vitamin D, calcium, phosphorus, sodium, potassium, HbA1c, insulin, c-peptide, haemogram, microalbumin/creatinine and protein/creatinine in spot urine, FGF-23 and Klotho values were studied. The patients were called for follow-up 6 months after the start of treatment. The changes in HbA1c, FGF-23 and Klotho levels at baseline and 6 months and the relationship between them were analysed. Results: Of the patients who participated in our study, 48 (59.3%) were male and 33 (40.7%) were female. The mean age and BMI of the patients were 59.13±10.02 and 31.09±5.48, respectively. Hypertension was diagnosed in 49 (60.5%), coronary artery disease in 24 (29.6%) and hyperlipidaemia in 20 (24.7%) of the patients included in the study. No statistically significant difference was found between Klotho and FGF-23 levels and CAD, albuminuria and HT. Klotho and FGF-23 levels measured at 6 months were found to be statistically significantly higher than baseline. HbA1c levels of the patients were found to be statistically significantly lower at 6 months compared to baseline. There was no statistically significant difference between the changes in Klotho, FGF-23 and HbA1c levels measured at baseline and 6th month. In the partial correlation analysis performed by keeping the baseline and 6-month HbA1c levels constant, an excellent positive correlation was found between Klotho and FGF-23 levels measured at baseline and 6 months. Conclusion: Our study was conducted to investigate the relationship between HbA1c and changes in FGF-23 and Klotho at baseline and 6 months in patients with T2DM who were treated with SGLT-2 inhibitor. After SGLT-2 inhibitor, Klotho and FGF-23 levels increased and HbA1c value decreased. There was no statistically significant difference between the changes in Klotho, FGF-23 and HbA1c levels. Partial correlation analysis performed by keeping HbA1c and glucose levels constant at baseline and 6 months showed that the correlation between Klotho and FGF-23 levels continued. Considering these data, SGLT-2 inhibitors were thought to cause changes in FGF-23 and Klotho levels with an effect independent of blood glucose reduction.
Objective: The aim of the study was to investigate the changes in HbA1c, FGF-23 and serum Klotho at baseline and at 6 months in patients with T2DM who were started on SGLT-2 inhibitors and whether there was a relationship between them. Methods: The study included 81 patients with T2DM who were admitted to the Endocrinology Department outpatient clinic, met the inclusion criteria and were started on SGLT-2 inhibitors. Patients with a diagnosis of T2DM who used oral antidiabetic or insulin, were over 18 years of age, had a BMI below 45 kg/m2 and signed a consent form were included in the study. Patients younger than 18 years of age, pregnant women, patients with malignancy, patients with a history of taking systemic steroids in the last 3 months, patients with active infection and patients with contraindications for the use of SGLT-2 inhibitors were excluded. Routine tests including glucose creatinine, urea, ALT, AST, LDL, HDL, triglyceride, cholesterol, TSH, vitamin D, calcium, phosphorus, sodium, potassium, HbA1c, insulin, c-peptide, haemogram, microalbumin/creatinine and protein/creatinine in spot urine, FGF-23 and Klotho values were studied. The patients were called for follow-up 6 months after the start of treatment. The changes in HbA1c, FGF-23 and Klotho levels at baseline and 6 months and the relationship between them were analysed. Results: Of the patients who participated in our study, 48 (59.3%) were male and 33 (40.7%) were female. The mean age and BMI of the patients were 59.13±10.02 and 31.09±5.48, respectively. Hypertension was diagnosed in 49 (60.5%), coronary artery disease in 24 (29.6%) and hyperlipidaemia in 20 (24.7%) of the patients included in the study. No statistically significant difference was found between Klotho and FGF-23 levels and CAD, albuminuria and HT. Klotho and FGF-23 levels measured at 6 months were found to be statistically significantly higher than baseline. HbA1c levels of the patients were found to be statistically significantly lower at 6 months compared to baseline. There was no statistically significant difference between the changes in Klotho, FGF-23 and HbA1c levels measured at baseline and 6th month. In the partial correlation analysis performed by keeping the baseline and 6-month HbA1c levels constant, an excellent positive correlation was found between Klotho and FGF-23 levels measured at baseline and 6 months. Conclusion: Our study was conducted to investigate the relationship between HbA1c and changes in FGF-23 and Klotho at baseline and 6 months in patients with T2DM who were treated with SGLT-2 inhibitor. After SGLT-2 inhibitor, Klotho and FGF-23 levels increased and HbA1c value decreased. There was no statistically significant difference between the changes in Klotho, FGF-23 and HbA1c levels. Partial correlation analysis performed by keeping HbA1c and glucose levels constant at baseline and 6 months showed that the correlation between Klotho and FGF-23 levels continued. Considering these data, SGLT-2 inhibitors were thought to cause changes in FGF-23 and Klotho levels with an effect independent of blood glucose reduction.
Açıklama
Anahtar Kelimeler
SGLT-2 İnhibitörü, FGF-23, Klotho, HbA1c, SGLT-2 Inhibitor
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Özkan, H. C. (2023). Tip 2 diyabetes mellitus hastalarında SGLT-2 inhibitörü tedavisi ile serum klotho ve FGF-23 düzeylerindeki değişimin değerlendirilmesi. (Uzmanlık Tezi). Selçuk Üniversitesi, Tıp Fakültesi, Konya.
