Supplementary Material for: Impact of Obesity on the Metabolic Control of Type 2 Diabetes: Results of the Turkish Nationwide Survey of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Obesity Study)

Background: Obesity is the main obstacle for metabolic control in patients with type 2 diabetes. Turkey has the highest prevalence of obesity and type 2 diabetes in Europe. The effect of obesity on the metabolic control, and the macro- and microvascular complications of patients are not apparent. Objectives: This nationwide survey aimed to investigate the prevalence of overweight and obesity among patients with type 2 diabetes and to search for the impact of obesity on the metabolic control of these patients. We also investigated the independent associates of obesity in patients with type 2 diabetes. Methods: We consecutively enrolled patients who were under follow-up for at least 1 year in 69 tertiary healthcare units in 37 cities. The demographic, anthropometric, and clinical data including medications were recorded. Patients were excluded if they were pregnant, younger than 18 years, had decompensated liver disease, psychiatric disorders interfering with cognition or compliance, had bariatric surgery, or were undergoing renal replacement therapy. Results: Only 10% of patients with type 2 diabetes (n = 4,648) had normal body mass indexes (BMI), while the others were affected by overweight (31%) or obesity (59%). Women had a significantly higher prevalence of obesity (53.4 vs. 40%) and severe obesity (16.6 vs. 3.3%). Significant associations were present between high BMI levels and lower education levels, intake of insulin, antihypertensives and statins, poor metabolic control, or the presence of microvascular complications. Age, gender, level of education, smoking, and physical inactivity were the independent associates of obesity in patients with type 2 diabetes. Conclusion: The TEMD Obesity Study shows that obesity is a major determinant of the poor metabolic control in patients with type 2 diabetes. These results underline the importance of prevention and management of obesity to improve health care in patients with type 2 diabetes. Also, the results point out the independent sociodemographic and clinical associates of obesity, which should be the prior targets to overcome, in the national fight with obesity.

研究背景：肥胖是2型糖尿病（type 2 diabetes）患者代谢控制的主要障碍。土耳其的肥胖与2型糖尿病患病率位居欧洲之首。目前肥胖对该类患者代谢控制及其大血管、微血管并发症的影响尚不明确。研究目的：本项全国性调查旨在探究2型糖尿病患者超重与肥胖的患病率，分析肥胖对该类患者代谢控制的影响，并探讨2型糖尿病患者肥胖的独立相关因素。研究方法：本研究连续纳入37座城市的69家三级医疗中心中，接受至少1年随访的2型糖尿病患者。收集患者的人口学特征、人体测量学指标及临床资料（包括用药情况）。排除标准如下：妊娠者、年龄未满18周岁者、失代偿性肝病患者、存在影响认知功能或治疗依从性的精神疾病患者、既往接受减重手术者，以及正在接受肾脏替代治疗者。研究结果：本研究共纳入4648例2型糖尿病患者，仅10%的患者体重指数（Body Mass Index, BMI）正常，其余患者分别为超重（31%）或肥胖（59%）。女性患者的肥胖患病率（53.4%相较于40%）及重度肥胖患病率（16.6%相较于3.3%）均显著高于男性。高BMI水平与低学历、使用胰岛素、降压药物及他汀类药物、代谢控制不佳，或合并微血管并发症存在显著相关性。年龄、性别、学历水平、吸烟及运动不足是2型糖尿病患者肥胖的独立相关因素。研究结论：本TEMD肥胖研究显示，肥胖是2型糖尿病患者代谢控制不佳的主要影响因素。上述结果凸显了针对2型糖尿病患者开展肥胖预防与管理以改善其医疗照护质量的重要性。同时，本研究明确了2型糖尿病患者肥胖的独立社会人口学及临床相关因素，此类因素应作为全国肥胖防控工作中的优先干预目标。