Turkiye Klinikleri Journal of Nursing Sciences

.: REVIEW
Diyabete Bağlı Kronik Komplikasyonların Yönetiminde Güncel Yaklaşımlar
Current Approaches in the Administration of Chronic Complications Related to Diabetes
Merve YÜKSELa, Hicran BEKTAŞa
aAkdeniz Üniversitesi Hemşirelik Fakültesi, İç Hastalıkları Hemşireliği ABD, Antalya, TÜRKİYE
Turkiye Klinikleri J Nurs Sci. 2020;12(1):133-57
doi: 10.5336/nurses.2019-70201
Article Language: TR
Full Text
ÖZET
 Diabetes mellitus (DM); tüm dünyada çok sık görülen kronik ve metabolik bir hastalıktır. Günümüzde, diyabeti olan her iki erişkinden birine (212 milyon) tanı konulamamakta ve her 11 kişiden bir kişide diyabet bulunmaktadır. Yaşam tarzının hızla değişmesi sonucu prevalansı gittikçe artan diyabet, uygun şekilde yönetilemediği zaman, organlara zarar vererek komplikasyonların gelişmesine neden olmaktadır. Diyabetin kronik komplikasyonlarına yönelik kılavuzlarda tedavi ve bakım önerileri yer almaktadır. Kılavuzlara göre komplikasyonların tedavisi ve yönetimi için; diyabetli bireylerde uygun glisemi, kan basıncı ve serum lipid kontrolü sağlanmalıdır. Diyabetik retinopatiyi önlemek için, yılda bir kez kapsamlı göz muayenesi yapılmalıdır. Diyabetli bireylerde kronik böbrek hastalığı taraması için idrarda albümin/kreatinin ve tahmini glomerüler filtrasyon hızı oranı ölçülmelidir. Diyabetik nefropatinin erken tanısında önemli yeri olan mikroalbüminüri ölçümünün her yıl düzenli olarak yapılması konusunda birey ve ailesi bilgilendirmelidir. Diyabetik nöropatiye bağlı ağrıyı azaltmak ve yaşam kalitesini artırmak için bireyler kapsamlı bir şekilde değerlendirilmeli ve tedavi edilmelidir. Hipertansiyonu olan diyabetli bireylerde kan basıncı hedefi <130/80 mmHg olmalı ve bireyler evde kan basıncı takibi yapmalıdır. Kardiyovasküler komplikasyonların önlenmesi için; sigarayı bırakma, sağlıklı beslenme, düzenli fiziksel aktivite ve tıbbi tedavinin sürdürülmesi sağlanmalıdır. Sağlık profesyonelleri tarafından tedavi ve hemşirelik bakımında kanıta dayalı güncel yaklaşımların takip edilmesi, bireylerin tedaviye uyumlarının artırılması ve komplikasyonların önlenmesi açısından oldukça önemlidir. Bu çalışmada; diyabete bağlı gelişen komplikasyonlar, komplikasyonların fizyopatolojisi, tanı ve evreleri, yönetiminde kullanılan güncel tedavi ve hemşirelik bakımı yaklaşımlarının incelenmesi amaçlanmıştır.

Anahtar Kelimeler: Diabetes mellitus; güncel yaklaşım; hemşirelik bakımı; kronik komplikasyonlar
ABSTRACT
 Diabetes mellitus is a frequent chronic and metabolic disease. In today's world, one in every two person (212 million) can not be diagnosed with diabetes and one in every eleven person has diabetes. Quick shifts in lifestyle results in increasing prevalence of diabetes and mismanagement of diabetes results in damaging organs and increasing complications. Guidelines for chronic complications of diabetes include treatment and care recommendations. According to the guidelines for the treatment and management of complications; appropriate glycemia, blood pressure and serum lipid control should be maintained in people with diabetes. To prevent diabetic retinopathy, a comprehensive eye examination should be performed once a year. Urine albumin/creatinine and estimated glomerular filtration rate should be measured for screening for chronic kidney disease in individuals with diabetes. The microalbuminuria measurement, which has an important role in the early diagnosis of diabetic nephropathy, should inform the individual and his/her family regularly. Individuals should be extensively evaluated and treated to reduce pain and improve quality of life due to diabetic neuropathy. Blood pressure target should be <130/80 mmHg in diabetic individuals with hypertension and individuals should monitor blood pressure at home. For the prevention of cardiovascular complications; smoking cessation, healthy eating, regular physical activity and medical treatment should be maintained. Accordingly, following the evidencebased current approaches about nursing care and treatments by health professionals is highly important for increasing adaptation of the patients to treatment and preventing complications. In this study, examining the diabetes related complications, pathophysiology, diagnosis and stages of complications and the current treatments and nursing approaches used in the management of complications is aimed.

Keywords: Diabetes mellitus; current approach; nursing care; chronic complications
REFERENCES:
  1. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2018 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes. 2018;42(1):162-228. [Crossref] 
  2. Türkiye Endokrinoloji ve Metabolizma Derneği (TEMD) Diabetes Mellitus Çalışma ve Eğitim Grupları. Diabetes Mellitus ve Komplikas-yonlarının Tanı, Tedavi ve İzlem Kılavuzu. ["Diagnosis, classification and screening in glycemic disorders", "Chronic complications of diabetes", "Diabetic foot problems", "Hypertension and its treatment in diabetes mellitus"]. 2. Baskı. Ankara: Miki Matbaacılık San ve Tic Ltd Şti; 2019. p.15-187.
  3. Satman İ, İmamoğlu Ş, Yılmaz C, Ayvaz G, Çömlekçi A. [Turkey and diabetes in the world, Turkey endocrinology and metabolism association of diabetes mellitus work and study group report]. Turkjem. 2012;16(1):7-8.
  4. T.C. Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu. Türkiye Diyabet Programı 2015-2020. ["Types of Diabetes", "Chronic Complications of Diabetes"]. 2. Baskı. Ankara: Kuban Matbaacılık Yayıncılık; 2014. p.13-25.
  5. International Diabetes Federation. Diabetes Atlas. 8th ed; 2017. https://www.diabetesatlas.org/ (Erişim tarihi: 18.02.2019).
  6. Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol. 2013;28(2):169-80. [Crossref]  [PubMed]  [PMC] 
  7. Emral R, Sarı R, Güler S. Implication of findings from international studies on hypoglycemia for management of diabetes in insulin--treated patients in Turkey. Turk J Endocrinol Metab. 2018;22(1):32-40. [Crossref] 
  8. Eroğlu N. Complications of diabetes mellitus. Izmir Democracy University Health Sciences Journal. 2018;1(2):6-12.
  9. Gregg EW, Sattar N, Ali MK. The changing face of diabetes complications. Lancet Diabetes Endocrinol. 2016;4(6):537-47. [Crossref] 
  10. Tran J, Mirzaei M, Anderson L, Leeder SR. The epidemiology of stroke in the Middle East and North Africa. J Neurol Sci. 2010;295(1-2):38-40. [Crossref]  [PubMed] 
  11. American Diabetes Association. Standards of medical care in diabetes-2019. Diabetes Care. 2019;42(1):108-38. [Crossref]  [PubMed] 
  12. Hautala N, Hannula V, Palosaari T, Ebeling T, Falck A. Prevalence of diabetic retinopathy in young adults with type 1 diabetes since childhood: the Oulu cohort study of diabetic retinopathy. Acta Ophthalmol. 2014;92(8):749-52. [Crossref]  [PubMed] 
  13. Thomas MC, Brownlee M, Susztak K, Sharma K, Jandeleit-Dahm KA, Zoungas S, et al. Diabetic kidney disease. Nat Rev Dis Primers. 2015;1:15018. [Crossref] 
  14. Nentwich MM, Ulbig MW. Diabetic retinopathy-ocular complications of diabetes mellitus. World J Diabetes. 2015;6(3):489-99. [Crossref]  [PubMed]  [PMC] 
  15. Ruta LM, Magliano DJ, Lemesurier R, Taylor HR, Zimmet ZP, Shaw JE. Prevalence of diabetic retinopathy in Type 2 diabetes in developing and developed countries. Diabetic Med. 2013;30(4):387-98. [Crossref]  [PubMed] 
  16. He F, Xia X, Wu XF, Yu XQ, Huang FX. Diabetic retinopathy in predicting diabetic nephropathy in patients with type 2 diabetes and renal disease: a meta-analysis. Diabetologia. 2013;56(3):457-66. [Crossref]  [PubMed] 
  17. Mottl AK, Pajewski N, Fonseca V, Ismail-Beigi F, Chew E, Ambrosius WT, et al. The degree of retinopathy is equally predictive for renal and macrovascular outcomes in the ACCORD Trial. J Diabetes Complications. 2014;28(6):874-9. [Crossref]  [PubMed]  [PMC] 
  18. Bandello F, Lattanzio R, Zucchiatti I, Del Turco C. Pathophysiology and treatment of diabetic retinopathy. Acta Diabetol. 2013;50(1):1-20. [Crossref]  [PubMed] 
  19. Önmez A. [Management of microvascular complications in diabetes mellitus]. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi. 2017;7(2):117-9.
  20. Heier JS, Korobelnik JF, Brown DM, Schmidt-Erfurth U, Do DV, Midena E, et al. Intravitreal aflibercept for diabetic macular edema: 148-week results from the VISTA and VIVID studies. Ophthalmology. 2016;123(11):2376-85. [Crossref]  [PubMed] 
  21. Olgun N, Eti Aslan F, Coşansu G, Çelik S. [Diabetes mellitus]. Karadakovan A, Eti Aslan F, editörler. Dahili ve Cerrahi Hastalıklarda Bakım. 3. Baskı. Ankara: Akademisyen Kitabevi; p.769-99.
  22. Bektaş H. [Endocrine system care plan]. Şenol Çevik S, Karadağ A, editörler. Hemşirelik Bakım Planları: Tanılar, Girişimler ve Sonuçlar. 1. Baskı. İstanbul: Akademi Basım ve Yayıncılık; 2019. p.461-8.
  23. Ignatavicius DD, Worman ML, Rebar CR. Care of patients with diabetes mellitus. In: Heimgartner NM, ed. Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th ed. Philadelphia: Saunders; 2018. p.1238-308.
  24. Molitch ME, Adler AI, Flyvbjerg A, Nelson RG, So WY, Wanner C, et al. Diabetic kidney disease: a clinical update from kidney disease: improving global outcomes. Kidney Int. 2015;87(1):20-30. [Crossref]  [PubMed]  [PMC] 
  25. Gheith O, Farouk N, Nampoory N, Halim MA, Al-Otaibi T. Diabetic kidney disease: world wide difference of prevalence and risk factors. J Nephropharmacol. 2016;5(1):49-56.
  26. Olgun N, Yalın H, Demir H. [How person with diabetes should be monitored?]. Family Physician. 2011;2(3):8-10.
  27. Lim AKh. Diabetic nephropathy-complications and treatment. Int J Nephrol Renovasc Dis. 2014;7:361-81. [Crossref]  [PubMed]  [PMC] 
  28. Avcı E, Çakır E. [Microvascular complication of diabetes mellitus: diabetic nephropathy]. Selçuk Tıp Derg. 2014;30(Ek Sayı-1):15-8.
  29. de Boer IH; DCCT/EDIC Research Group. Kidney disease and related findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes Care. 2014;37(1):24-30. [Crossref]  [PubMed]  [PMC] 
  30. DCCT/EDIC Research Group. Effect of intensive diabetes treatment on albuminuria in type 1 diabetes: long-term follow-up of the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications study. Lancet Diabetes Endocrinol. 2014;2(10):793-800. [Crossref] 
  31. Haneda M, Utsunomiya K, Koya D, Babazono T, Moriya T, Makino H, et al. A new classification of diabetic nephropathy 2014: a report from joint committee on diabetic nephropathy. J Diabetes Investig. 2015;6(2):242-6. [Crossref]  [PubMed]  [PMC] 
  32. Bulechek GM, Butcher HK, Dochterman JM, Wagner C. [Foot care]. Hemşirelik Girişimleri Sınıflaması (NIC). Erdemir F, Kav S, Akman Yılmaz A, çeviri editörleri. 6. Baskı. İstanbul: Nobel Tıp Kitabevleri; 2017. p.75-108.
  33. Chawla A, Chawla R, Jaggi S. Microvasular and macrovascular complications in diabetes mellitus: distinct or continuum? Indian J Endocrinol Metab. 2016;20(4):546-51. [Crossref]  [PubMed]  [PMC] 
  34. Ang L, Jaiswal M, Martin C, Pop-Busui R. Glucose control and diabetic neuropathy: lessons from recent large clinical trials. Curr Diab Rep. 2014;14(9):528. [Crossref]  [PubMed]  [PMC] 
  35. Pop-Busui R, Lu J, Brooks MM, Albert S, Althouse AD, Escobedo J, et al. Impact of glycemic control strategies on the progression of diabetic peripheral neuropathy in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) cohort. Diabetes Care. 2013;36(10):3208-15. [Crossref]  [PubMed]  [PMC] 
  36. Türkiye Diyabet Vakfı Ulusal Diyabet Konsensus Grubu (TÜRKDİAB). Diyabet Tanı ve Tedavi Rehberi 2017. ["Diabetes mellitus diagnosis, classification and following principles", "Diseases according to diabetes", "Chronic complications of diabetes"]. 7. Baskı. İstanbul: Armoni Nüans Baskı Sanatları A.Ş; 2017. p.67-102.
  37. Farhat NM, Yezback KL. Treatment of diabetic peripheral neuropathy. The Journal for Nurse Practitioners. 2016;12(10):660-6. [Crossref] 
  38. Hershey DS. Diabetic peripheral neuropathy: evaluation and management. The Journal for Nurse Practitioners. 2017;13(3):199-204.e1. [Crossref] 
  39. Singh R, Kishore L, Kaur N. Diabetic peripheral neuropathy: current perspective and future directions. Pharmacol Res. 2014;80:21-35. [Crossref]  [PubMed] 
  40. Araç E. [Current diagnosis and treatment approaches in diabetic autonomic neuropathy]. Abant Tıp Dergisi. 2017;6(3):129-33. [Crossref] 
  41. Martin CL, Albers JW, Pop-Busui R; DCCT/EDIC Research Group. Neuropathy and related findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes Care. 2014;37(1):31-8. [Crossref]  [PubMed]  [PMC] 
  42. Yazdanpanah L, Nasiri M, Adarvishi S. Literature review on the management of diabetic foot ulcer. World J Diabetes. 2015;6(1):37-53. [Crossref]  [PubMed]  [PMC] 
  43. Ekim M, Ekim H. [Etiology and treatment of diabetic foot ulcers]. Van Tıp Dergisi. 2016;23(2):235-41. [Crossref] 
  44. Amin N, Doupis J. Diabetic foot disease: from the evaluation of the "foot at risk" to the novel diabetic ulcer treatment modalities. World J Diabetes. 2016;7(7):153-64. [Crossref]  [PubMed]  [PMC] 
  45. Sevinç E. [Are the nurses able to use pdca cycle in the risk management of foot care for diabetic patients?]. Anatolian Journal of Clinical Investigation. 2015;9(4):225-8.
  46. Shaikh A. A practical approach to hypertension management in diabetes. Diabetes Ther. 2017;8(5):981-9. [Crossref]  [PubMed]  [PMC] 
  47. Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, et al; SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373(22):2103-16. [Crossref]  [PubMed]  [PMC] 
  48. Sink KM, Evans GW, Shorr RI, Bates JT, Berlowitz D, Conroy MB, et al. Syncope, hypotension, and falls in the treatment of hypertension: results from the randomized clinical Systolic Blood Pressure Intervention Trial. J Am Geriatr Soc. 2018;66(4):679-86. [Crossref]  [PubMed] 
  49. Brouwer TF, Vehmeijer JT, Kalkman DN, Berger WR, van den Born BH, Peters RJ, et al. Intensive blood pressure lowering in patients with and patients without type 2 diabetes: a pooled analysis from two randomized trials. Diabetes Care. 2018;41(6):1142-8. [Crossref]  [PubMed] 
  50. Group UPDS. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837-53. [Crossref] 
  51. Patel A, MacMahon S, Chalmers J, Neal B, Woodward M, Billot L, et al; ADVANCE Collaborative Group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet. 2007;370(9590):829-40. [Crossref] 
  52. Cushman WC, Evans GW, Byington RP, Goff DC Jr, Grimm RH, Cutler JA, et al; ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362(17):1575-85. [Crossref]  [PubMed]  [PMC] 
  53. de Boer IH, Bangalore S, Benetos A, Davis AM, Michos ED, Muntner P, et al. Diabetes and hypertension: a position statement by the American Diabetes Association. Diabetes Care. 2017;40(9):1273-84. [Crossref]  [PubMed] 
  54. Omboni S, Gazzola T, Carabelli G, Parati G. Clinical usefulness and cost effectiveness of home blood pressure telemonitoring: meta-analysis of randomized controlled studies. J Hypertens. 2013;31(3):455-68. [Crossref]  [PubMed] 
  55. Leon BM, Maddox TM. Diabetes and cardiovascular disease: epidemiology, biological mechanisms, treatment recommendations and future research. World J Diabetes. 2015;6(13):1246-58. [Crossref]  [PubMed]  [PMC] 
  56. Bittner V, Bertolet M, Barraza Felix R, Farkouh ME, Goldberg S, Ramanathan KB, et al. Comprehensive cardiovascular risk factor control improves survival: the BARI 2D trial. J Am Coll Cardiol. 2015;66(7):765-73. [Crossref]  [PubMed]  [PMC] 
  57. Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;348(5):383-93. [Crossref]  [PubMed] 
  58. Zoungas S, Chalmers J, Neal B, Billot L, Li Q, Hirakawa Y, et al. Follow-up of blood-pressure lowering and glucose control in type 2 diabetes. N Engl J Med. 2014;371(15):1392-406. [Crossref]  [PubMed] 
  59. Xie M, Shan Z, Zhang Y, Chen S, Yang W, Bao W, et al. Aspirin for primary prevention of cardiovascular events: meta-analysis of randomized controlled trials and subgroup analysis by sex and diabetes status. PloS One. 2014;9(10):e90286. [Crossref]  [PubMed]  [PMC] 
  60. Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HA, Livingstone SJ, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004;364(9435):685-96. [Crossref] 

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5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com