Glycemic Control in Patients with Diabetes across Primary and Tertiary Government Health Sectors in the Emirate of Dubai, United Arab Emirates: A Five-Year Pattern

Objectives: In the UAE, the comparative prevalence of diabetes is reported as 18.98%, but there are very few studies evaluating glycemic control. Attaining the optimum glycemic control has been a global challenge over the years. However, there is a trend of global improvement with the availability of newer options of antidiabetic medications, increasing numbers of physicians, and patient awareness. Our primary aim was to assess the level of glycemic control across Dubai Health Authority points of care over the past five years. Additionally, we aimed to compare the differences in glycemic control between primary and tertiary centers, between nationalities, and type I and II diabetes. Methods: We conducted a retrospective analysis of the electronic medical records of all patients who attended primary and tertiary care centers within the Dubai Health Authority between 2012 and 2016. All patients with any type of diabetes were included in this assessment. Results: A total of 26 447 patients were included in the study; of these, 73.8% (n = 19 508) were UAE nationals while the other nationalities accounted for 26.2% (n = 6939) of patients. The overall mean glycated hemoglobin (HbA1c) levels from 2012 to 2016 was 7.76%. Patients attending primary care clinics had a mean HbA1c of 7.64% compared to 7.68% for the tertiary care cohort. Out of the total population, 37.7% achieved HbA1c < 7%. Over 40% of the patients attending primary care centers achieved HbA1c < 7% compared to 34.9% of those who attended tertiary care centers. Conclusions: Optimum glycemic target was achieved by less than 40% of patients. Glycemic control is still below the desired levels. However, there has been a trend of improvement in the last few years and we are achieving the international average targets. Further collaborative actions from clinical, educational, and strategic sectors are needed to improve our goals further

Clinical Practice Recommendations for the Management of Obesity in the United Arab Emirates

With rapid urbanisation and improved living conditions as a result of rising incomes in Gulf Cooperation Council (GCC) countries, obesity has become a major and growing health problem for the region. The United Arab Emirates (UAE) has a resident population of 9.3 million (in 2016), many of whom (85.5%) lived in urban areas and led sedentary lifestyles. Based on the World Health Organisation (WHO) estimates for 2010, 25% of Emirati men and 40% of the women were obese. Obesity rates in this country has doubled from 16 to 34% compared to the year 2000, and severe obesity (BMI > 40 kg/m2) has risen dramatically from 2 to 11%. While a number of international guidelines for the management of obesity are already available in public domain, local guidelines for the UAE and the region, which are structured and individualized for the management of obesity, are sorely needed to help the family physician to provide affordable treatment for the patient at the point-of-care and to reduce the burden on the local healthcare system. A multi-disciplinary panel of international and regional experts who treat patients with overweight and obesity was convened with the aim of developing consensus recommendations for the UAE. The objective is to have a simple and easy-to-refer set of recommendations for busy clinicians as there were already many comprehensive international guidelines available. The panel reviewed and streamlined these recommendations in its entirety for relevance, coherence and usability in the local context. These recommendations for overweight and obesity management were circulated and endorsed by the local practising family medicine community, namely, the Emirates Medical Association and Family Medicine Society. We believe these recommendations would also be of interest to clinicians in other GCC countries. A summary and algorithm of these recommendations are provided

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

Emirates consensus recommendations on cardiovascular risk management in type 2 diabetes

BackgroundThe combination of cardiovascular disease and diabetes is a highly prevalent condition in the United Arab Emirates. Development and dissemination of evidence-based regional recommendations for optimal screening, treatment and referrals of people with diabetes and high cardiovascular risk is an important priority.Consensus panelAn expert panel of diabetologists, endocrinologists and cardiologists from the Emirates Cardiac Society and Emirates Diabetes and Endocrine Society as well as different entities in the UAE, discussed and reviewed evidence and also a consensus report from the American Diabetes Association to formulate contextualized recommendations that could be applied for optimal management of cardiovascular risk in people with diabetes in the UAE.Consensus findingsThe combination of heart failure and other cardiovascular risks is a highly prevalent finding among people with diabetes in the United Arab Emirates. The causal inter-relationships between diabetes and heart failure are multifactorial and regular assessments of symptoms and steps for mitigation of risk factors are an important priority. The universal definition and classification of heart failure provides a useful framework for recommending optimal screening, treatment, and referral strategies to diabetic individuals at various stages of the cardiovascular continuum. Routine measurement (at least yearly) of natriuretic peptides and high-sensitivity troponins can help identify patients requiring cardiac imaging referrals. However, recommending routine measurements of natriuretic peptides and/or high-sensitivity troponins to all diabetic individuals must balance clinical judgment and cost implications. While SGLT2i must be an important part of the standard of care, insulin, GLP1 receptor agonists and/or metformin can be useful for additional glycemic control.ConclusionThe consensus panel hopes that the recommendations presented herein can offer guidance for optimal screening, treatment and referral of people with a concomitance of diabetes and high cardiovascular risk in the United Arab Emirates

Role of Renin-Angiotensin-Aldosterone System (RAAS) inhibition in the renal continuum

Renal involvement in patients with type 2 diabetes carries a risk of increased cardiovascular mortality. This is particularly true in the presence of microalbuminuria being an early marker of endothelial dysfunction. The use of Renin Angiotensin Aldosterone System (RAAS) blockers has been found beneficial in improving endothelial dysfunction as well as preventing development of microalbuminuria and its progression to macroalbuminuria. This class of drugs has been proved effective in delaying the development of end stage renal disease. However; in patients with established end stage renal disease, it becomes controversial whether using these drugs may still be beneficial. Indeed, some studies have shown that they may even be harmful if used in late stages of chronic kidney disease. In this article, we will review firstly, the renovascular changes in health and disease and secondly appraise the different trial data pertaining to the assessment of the use of various RAAS inhibitors at different stages of the renal continuum. We hope the review will help put together a physiologicallybased fundamental knowledge and a trial-derived evidence base for to help inform day to day decision-making in clinical practice.</jats:p