3b. Laryngoscope, 126:2067-2072, 2016.

Background. Our aim was to define the conditions that affect therapeutic success when dipeptidyl peptidase-4 (DPP-4) inhibitor is added to metformin monotherapy. Materials and Methods. We reviewed the medical records of 56 patients who had received DPP-4 inhibitor as an add-on to metformin monotherapy and evaluated their response in the first year of therapy. Fasting blood glucose (FBG), HbA1c, C-peptide, and weight of the patients were recorded at 3-month intervals during the first year of treatment. Results. Patients who added DPP-4 inhibitor to metformin monotherapy had significant weight loss (P = 0.004) and FBG and HbA1c levels were significantly lowered during the first 6 months (both P < 0.001). Baseline levels of C-peptide were predictive for success of the treatment (P = 0.02), even after correction for confounding factors, for example, age, gender, or BMI (P = 0.03). Duration of diabetes was not a predictor of response to treatment (P = 0.60). Conclusion. Our study demonstrates that in patients having inadequate glycemic control, the addition of a DPP-4 inhibitor as a second oral agent to metformin monotherapy provides better glycemic control, protects β-cell reserves, and does not cause weight gain. These effects depend on baseline C-peptide levels.

This study investigated the severity of hirsutism and its correlation with serum total testosterone (tT) levels in 87 patients with polycystic ovary syndrome (PCOS) and 85 healthy control subjects from the south-eastern region of Turkey. A wide range of variability exists in both hirsutism and modified Ferriman-Gallwey (mFG) scores. Similar mFG scores and serum tT levels were found compared with previous studies of general populations, but lower scores than those previously reported from Turkey. The incidence of hirsutism was lower in hyperandrogenic PCOS patients compared with non-hyperandrogenic PCOS patients. There was no correlation between serum tT levels and the rate of hirsutism in patients with PCOS. Heritability, testosterone receptor sensitivity, 5α reductase activity or environmental/socioeconomic factors may play a role in the development of clinical hirsutism. Larger scale studies are needed to clarify which other factors may be responsible and to confirm these results.

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Purpose: In our study, we aimed to determine whether metabolically healthy subjects with obesity would show endothelial dysfunction (ED) when compared with insulin-resistant subjects with obesity. Material and Method: We enrolled 231 subjects with obesity (83% female) in this cross-sectional study. Brachial artery flow-mediated dilation was performed by Doppler ultrasonography and a standard 75-g oral glucose tolerance test were carried out in all participants. The subjects were stratified into tertiles based on their insulin sensitivity index values and defined as having insulin-resistant obesity if the values were in the lower tertile (n=77) or metabolically healthy obesity if the values were in the upper tertile (n=77). ED was defined as Δ flow-mediated dilation <4.5%. Results: Metabolically healthy obesity and insulin-resistant obesity groups had similar ages (39±9 vs. 40±10 years; p=0.59) and body mass index (38±5 vs. 39±5 kg/m 2 ; p=0.09). Waist circumference (101±11 vs. 106±13 cm; p=0.01), fasting blood glucose (87±9 vs. 97±13 mg/dL; p<0.001), diastolic blood pressure (79±11 vs. 82±12 mmHg; p=0.04) and uric acid levels (4.6±1.0 vs. 5.3±1.3 mg/dL; p<0.001) were lower in metabolically healthy obesity subjects, however, the incidence of ED was similar in both metabolically healthy obesity and insulin-resistant obesity subjects (80% vs. 71%; p=0.25, respectively). Discussion: The incidence of ED, assessed by flow-mediated dilation, was similar both in metabolically healthy obesity and insulin-resistant obesity subjects. In this study, we showed that subjects with obesity as defined as metabolically healthy obesity might also show ED.Amaç: Çalışmamızda metabolik olarak sağlıklı obez bireylerle, insülin direnci olan bireylerin endoteyal fonksiyonlarını (ED) değerlendirmeyi amaçladık. Gereç ve Yöntem: Bu kesitsel çalışmaya 231 obez birey (%83 kadın) alınmıştır. Katılımcıların brakial arterinde Doppler ultrasonografi ile akım aracılı genişleme değerlendirildi ve tüm katılımcılara 75 gram oral glukoz tolerans testi uygulandı. Katılımcılar insülin sensitivite indekslerine göre üç gruba ayrıldı ve insülin duyarlılık indeksi değerleri alt tertildeki (n=77) bireyler insülin resistant obez grup olarak ve üst tertildeki obezler (n=77) metabolik olarak sağlıklı obez grup olarak değerlendirildi. ED Δ akım aracılı dilatasyon <%4,5 olarak tanımlandı. Bulgular: Metabolik olarak sağlıklı obez grup ve insülin resistant obez grupları benzer yaş (39±9 vs. 40±10 yıl; p=0,59) ve vücut kitle indeksine (38±5 vs. 39±5 kg/m 2 ; p=0,09) sahiptiler. Bel çevresi (101±11 vs. 106±13 cm; p=0,01), açlık kan şekeri (87±9 vs. 97±13 mg/dL; p<0,001), diyastolik kan basıncı (79±11 vs. 82±12 mmHg; p=0,04) ve ürik asit düzeyleri (4,6±1,0 vs. 5,3±1,3 mg/dL; p<0,001) metabolik olarak sağlıklı obez grup grubunda daha düşüktü bununla birlikte ED görülme sıklığı her iki grupta benzerdi (%80 vs. %71; p=0,25, sırasıyla). Tartışma: ED görülme sıklığı metabolik olarak sağlıklı değerlendirilen obez bireylerde insulin direnci olan obez bireylerdeki gibidir. Ça...