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)

Abstract

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). Therapeutic 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 urgently needed to improve diabetes outcomes and treatment inertia (ClinicalTrials.gov number NCT06347445).