Type 1 Diabetes Mellitus in Saudi Arabia: A Soaring Epidemic

Type 1 diabetes mellitus (T1DM) is quite prevalent in the world, with a proportion of 1 in every 300 persons and steadily rising frequency of incidence of about 3% every year. More alarmingly, the incidence of T1DM among infants is also increasing, with children as young as 6 months succumbing to it, instead of that at a rather established vulnerable age of around seven and near puberty, when the hormones antagonize the action of insulin. These reports pose a unique challenge of developing efficient T1DM management system for the young children. The Kingdom of Saudi Arabia (KSA) is the largest country in the Middle East that occupies approximately four-fifths of the Arabian Peninsula supporting a population of more than 33.3 million people, of whom 26% are under the age of 14 years. As per the Diabetes Atlas (8th edition), 35,000 children and adolescents in Saudi Arabia suffer from T1DM, which makes Saudi Arabia rank the 8th in terms of numbers of TIDM patients and 4th country in the world in terms of the incidence rate (33.5 per 100,000 individuals) of TIDM. However, in comparison with that in the developed countries, the number of research interventions on the prevalence, incidence, and the sociodemographic aspects of T1DM is woefully inadequate. In this review we discuss different aspects of T1DM in Saudi Arabia drawing on the published literature currently available

Skin-Related Complications Among Adolescents With Type 1 Diabetes Using Insulin Pump Therapy

Background: To identify the skin-related complications in adolescents with type 1 diabetes (T1D) using the insulin pump therapy (IPT). Methods: A total of 64 T1D adolescents (between ages 13 and 19) using the insulin pump were included in this cross-sectional study. They had visited the Diabetes Clinic at Diabetes Treatment Center, Prince Sultan Military Medical City, Saudi Arabia, for treatment from January 2018 to March 2018. Data on the prior and present skin-related complications, for a 6-month interval, were gathered via a closed/structured questionnaire. Besides this, demographic information was also recorded. Results: From the patients in this study (n = 64), 9.3% experienced 3 or more skin-related complications, whereas 7.8% patients registered 2 and 25% had only 1 such disorder. However, in 37 patients (51.8%), there was no evidence of skin-related complications. Significantly, the female revealed a higher level of issues ( P  = .036), >3 years on IPT ( P  = .039), negligence of infusion set rotation ( P  = .001), needle length of 9 mm ( P  = .021), and beyond 3 days for catheter replacement ( P  = .022). The factors age, body mass index, diabetes duration, and insulin dosage remained quite unaffected. From the regression analysis, the factors female gender, catheter replacement, and infusion set rotation showed up as the independent risk factors for the skin complications. Conclusions: The IPT users invariably experience dermatologic conditions. Through this study, female gender, length of IPT usage time, and infusion set rotations were identified as the independent risk factors responsible for the skin issues

Clinical Characteristics and Satisfaction of Liraglutide Treatment among Patients with Type 2 Diabetes: A Prospective Study

Background: Evaluation of patient-reported results, treatment satisfaction, in particular, is popularly gaining recognition as crucial to the assessment of the efficiency of new therapies. The aim of this study is to examine the clinical features and treatment satisfaction with liraglutide in insulin-dependent obese patients having uncontrolled diabetes. Methods: A prospective study was performed for 12 weeks using 64 type 2 diabetes (T2D) patients, 30 to 70 years of age, who came in for treatment to the Diabetes Treatment Center in Prince Sultan Military Medical City, Riyadh, Saudi Arabia, from November 2017 to July 2018. All the patients enrolled in this study were given liraglutide in addition to their existing treatment. For the first week, they were subcutaneously administered 0.6 mg once per day, which was gradually raised to 1.2 mg after 1 week, and the final given dose went up to 1.8 mg per day until the study period was completed. Purposive and suitable selection of the respondents was performed at their convenience. They were interviewed adopting the Diabetes Treatment Satisfaction Questionnaire (Arabic version) at baseline and after 12 weeks. Besides, the clinical variables like hemoglobin A 1c (HbA 1c ), fasting blood sugar (FBS), total daily insulin dose (TDD), number of injections, and hypoglycemia/weeks were also recorded at baseline and at the end of the study. Results: In comparison with the baseline values, notable positive differences were identified in the domains of treatment satisfaction, namely, satisfied with current treatment ( P  = .0001), frequency of perceived hyperglycemia ( P  = .0001), frequency of perceived hypoglycemia ( P  = .0001), convenience of current treatment ( P  = .0001), understanding diabetes ( P  = .0001), recommend the current treatment ( P  = .018), and continue the present treatment ( P  = .0001) when the study is completed. After 12 weeks, the addition of liraglutide to the existing treatment showed significant positive changes on FBS ( P  = .0001), HbA 1c ( P  = .001), TDD ( P  = .0001), number of injections ( P  = .0001), documented hypoglycemia/weeks ( P  = .0005), and body weight ( P  = .0001) in comparison with the baseline values. Conclusions: The addition of liraglutide to the existing treatment raised the level of treatment satisfaction and minimized the frequency of hypoglycemic/hyperglycemic events apart from the other clinical variables

Evaluation of FreeStyle Libre Flash Glucose Monitoring System on Glycemic Control, Health-Related Quality of Life, and Fear of Hypoglycemia in Patients with Type 1 Diabetes

Background/objectives: In the current era of modern technology and the development of smart devices such as the flash glucose monitoring (FGM) systems, patients can easily monitor their glucose levels more frequently without any inconvenience. In this study, we evaluate the effect of FreeStyle Libre FGM system on glycemic control, hypoglycemia, health-related quality of life (QoL), and the fear of hypoglycemia (FOH) among children and young people with type 1 diabetes (T1D). Design and methods: A prospective study was conducted at the Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia, between January 2017 and May 2017 on 47 (aged 13-19 years) registered patients with T1D who used conventional finger-pricking method for self-testing the glucose. At baseline visit, the FGM sensors were placed on each participant by a trained diabetes educator. The data collected from the sensors were computed to generate the respective ambulatory glucose profiles so as to determine the total number of scans conducted during the study period. At the baseline and at 3 months of the experiment, a trained interviewer administered the questionnaire Hypoglycemia Fear Survey-Child Version (HFS-C) and PedsQL 3.0 (QoL questionnaire) to each patient. The age, sex, weight, height, adjusted body mass index, duration of diabetes, treatment modality, and glycosylated hemoglobin A 1c (HbA 1c ) levels of each patient were recorded. Results: As compared with the baseline, a significant improvement was noted in the behavior of FOH ( P = .0001), worry ( P = .0001), QoL ( P = .002), HbA 1c level ( P = .008), and hypoglycemia ( P = .023) at 3 months. Significant improvement was noted in the behavior ( P = .0001), worry ( P = .0001), QoL ( P = .003), HbA 1c level ( P = .014), and hypoglycemia ( P = .001) among the multiple-dose insulin injection–treated patients as compared with baseline. Significant improvement was noted in the behavior ( P = .0001), worry ( P = .0001), and hypoglycemia ( P = .001) among the insulin pump–treated patients as compared with baseline. A positive correlation was recorded in the behavior ( r = .47; P < .001), QoL ( r = .70; P < .001), and the mean number of FGM scans. A negative correlation was recorded in the worry ( r = −.43; P = .002), HbA 1c level ( r = −.58; P < .001), hypoglycemia ( r = −.65; P < .001), and the mean number of FGM scans. Conclusions: The frequent use of FGM scanning reduced the frequency of hypoglycemia, HbA 1c level, and worry and increased the behavior and QoL. As compared with self-testing by the conventional finger-pricking method, the use of FGM increased the frequency of self-testing and thus diabetes control

Metabolic control, adherence to the gluten-free diet and quality of life among patients with type 1 diabetes and celiac disease

Abstract Aims In this cross-sectional study, we aimed to evaluate metabolic control, adherence to a gluten-free diet (GFD), and quality of life (QoL) in individuals with type 1 diabetes (T1D) and celiac disease (CD). Methods We targeted individuals with T1D and CD at a major tertiary hospital in Saudi Arabia. We gathered retrospective data from medical records and prospectively assessed glycemic control using HbA1c and ambulatory glucose metrics, adherence to a GFD using the Celiac Dietary Adherence Test (CDAT), and QoL using the Celiac Disease Quality of Life survey (CD-QoL). Results Forty-eight out of 1095 patients screened (4.38%) were included. Mean age and HbA1c were 21.3 (± 6.6) and 8.3% (± 0.8%). The average time in range% and above range% were 38.5 (range 24–68) and 29.6 (± 7.4). The median hypoglycemic events/month was 8, with a median duration of 80 min. The median overall CDAT and CD-QoL scores were 20.5 and 54. No significant correlations were observed between glucose management indicator (GMI), % in target, and CDAT/CD-QoL scores (all p > 0.05). Conclusions No significant effect of GFD on QoL or glycemic control was observed. Further prospective studies are warranted to establish solid evidence of the impact of GFD on individuals with T1D and CD

Additional file 2 of Metabolic control, adherence to the gluten-free diet and quality of life among patients with type 1 diabetes and celiac disease

Appendix S2: Instructions for Scoring the Celiac Disease Quality of Life survey (CD-QOL

Additional file 1 of Metabolic control, adherence to the gluten-free diet and quality of life among patients with type 1 diabetes and celiac disease

Appendix S1: Celiac Dietary Adherence Test (CDAT

Frequency of Lipohypertrophy and Associated Risk Factors in Young Patients with Type 1 Diabetes: A Cross-Sectional Study

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Impact of an education program on patient anxiety, depression, glycemic control, and adherence to self-care and medication in Type 2 diabetes

Background: Diabetes mellitus (DM) requires continuous medical care, patients′ self-management, education, and adherence to prescribed medication to reduce the risk of long-term complications. The aim of this study was to assess the benefits of an education program on diabetes, patient self-management, adherence to medication, anxiety, depression and glycemic control in type 2 diabetics in Saudi Arabia. Materials and Methods: This was a prospective study, conducted among 104 diabetic patients at a major tertiary hospital in Riyadh, Saudi Arabia, between May 2011 and October 2012. Education materials given to diabetic patients included pamphlets/handouts written in Arabic, the national language. Special videotapes about DM were made and distributed to all participants. In addition, specific educational programs through the diabetes educators and one-on-one counseling sessions with the doctor were also arranged. Patients were interviewed using a structured interview schedule both during the baseline, and after 6 months of the program. The interview schedule included, socio-demographics, clinical characteristics, diabetes self-management, adherence to medication, anxiety, and depression. Glycemic control was considered poor, if hemoglobin A1c (HbA1c) was ≥ 7%. Results: The mean age of the study population was 57.3 ΁ 14.4 years. Seventy one were males (68.3%) and 33 (31.7%) were females. After six months of the diabetes education program, there were significant improvements in patients′ dietary plan (P = 0.0001), physical exercise (P = 0.0001), self-monitoring of blood glucose (SMBG) (P = 0.0001), HbA1c (P = 0.04), adherence to medication (P = 0.007), and depression (P = 0.03). Conclusions: Implementation of education programs on diabetes among type 2 diabetic patients is associated with better outcomes such as their dietary plan, physical exercise, SMBG, adherence to medication, HbA1c and depression