Management of patients with acromegaly in clinical practice in the gulf countries: a Delphi consensus survey

BackgroundAcromegaly management practices in the Gulf region lack standardized guidelines, leading to variability in care. This study aimed to establish evidence-based regional consensus recommendations to address clinical challenges and align management with local healthcare resources.MethodsA three-round Delphi consensus survey was conducted among 15 endocrinology experts from six Gulf countries. Forty-six statements across six domains—primary treatment, pre-surgery treatment with somatostatin analogs (SSAs), second-line therapy, radiotherapy, post-surgery follow-up, and long-term management—were evaluated. Consensus was predefined as ≥66.8% agreement.ResultsStrong consensus was achieved on surgical resection as first-line therapy for eligible patients (100% agreement), with referrals to multidisciplinary centers emphasized (93.8%). Preoperative SSAs were endorsed to reduce surgical/anesthesia risks in high-risk patients (93.8%). For second-line management, watchful waiting for asymptomatic patients with mildly elevated insulin-like growth factor-1 (IGF-1) (93.8%) and combination therapy (where feasible) were supported. Radiotherapy received unanimous agreement for specific cases. Structured post-surgical follow-up protocols, including biochemical testing timelines and remission criteria, were established. Long-term monitoring emphasized individualized risk assessment.DiscussionThese guidelines provide a regionally tailored framework for acromegaly management, prioritizing surgery as the cornerstone of treatment while integrating adjuvant therapies and follow-up strategies aligned with Gulf healthcare infrastructures. The consensus reflects pragmatic adaptations to resource availability, such as endorsing watchful waiting in specific contexts. While acknowledging limitations such as potential expert bias, these consensus guidelines provide a framework for standardizing acromegaly care across the Gulf countries, with emphasis on surgical intervention as the cornerstone of treatment while recognizing the importance of adjunctive therapies

Differential Expression of Inflammatory Markers in Hypoglycemia Unawareness Associated with Type 1 Diabetes: A Case Report

The recurrence of hypoglycemic episodes leads to attenuation of the normal counter-regulatory mechanisms that are controlled by the hypothalamus, which results in hypoglycemia unawareness (HU). In this case report, we described for the first time the differential expression of TNF-α, IL-1β, IL-6, and IFN-γ in a blood sample that was taken from a 27-year-old patient with type 1 diabetes mellitus (T1DM) who was diagnosed with HU. The anti-diabetic regimen is currently based on insulin injection, but the patient is planning to start the use of an insulin pump to have better control of glucose levels. Our results showed a trend toward an increase in the expression of IL-1β, IL-6, and IFN-γ in T1DM patient with HU. However, the mRNA level of TNF-α showed a significant decrease. These observations suggest that systemic inflammation could be an underlying cause of HU.</jats:p

Saliva as a potential and non-invasive approach to identify upregulated genes associated with comorbidities of T1DM: a brief report

Abstract Background One of the main challenges in Type 1 diabetes mellitus (T1DM) research is the sample size of the participants and the invasive process of collecting an adequate number of blood samples from young patients with T1DM. Therefore, it is of great interest to investigate the possibility of using saliva as a non-invasive tool to investigate the genetic factors that are associated with T1DM comorbidities. The present study aims to identify differentially expressed genes (DEGs) in saliva samples of T1DM patients with various comorbidities using transcriptomic profiling. Methods A total of 56 participants were recruited from the University Hospital Sharjah, Dubai Hospital and Rashid Hospital, United Arab Emirates. Participants were divided into various groups: Control Group: healthy Emirati (n = 13), Group 1: patients with T1DM without any comorbidities (G1; n = 14), Group 2: patients with T1DM and hyperlipidemia (G2; n = 10), Group 3: patients with T1DM and neuropathy (G3; n = 5), Group 4: patients with T1DM and ketoacidosis (G4; n = 6), Group 5: patients with T1DM and hypothyroidism (G5; n = 6) and Group 6: patients with T1DM and polycystic ovary syndrome (PCOS, G6; n = 5). Saliva samples and blood were collected from all participants and RNA was extracted for transcriptomic analysis. Results The transcriptomic analysis of saliva samples of T1DM patients showed several DEGs that were associated with T1DM comorbidities. Interestingly, the number of upregulated genes in blood (n = 350) and saliva (n = 353) was comparable in the PCOS group (G6). In addition, the number of DEGs was more than double in saliva (n = 270) compared to blood (n = 118) samples in the ketoacidosis group (G4). Ten common upregulated genes between saliva and blood were identified in T1DM patients with hyperlipidemia (G2): LYPD5, TCF15, PRKY, CYHR1, CCDC173, CHRNA5, MIAT, HBA2, RAD54L, and TSHZ3. In addition, two common upregulated genes were identified in the neuropathy group (G3): KCTD19, FAM209B. Moreover, the following upregulated genes were observed in ketoacidosis (G4), hypothyroidism (G5) and PCOS (G6): (NCKAP5, ADAD2, C20orf144), (ZFY, KCTD19, P2RY14, RPS60) and (C4orf19, RSAD2, MEGF10, CMPK2, CHRNA5, TSHZ3, CCDC77, CLEC12A, RTP4), respectively. Conclusions The present findings demonstrated that the number of upregulated genes can be comparable between saliva and blood of T1DM patients with comorbidities, and in some groups, the number of upregulated genes was higher in the saliva compared to blood, emphasizing that saliva can be a potential non-invasive tool to identify DEGs in T1DM comorbidities

Emirates Diabetes Society Consensus Guidelines for the Management of Type 2 Diabetes Mellitus – 2020

Rapid urbanisation and socioeconomic development in the United Arab Emirates (UAE) have led to the widespread adoption of a sedentary lifestyle and Westernised diet in the local population and consequently a high prevalence of obesity and diabetes. In 2019, International Diabetes Federation statistics reported a diabetes prevalence rate of 16.3% for the adult population in the UAE. In view of the wealth of recent literature on diabetes care and new pharmacotherapeutics, the Emirates Diabetes Society convened a panel of experts to update existing local guidelines with international management recommendations. The goal is to improve the standard of care for people with diabetes through increased awareness of these management practices among healthcare providers licensed by national health authorities. These consensus guidelines address the screening, diagnosis and management of type 2 diabetes mellitus in adults including individuals at risk of developing the disease. </jats:p

Cardiometabolic Guidelines: Cardiovascular Risk Assessment and Management in Patients with Dysglycemia

Background: Cardiovascular diseases (CVDs) are the major cause of mortality and disability in patients with type 2 diabetes mellitus (T2DM). The increased risk of major cardiovascular (CV) events in patients with T2DM causes an estimated 12-year reduction in life expectancy. Despite their heightened CV risks, most T2DM patients do not meet treatment targets for multiple CV risk factors. Moreover, in the UAE, the incidence of cardiometabolic diseases is exceedingly high, impacting young patients and leading to a high burden of premature CV events. Summary: We propose this comprehensive cardiometabolic evaluation to address both glycemic control and early diagnosis of CV complications as well as early implementation of multifactorial intensive therapies that are evidence and guideline based. Widespread utilization and implementation of the guidelines in primary diabetic care, coupled with early referral to a CV or the relevant specialists, will result in a significant reduction of CV events and CV hospitalization in the UAE population. Hence, the Emirates Diabetes and Endocrine Society with the Emirates Cardiac Society collaborated for the first time to develop these recommendations. These will aid in the early identification of CV risk factors in persons with prediabetes and diabetes, as well as their effective assessment and management. These guidelines are aimed not just at primary care physicians but also specialists, perhaps leading to a more collaborative and multidisciplinary approach to the prevention, diagnosis, and treatment of patients with diabetes and CVD. Key Message: The establishment of combined cardiometabolic clinics providing comprehensive assessment and management in every major cardiology and diabetology center, particularly in patients who have already had a CV event, where the combined involvement of a cardiologist and a diabetologist in an intensive multifactorial outpatient program is urgently required to prevent recurrent CV events. In addition, establishing a National Cardiometabolic Registry is an essential element of this recommendation