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    Coronary heart disease in patients with type 2 biabetes: The role of traditional, behavioral and atherogenic risk factors in a large multicenter study
    (Oxford University Press, 2026) Telci Çaklılı, Özge; Demirci, İbrahim; Haymana, Cem; Hacışahinoğulları, Hülya; Kılınç, Faruk; Karakoç, Ayhan; Sarı, Ramazan; Taşçı, İlker; Salman, Serpil; Ersoy, Canan; Bayram, Fahri; Satman, İlhan; Sönmez, Alper
    Background Type 2 diabetes mellitus (T2DM) substantially increases the risk of coronary artery disease (CAD) through insulin resistance, inflammation, and related complications. In this large, nationally representative multicenter study, we investigated behavioral and metabolic risk factors associated with CAD in T2DM. Materials and Methods This cross-sectional study was conducted across Türkiye, including 70 endocrine clinics in 36 cities. Adults with T2DM followed at the same center for at least one year were included. Sociodemographic, anthropometric, clinical, laboratory, and lifestyle data were recorded using a standardized web-based system. Results A total of 5707 patients with diabetes were recruited, of whom 4956 (86.8%) had T2DM (mean age 58.9 ± 10.0 years; 59.8% women). CAD status was available in 4750 patients, among whom 1061 (22.3%) had CAD. CAD was more frequent in men than women (30.4% vs 16.9%, P < .001). Patients with CAD were older (62.8 ± 8.6 vs 57.8 ± 10.2 years, P < .001) and had longer diabetes duration (16.1 ± 8.8 vs 12.2 ± 7.7 years, P < .001). Body mass index was lower (31.2 ± 5.8 vs 31.8 ± 6.8 kg/m2, P = .005), whereas waist circumference was higher (106.7 ± 13.7 vs 105.1 ± 14.1 cm, P = .004). Lower income was associated with CAD (23.4% vs 19.5%, P = .003), whereas smoking and exercise were not (P = .219 and P = .977). Hypertension was associated with CAD (28.2% vs 14.5%, P < .001). Systolic blood pressure was higher (126.1 ± 13.6 vs 124.3 ± 13.6 mmHg, P = .004), while diastolic pressure did not differ (P = .603). HbA1c was higher in the CAD group (8.27 ± 1.94 vs 7.84 ± 1.89%, P < .001), and hypoglycemia was more frequent (24.6% vs 20.8%, P = .002). In multivariable logistic regression, independent predictors of CAD were older age (OR 1.04, 95% CI 1.03-1.05, P < .001), male sex (OR 0.39, 95% CI 0.33-0.46, P < .001), current smoking (OR 1.37, 95% CI 1.12-1.66, P = .002), hypertension (OR 2.00, 95% CI 1.68-2.38, P < .001), microvascular complications (OR 1.48, 95% CI 1.26-1.74, P < .001), higher HbA1c (OR 1.12 per %, 95% CI 1.07-1.17, P < .001), longer diabetes duration (OR 1.04 per year, 95% CI 1.02-1.05, P < .001), and lower income (OR 0.74, 95% CI 0.62-0.88, P = .001). Exercise, diet, hypoglycemia, education, and body mass index were not independently associated with CAD (all P > .05). Conclusion In this large national cohort of T2DM patients, CAD was independently associated with classical cardiometabolic risk factors, microvascular complications, and lower income, whereas lifestyle factors were not independently associated after adjustment. These findings highlight dominant role of cumulative metabolic burden and vascular damage in determining CAD risk and emphasize the importance of early, sustained, risk factor–targeted management.
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    Suboptimal LDL-cholesterol control under the 2019 ESC/EAS dyslipidemia guidelines: Results from the nationwide TEMD-2 study in type 2 diabetes
    (Wiley, 2026) Telci Çaklılı, Özge; Haymana, Cem; Demirci, İbrahim; Kebapçı, Medine Nur; Sarıakçalı, Barış; Evren, Bahri; Dizdar, Oğuzhan Sıtkı; Salman, Serpil; Ersoy, Canan; Satman, İlhan; Bayram, Fahri; Sönmez, Alper
    Background: Lowering LDL cholesterol (LDL-C) decreases cardiovascular risk substantially in type 2 diabetes. Despite stricter LDL-cholesterol targets in the 2019 ESC/EAS dyslipidemia guidelines, target achievement in clinical practice remains insuffi cient. TEMD-2 is designed to evaluate LDL-cholesterol target attainment in Turkish patients with type 2 diabetes in the context of the updated 2019 ESC/EAS guidelines. Methods: This multicenter cross-sectional study included adults with type 2 diabetes followed in 70 tertiary endocrine clinics across 36 cities between October 2022 and January 2023. Sociodemographic characteristics, comorbidities, lifestyle factors, com plications, laboratory measurements, and lipid-lowering therapies were assessed using standardized questionnaires and clinical evaluations. LDL-C target was assigned according to cardiovascular risk categories. Independent predictors of goal attainment were identified using multivariable logistic regression. Results: Among 4956 adults with type 2 diabetes, 99.5% required statin therapy, whereas 37.1% were on treatment. Overall, 8.3% of the cohort achieved LDL-cholesterol targets, with attainment lowest in those at very high risk (5.8%). Target achievement among statin users was 57.7% in moderate-risk, 18.1% in high-risk, and 9.4% in very-high-risk patients. Individuals on target had lower body mass index, haemoglobin A1c (HbA1c), triglycerides, and a lower prevalence of microvascular complications. Statin therapy was the strongest positive predictor of success (odds ratio 2.39), while smoking, presence of neuropathy, nephropathy, female sex, older age, and higher HbA1c were associated with lower likelihood of achieving LDL-cholesterol goals. Therapeutic inertia was present in 87.2% of patients, defined as no intensification of lipid-lowering therapy despite LDL-cholesterol levels above target.
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    Turkish cross-sectional survEy of glycemic and other metabolic parameters in patients with type 2 diabetes in 2023: Comparison with 2018 nationwide data (TEMD-2 study)
    (Elsevier, 2026) Sönmez, Alper; Haymana, Cem; Demirci, İbrahim; Çetinarslan, Berrin; Gönen, Mustafa Sait; Akbaş, Emin Murat; Yenidünya Yalın, Gülşah; Avcı, Uğur; Taşcı, İlker; Salman, Serpil; Ersoy, Canan; Bayram, Fahri; Satman, İlhan
    Aim: Five years after the first “Turkish nationwide survEy of glycemic and other Metabolic parameters of patients with type 2 Diabetes” (TEMD-1), attainment of glycemic, arterial blood pressure (ABP), and LDL-cholesterol (LDL-C) goals was re-investigated in patients with type 2 diabetes mellitus (T2DM), with an additional focus on therapeutic inertia. Methods: This cross-sectional study consecutively enrolled patients from 70 tertiary endocrine centers across Türkiye (November 2022–January 2023). Metabolic targets were HbA1c <7% (<53 mmol/mol), home ABP <135/85 mmHg, and risk-stratified LDL-C <55, <70, or <100 mg/dL (<1.4, <1.8, or <2.6 mmol/L). Thera peutic inertia was defined as failure to intensify treatment at enrollment. Results: Among the 4956 participants (mean age: 58.9 ± 10.0 years, women: 59.8%), HbA1c, ABP, LDL-C and triple metabolic control target attainment rates were 36.7%, 71.1%, 8.7%, and 2.8%, respectively. Glycemic control rate was found lower than the previous survey (40.0% vs. 36.7%, p < 0.001), while LDL-C control rate improved (7.0% vs. 8.7%, p = 0.002). Patients with established cardiovascular disease (CVD) showed worse outcomes, with triple metabolic control rate of 1.6%. The rate of severely uncontrolled diabetes (HbA1c >9%/ 75 mmol/mol) was 23.6%. Therapeutic inertia was observed by 33.5%, persisting uniformly across subgroups. Younger age, male sex, longer diabetes duration, lower socioeconomic status, and microvascular complications were independently associated with poor glycemic control. Conclusions: Metabolic control remains suboptimal in Turkish T2DM patients, and one-third of patients with severe hyperglycemia showed therapeutic inertia. Systematic interventions and intensified strategies are ur gently needed to improve diabetes outcomes and treatment inertia (ClinicalTrials.gov number NCT06347445).