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    Impact of obesity on metabolic control in type 2 diabetes: Five-year trends of Turkish nationwide survEy of glycemic and other Metabolic parameters of patients with Diabetes (TEMD Obesity Study, 2017-2022)
    (S. Karger AG, 2025) Kıyıcı, Sinem; Demirci, İbrahim; Sönmez, Alper; Haymana, Cem; Mert, Meral; Nuhoğlu, İrfan; Taşçı, İlker; Salman, Serpil; Satman, İlhan; Bayram, Fahri
    Background: Türkiye has the highest obesity prevalence in Europe. Obesity not only causes type 2 diabetes mellitus (T2DM) but also impairs glycemic control in patients with T2DM. There is insufficient information about the demographic and clinical differences between individuals with T2DM who are living with or without obesity. Objectives: The second TEMD survey across Türkiye investigated the latest overweight and obesity prevalence in patients with T2DM. The present study evaluated the five-year changes in the prevalence, factors associated with an obesity diagnosis and the association between obesity and metabolic control. Methods: Patients under follow-up in tertiary units specialized for diabetes care were consecutively enrolled. The sociodemographic, anthropometric, and clinical variables were recorded. Metabolic targets were defined as HbA1c <7%, home arterial blood pressure (ABP)<135/85 mmHg, or LDL-C<100 mg/dL or <70 mg/dL or <55 mg/dL according to the risk factors or complications of patients. Metabolic target attainment rates were investigated across normal-weight, overweight and obesity body mass index (BMI) classes. Results: The TEMD Obesity Study enrolled 4935 patients with T2DM (age 58.9±10.1 years; women 59.8%). The prevalence of overweight and obesity was 33.4% and 55.1%, respectively. Obesity was more frequent in women with T2DM than men (66.2% vs. 38.1%; p=<0.001). From 2017 to 2022, the obesity rate decreased from 59.0% to 55.1%, while the overweight rate increased from 31.0% to 33.4%. As BMI class increased, the achievement of three metabolic targets decreased while the incidence of microvascular complications rose. Significant associations were found between obesity and sociodemographic characteristics (age, sex, education level) and lifestyle measures (diet, exercise, smoking) in multivariable logistic regression analysis. Conclusion: The TEMD Obesity study showed a decrease in obesity rates among patients with T2DM between 2017 and 2022. Also, the findings suggest that obesity poses an important barrier to the achievement of metabolic goals.
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    Real-world comparison of short-term adverse events, treatment persistence, and efficacy of semaglutide and tirzepatide: A nationwide multicenter study
    (Karger, 2026) Hepşen, Sema; Haymana, Cem; Ertepe Küçükgöde, Gizem; Özcan, Büşra; Özbaş, Burak; Or Koca, Arzu; Aydoğan, Berna İmge; Tura Bahadır, Çiğdem; Salman, Serpil; Sönmez, Alper
    Introduction: Real-world data directly comparing the safety, tolerability, and effectiveness of semaglutide and tirzepatide in patients with obesity remain limited. This nationwide multicenter observational study compared short-term adverse events, treatment discontinuation, body weight loss (BWL), and metabolic outcomes between the two treatments. Methods: This study included 2,549 patients with obesity treated with semaglutide (n=1,434) or tirzepatide (n=1,115). Adverse events, including time to onset, dose at occurrence, and related discontinuation, were evaluated. Changes in BWL and metabolic parameters up to 6 months were assessed. Subgroup analyses were performed in patients with and without type 2 diabetes mellitus (T2DM). Results: At least one adverse event occurred in 50.9% in the semaglutide group and 51.0% in the tirzepatide group (p=0.524), with gastrointestinal events the most frequently reported. Overall adverse event rates were comparable between groups; however, musculoskeletal and allergic reactions were more common in the tirzepatide group. The onset of gastrointestinal, neuropsychiatric, musculoskeletal symptoms, and hypoglycemia occurred earlier in the tirzepatide group. Discontinuation due to adverse events was similar between groups, except for pancreatic events, which were more frequent in the semaglutide group (p=0.006). Tirzepatide was associated with greater early BWL at all time points. At 6 months, median percentage BWL was 12.6% with semaglutide and 14.4% with tirzepatide. HbA1c reductions were comparable between groups in patients with T2DM. Conclusion: In real-world clinical practice, semaglutide and tirzepatide show similar short-term tolerability and treatment persistence, although tirzepatide is associated with a higher incidence of musculoskeletal and allergic reactions and greater early BWL.
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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.