Frequency and associated risk factors of recurrent diabetic ketoacidosis among Saudi adolescents with type 1 diabetes mellitus

To explore the frequency and associated risk factors of recurrent diabetic ketoacidosis [RDKA] among Saudi adolescents with type 1 diabetes mellitus [T1DM]. A cross-sectional study was conducted among 103 T1DM adolescents [aged 13-18 years, 57 males] who were hospitalized for diabetic ketoacidosis][DKA] between January 2013 and May 2014 at Prince Sultan Military Medical City [PSMMC], Riyadh, Kingdom of Saudi Arabia. The respondents were purposively, conveniently selected, and interviewed using a structured Arabic questionnaire including clinical information and demographics. Fifty-six participants had experienced one episode of DKA, 41 had 2 episodes, and 6 had >/=3 episodes. Compared with adolescents who had hemoglobin A1c [HbA1c] 9 HbA1c. Similarly, adolescents who stopped insulin and those with lipodystrophy at the injection site had a higher frequency of RDKA. Discontinuing insulin [67%] was the major reason for RDKA followed by infection [31%]. Among adolescents who discontinued insulin treatment, 31 [46.3%] gave no reason for stopping, 25 [37.3%] reported feeling sick, 7 [10.4%] gave a combination of reasons, and 4 [6%] reported a lack of supplies or other reasons. Regression analysis revealed that a higher HbA1c level and the presence of lipodystrophy were independent risk factors for RDKA. The frequency of RDKA was significantly greater in the T1DM adolescents with a higher HbA1c level, lipodystrophy, and those who had discontinued insulin treatment. Comprehensive multidisciplinary diabetes education should be offered to control modifiable risk factors in these patients

Predictive risk factors for fear of hypoglycemia and anxiety-related emotional disorders among adolescents with type 1 diabetes

To explore the fear of hypoglycemia [FOH] and anxiety-related emotional disorders and their risk factors among adolescents with type 1 diabetes mellitus [T1DM].Subjects and A cross-sectional study was conducted among 187 adolescents [aged 13-18 years; 92 males, 95 females] with T1DM at the Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia, from June 2013 to February 2014. The participants were interviewed using FOH and Screen for Child Anxiety-Related Disorders [SCARED] scales. Females had significantly higher scores on all FOH and SCARED subscales compared to males. The mean scores for many subscales of FOH and SCARED were higher in the older age group [16-18 years], in those under multiple-dose injection [MDI] treatment [compared with the insulin pump treatment], and in those with a longer duration of T1DM. Similarly, significant differences were observed in those with high frequencies of hypoglycemia, passing out, hypoglycemia while asleep and awake, and hypoglycemia in front of friends and at school. Regression analysis revealed that higher age, female gender, MDI treatment, longer duration of T1DM, higher frequencies of hypoglycemia, passing out, hypoglycemia while asleep and awake, and hypoglycemia in front of friends and at school were the risk factors associated with the majority of the FOH and SCARED subscales. The behavior of the FOH subscale correlated with all the subscales of SCARED except the subscale of generalized anxiety disorder. Similarly, the FOH subscale of worry significantly correlated with all the subscales of SCARED. The strongest determinants of higher risk for the majority of the FOH and SCARED subscales were higher age, female gender, MDI treatment, longer duration of T1DM, higher frequency of hypoglycemia, passing out due to hypoglycemia, hypoglycemia while asleep and awake, and hypoglycemia in front of friends and at school

Factors Associated with Health-Related Quality of Life among Saudi Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Survey

BACKGROUND: Diabetes mellitus (DM) is associated with high mortality, morbidity, poor general health, and loss of health-related quality of life (HRQOL). The objective of the study was to assess the factors associated with HRQOL among patients with type 2 diabetes mellitus (T2DM). METHODS: This was a cross sectional study conducted among 283 T2DM patients during June 2011 and September 2012 at a major tertiary hospital in Riyadh, Saudi Arabia. The respondents were purposively and conveniently selected according to their availability during their routine visit to the outpatient clinics and they were interviewed using the Arabic version of the Short-Form 36-item survey (SF-36) to assess the HRQOL. RESULTS: The mean age of the participants was 56.4+/-13.2 years. Around 63% (178) were males and 37% (105) were females. Glycosylated hemoglobin level was found to be significantly higher among female and HRQOL was higher among male. Respondents who were more than 50 years old had poor HRQOL than less than 50 years age group. Poor economic status, reported diabetic complications and longer duration of diabetes were significantly associated with poor HRQOL. The respondents treated with combination of therapies (oral medication plus insulin) indicated better HRQOL than patients with insulin therapy alone. Multivariate analysis indicated that gender, economic status (except subscale energy), and complications of DM (except subscale energy) as independent risk factor for HRQOL. CONCLUSION: Gender, economic status, and complication of DM were independent risk factors for majority of the subscales of HRQOL.

Assessment of health-related quality of life among adolescents with type 1 diabetes mellitus in Saudi Arabia

To evaluate the health-related quality of life [HRQoL] for adolescents with type 1 diabetes mellitus [T1DM]. A cross-sectional study was conducted among 214 adolescents [13-18 years] with T1DM at the Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia from June to September 2013. Respondents were selected by their availability during routine visits to outpatient clinics, and interviewed using the Arabic translated version of the Pediatric Quality of Life Inventory 3.0 Diabetes Module [PedsQL 3.0 DM] independently. Female gender, multiple daily injection [MDI], longer duration of T1DM [>7 years], diabetic ketoacidosis [DKA] and adolescents with >7 HbA1c level had at least one poor HRQoL outcome. Multivariate linear regression analysis showed that age, treatment type [MDI], DKA, and >7 HbA1c were independent influencing factors for subscale diabetes symptoms, whereas >7 HbA1c was the independent influencing factor for treatment barriers and overall HRQoL. The DKA was the independent influencing factor for the subscale of worry, and female gender was the independent influencing factor for the subscale of communication. Female gender, age, treatment type, >7 HbA1c, and DKA are the strongest determinants for lower HRQoL for at least one subscale of the PedsQL 3.0 DM

Prevalence of low testosterone levels in men with type 2 diabetes mellitus: a cross-sectional study

A high prevalence of low serum testosterone [LST] in men with type 2 diabetes have been reported worldwide. The aim of this study was to determine the prevalence and associated factors of LST in men with type 2 diabetes. This was a cross-sectional study, conducted among 1,089 men [aged 30-70 years] with type 2 diabetes who consecutively attended a major diabetes center in Amman, Jordan, between August 2008 and February 2009. The patients' demographic characteristics were collected using a prestructured questionnaire. Duration of diabetes, smoking habits, presence of retinopathy, neuropathy, and nephropathy were collected from the medical records. All participants were asked to complete the Androgen Deficiency in Ageing Male [ADAM] questionnaire. Venous blood sample was collected to test for total testosterone [TT], free testosterone [FT], sex hormone binding globulin [SHBG], follicle-stimulating hormone [FSH], luteinizing hormone [LH], prolactin [PRL], serum lipids, and glycosylated hemoglobin [HbA1c]. LST was defined as TT <3 ng/ml. Overall, 36.5% of patients with diabetes had TT level <3 ng/ml and 29% had symptoms of androgen deficiency. Of those with serum testosterone level <3 ng/ml, 80.2% had symptoms of androgen deficiency, 16.9% had primary hypogonadism [HG], and 83.1% had secondary HG. Univariate analysis showed a significant relationship between age, income, education, body mass index [BMI], smoking, duration of diabetes, diabetic nephropathy, diabetic neuropathy, and HbA1c. Multivariate logistic regression analysis indicated age, income, BMI, and diabetic neuropathy as the independent risk factors of LST. The prevalence of LST among men with type 2 diabetes is high. Age, income, BMI, and diabetic neuropathy were found to be the independent risk factors for LST

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

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. 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%.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]. 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