AHP ve TOPSIS yöntemlerini kullanarak tip 2 diyabet hastalığı için risk puanı hesaplama ve en iyi tedavi seçeneğini belirleme
Identification of the ideal treatment option and calculation the risk score for the type 2 diabetes mellitus by using AHP and TOPSIS methods
Yazar: SERCAN DİNÇ
Danışman: PROF. DR. YUSUF İLKER TOPCU
İstanbul Teknik Üniversitesi / Fen Bilimleri Enstitüsü / Endüstri Mühendisliği Ana Bilim Dalı / Mühendislik Yönetimi Bilim Dalı
Derece: Yüksek Lisans, 2019
Konu: Endüstri ve Endüstri Mühendisliği = Industrial and Industrial Engineering

Özet:
Karar verme eylemi hayatın her aşamasında yer alan ve insanoğlunun sık sık karşılaştığı
problemlerden biridir. İnsanlık tarihinin başından beri ve hayatın her alanında yer alan karar
verme eyleminin daha önemli hale gelmesi; sistem içinde yer alan çok çeşitli bileşenlerin
gitgide daha fazla birbirleriyle etki içerisinde olması, maliyetlerin artması gibi çeşitli
faktörlerden kaynaklanmaktadır. Medikal karar verme ise hekimlerin hastalara en doğru tedavi
yöntemini seçme konusunda verdikleri kararları içeren ve hekimlerin çok sık karşılaştığı ve çok
fazla bileşenin etki içerisinde olduğu karar verme çeşididir. Medikal karar vermeyi diğer karar
verme tiplerinden ayıran en önemli özelliği, uzmanlık bilgisinin yoğun olduğu bir alan olması
ve karar verirken çok fazla bileşenin göz önünde bulundurulması gerekliliğidir. Medikal karar
vermenin alt başlıkları, hastane yeri seçimi, tıbbi cihaz seçimi ve tedavi seçeneklerinin
sıralanması ve seçimi olarak sınıflandırılabilir. Bu alt başlıklardan tedavi seçeneklerinin
sıralanması ve seçimi, belirli hastalıklar için mevcut kullanılmakta olan tedavi seçeneklerinin
etkinliğinin belirli faktörler doğrultusunda sıralanması ve bu doğrultuda uzman görüşlerine
göre belirlenen faktörler sonucu en etkin ya da en iyi tedavi seçeneğinin belirlenmesini içerir.
Bu tez çalışmasının ilk amacı, günümüzün en yaygın metabolizma hastalıklarından biri olan tip
2 diyabet hastalığı için AHP Puanlama yöntemini kullanarak potansiyel hastaların risk puanını
hesaplayan ve risk sınıflandırması yapan bir karar destek sistemi geliştirmektir. Bu sayede çok
ayrıntılı tahlil/medikal inceleme vs. yapmadan pratik bir yöntem ile hastalık riskinin
hesaplanması ve risk sınıfında yer alan hastaların daha ayrıntılı analizlere yönlendirilmesi
sağlanabilecektir. Çalışmanın ikinci amacı ise Tip 2 Diyabet tedavisinde kullanılan tedavi
seçeneklerini sıralayarak, ilk aşamada orta ve yüksek risk sınıfında yer alan hastalar için en iyi
tedavi seçeneğinin belirlenmesidir. Dolayısıyla, uygulama iki aşamadan oluşmaktadır; ilk
aşamada, İstanbul Fatih Sultan Mehmet Eğitim ve Araştırma Hastanesi Diyabet Polikliniğinde
görevli 4 uzman hekimin görüşleri alınarak belirlenmiş kriterler üzerinden AHP Puanlama
sistemi kullanılarak, potansiyel hastalarda risk puanı hesaplayan bir uygulama geliştirilmiş,
aynı hastanede çalışan yedi potansiyel hastaya model uygulanmış ve her potansiyel hastanın
risk puanı hesaplanmıştır. İkinci aşamada ise uzman görüşleri ve literatür araştırmalarına
dayanarak belirlenen kriterler, yine İstanbul Fatih Sultan Mehmet Eğitim ve Araştırma
Hastanesinde görevli 4 karar verici uzman hekime AHP yöntemine göre ikili karşılaştırılmış ve
ağırlık değerleri belirlenmiştir, daha sonra her bir alternatif için kriterler uzman görüşleri ve
literatür araştırmaları ile değerlendirilmiş ve oluşan karar matrisine TOPSIS yöntemi
uygulanarak en iyi tedavi seçeneği belirlenmiştir.

Abstract:
Decision-making is one of the problems that human beings often face in every stage of life.
Since the beginning of human history and in every field of life, decision-making has become
more important; There are several factors in the system, such as increasing the cost of the
various components in the system, and increasing the costs. The most important feature that
distinguishes the mental decision making from other types of decision-making is that it is an
area of intensive knowledge and many components must be considered when making decisions.
Subheadings of medical decision making can be classified as selection of hospital sites,
selection of medical devices, and sorting and selection of treatment options. The selection of
treatment options from these subtitles include the effectiveness of the treatment options
available for certain diseases in order to determine the most effective or best treatment option.
The selection of the best treatment option is an important for a decision support to medical
doctors. Moreover, multi-criteria decision methods can be used for disease evaluation for the
people so by this way, risk evaluation can be performed for the people, who are the potential
patients.
The aim of this thesis is to determine the risk scores of the potential Type 2 Diabetes patients
and also determine the best treatment options by listing the treatment options used in the
treatment of Type 2 Diabetes, one of the most common metabolic diseases. When choosing
treatment options and criteria, expert opinions were consulted. In the first part of the study,
Analytic Hierarchy Process (AHS) Scoring method was applied and in the second part, AHP
and TOPSIS method were used for determining the best theraphy option for Type 2 Diabetes.
So, the study includes two stages and uses two multi-criteria decision making methods to
develop the model, which calculate the risk scores of the Type 2 Diabetes for the potential
patiens, and to identify the best treatmet option according to the criteria determined.
In the first stage of the application, risk scores were calculated for the potential patients
according to the criteria determined by expert opinions, who are the medical doctors in the Fatih
Sultan Mehmet Research and Training Hospital, Istanbul, and also literature was searched. To
calculate risk scores, there wereseven determined main criteria which were patient' age and
gender. HbA1C level, body mass index and medical history, patient' income status and disease
awareness.
To calculate criteria' weights, four medical doctors evaluated the criteria according to Saaty
scale and the pairwise evaluations were analyzed by AHP method. The developed model was
applied on seven potential patients, who work in the same hospital. The results showed that
disease awareness was the most important criteria for calculating patient's type 2 diabetes' risk
score and other criteria that follow were medical history, HbA1C level, body mass index,patient's income status, age and gender respectively. The application showed that the potential
patient, who has number 4, has the highest risk score for the Type 2 Diabetes Mellitus Disease
and the potential patient, who has number 1, has the lowest risk score for the disease. By this
study, potential patients are also classified according to their risk scores, this classificaton
includes low risk, medium and high risk classes. So this model can be used as an early warning
system for the disease and can be applied to bigger patient population.
In the second stage of the application, to determine the best teraphy option for the Type 2
Diabetes Mellitus, 4 teraphy options and 5 criteria were determined by expert opinions. The
same medical doctors, who works in hospital in Istanbul, were evaluated the criteria for the
patients, who are in the high and medium risk group according to risk scores mentioned as stage
I.There are five criteria determine, which are therapy option's applicability, scope, side effects,
therapy option' time period and cost. For these criteria, four alternatives therapy, surgery,
exercise program, diet program and using a drugwere evaluated by 4 medical doctors. In the
first part, five criteria were pairwise compared by 4 medical doctors according to AHP method.
In the second part, for each criteria, alternatives were evaluated by four experts, which are the
medical doctors, and then decision matrx was generated. Lastly, TOPSIS method was applied
to the decision matrix and best therapy option was determined. Results show that side effect
evaluation is the most weighted criteria and it is followed by applicability, cost, scope and time
period. As the best treatment option , diet program was selected, which is followed by exercise
program and using a medicine, while surgery was determined as last option for the Type 2
Diabetes Mellitus Treatment. Determining the best treatment option for the diseases like Type
2 Diabetes Mellitus is the critical decision making problem, since patient population of the
disease is very large and also the disease has a big impact on a life quality
As a result, diet program, which has wide applicability and scope, minimum side effects and
cost, can be recommended as a first step treatment for the patient number 1,2,4 and 5 while it
is in the second row; exercise program, which is the second row option for the patient number
4 and five and in the third row for the patient number 1,2 and 3, has also wide scope and
applicability, but patients with older age can be faced difficulties to apply the exercise program
but it is still an efective option, while considering its cost and minimum side effects.Moreover,
using a drug is the ideal option for the patient number 3, while in the second row for the patient
1 and 2; and in the third row for the patient 4 and 5, since the drug prices are expensive and
they are need to persistence for long term. The other thing for the drugs, used in Type 2 Diabetes
Mellitus, is that while some drugs can be useful for other diseases , they might also have a side
effects, which affect to life quality. They are many drugs, which can be prescribed for the Type
2 Diabetes Mellitus. And some of them, such as subcutaneous drugs have difficulties for the
patients and this situation affects an applicability criteria for the alternative, using a drug. The
last alternative for each patient, surgery, is the new treatment option for the Type 2 Diabetes
Mellitus. Surgery takes shortest time when it is compared with other treatment options but its
cost is much more expensive than the other treatment options and also its applicability is very
limited. Since it can cause complications, it can be thought that there might be side effects
after the surgery. So , in the terms of criteria, applicability, cost and side effects, surgery is not the ideal option. But in the terms of the criteria, time and scope, this option can be compared
between the other options. Even so, the results show that surgery is the last option for the
treatment of the Type 2 Diabetes Mellitus. Also treatment options can be used together but this
study shows priority of each treatment, and ranking of each treatment option when they are
considered seperately.

This study aims to apply multicriteria decision making methods in health area. While there are
many studies especially appyling the multicriteria decision making methods in oncology; in
the are of diabetes, this study is the candidate to be pioneer for future studies. By using risk
score and models and in health area, people can have an awareness for the diseases and can
change life style for living healthier. Moreover, sometimes determining the best therapy option
can be difficult decision for the doctors and so multi-criteri decision making methods are the
helpful tools at this point. By using this tools, accurate therapy options can be applied for
patients. Thus, patients' health costs can be decreased and their life qualities can be increased.
But for more complex situations, complex models can be required to be developed. So, fuzzy
AHP and TOPSIS or other multicriteria decision making methods can be studied for
developing more complex models in the future. By developing more complex models, lost of
problem can be solved in healtcare industry. Furthermore, by using the multicriteria decision
making models in healtcare industry, government's health expenses can be decreased.