Subclinical autonomic neuropathy in Saudi type 2 diabetic patients

To compare the results of autonomic function tests obtained from diabetic patients who had no symptoms or signs of somatic or autonomic neuropathy with those obtained from control subjects. We studied 32 diabetic Saudi patients [17 males, 15 females] and 34 control subjects [17 of either gender] at King Khalid University Hospital, Riyadh, in the period 2004-2005. The mean age of patients was 50.3 +/- 5.04, and of controls was 49.9 +/- 5.86 years. In diabetics, the mean duration of the disease was 8.7 +/- 3.1 years [range 5-15 years], and the mean glycated hemoglobin was 7.76 +/- 1.14. The same observer performed the autonomic function tests. In diabetics, the resting heart rate [beats/min] was 80.5 +/- 4.13, mean orthostasis ratio was 1.06 +/- 0.035, mean Valsalva ratio was 1.19 +/- 0.036, mean forced sinus arrhythmia was 12.66 +/- 0.8 beats/min, mean diastolic blood pressure increase in response to isometric exercise was 13.03 +/- 1.36 mm Hg, and sympathetic skin response was present in only 18 [56.3%] out of 32 patients. These results were significantly different from the control group [p<0.001]. Diabetic patients, with no symptoms or signs of neuropathy, can have impaired autonomic function. We consider this subclinical autonomic neuropathy

Treatment of Graves' hyperthyroidism - prognostic factors for outcome

To determine whether clinical and biochemical features of Graves' disease at presentation predict response to medical and radioiodine treatment. We carried out a retrospective 10-year study of 194 consecutive Saudi subjects with Graves' disease who were treated with antithyroid drugs, radioiodine therapy, or both, between January 1995 and December 2004 at King Khalid University Hospital, Riyadh, Saudi Arabia. At diagnosis, the mean age was 32 +/- 0.9 years. Only 26% of patients had successful outcome after a course of antithyroid medication. None of the clinical or biochemical factors were associated with a favorable outcome of antithyroid treatment. One dose of radioiodine [13-15 mCi [481-555 MBq]] cured hyperthyroidism in 83% of patients. Presence of ophthalmopathy at presentation was shown to be a significant contributing factor to failure to respond to a single dose of radioiodine [odds ratio, 6.4; 95% CI, 1.51-24.4; p<0.01]. Failure of radioiodine treatment was also associated with higher serum free T3 concentration at presentation [p=0.003]. In patients with Graves' hyperthyroidism, radioiodine treatment is associated with higher success rate than antithyroid drugs. A dose of 13-15 mCi [481-555 MBq] seems to be practical and effective, and should be considered as first line therapy. Patients with high free T3 concentration and, those with ophthalmopathy at presentation were more likely to fail radioiodine treatment. A higher dose of radioiodine may be advisable in such patients

Prevalence of osteoperosis among postmenopausal females with diabetes mellitus

To assess the prevalence of osteopenia and osteoporosis among Saudi postmenopausal women with non-insulin dependent type 2 diabetes mellitus [T2DM]. The study was carried out at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia from February 2000 to September 2002. Bone mineral density [BMD] of the lumbar spine and femoral neck using dual x-ray absorptiometry [DXA; Lunar Wisconsin], were performed in 104 postmenopausal Saudi women with T2DM, and 101 postmenopausal non-diabetic women [control]. Bone mineral density was measured in gm/cm2 and both T-score and Z-score were measured but only T-score was used for analysis based on World Health Organization criteria. Bone profile, 25[OH] Vitamin D, 1,25[OH]2 Vitamin D, parathyroid hormone and urine deoxypyridinoline [DPD] were measured in most patients and controls. Body fat measurement around the biceps muscles using Futrex [body composition analyzer] were performed in patients and controls. Years postmenopausal, duration of diabetes mellitus, parity, exercise, sun exposure and milk consumption were also recorded. In the diabetic group, the mean spine BMD was 0.928 gm/cm2 [T-score = -2.28 SD] and for femoral neck the mean BMD was 0.817 gm/cm2 [T-score = -1.21 SD]. In control group, the mean spine BMD was 1.036 gm/cm2 [T-score = -1.2] and mean femoral neck BMD was 0.914 gm/cm2 [T-score = -0.608]. In the diabetic group, there was 16 [16.64%] patients with normal BMD of the spine, 42 patients [43.68%] with osteopenia [mean T-score = -1.8 SD] and 45 [46.8%] with osteoporosis [mean T-score = -3.3 SD]. Osteoporosis is more common among Type 2 postmenopausal females in this ethnic group. Since both groups are postmenopausal, having equal percentage of Vitamin D deficiency, multi-parity, non exposure to sun, lack of exercise and negligible milk intake, one can conclude that the low BMD can be attributed to DM in the absence of other causes of osteoporosis

prevalence of obesity among Saudi males in the Riyadh region

Attendees of 15 health centers in urban and rural areas in the Riyadh region were screened for obesity during May and June 1994. Systemic selection yielded 1580 Saudi males for analysis. The mean age was 33.6 +/- 13.5 years and body mass index [BM1] was 26.9 +/- 5.7 kg/m 2. Only 36.6% of subjects were their ideal weight [BMI < 25 kg/m [2]], while 34.8% were overweight [BMI 25-29.9 kg/m [2]], 26.9% were moderately obese [BMI 30-40 kg/m [2]] and 1.7% were morbidly obese [BMI > 40 kg/m [2]]. Middle age, lower education and joblessness predicted a higher risk for obesity. Patients living in rural areas had greater BMIs than those living in urban areas [P < 0.01]. Forty percent of overweight participants did not think they were so. The high prevalence of obesity and the lack of awareness among those afflicted emphasizes the need for community-based programs for preventing and reducing obesity, since weight control is effective in ameliorating most of the disorders associated with obesity, such as Type II non-insulin-dependent diabetes mellitus, hypertension, stroke, heart disease, sleep apnea syndrome and osteoarthritis of the knees. Young parents who are at risk of developing obesity and who play a central role in perpetuating it in their offspring should be the target of obesity-prevention programs

Hospitalization patterns of diabetic patients: a six year experience at King Khalid University Hospital

To determine the pattern of hospitalization of patients with diabetes mellitus [DM], the computer stored data on admission with DM as the primary or secondary diagnosis to King Khalid University Hospital [KKUH], Riyadh, Saudi Arabia over six years [1986 to 1991] were analyzed. There were 3037 admissions of 2299 patients with diabetes mellitus [2.6% of all hospital admissions], occupying 33,253 hospital bed days [3.5% of all hospitalization days]. Twenty-four percent of admissions were recurrent, 4% were frequent [more than once a year] and 6% were prolonged [more than four weeks]. DM was the primary diagnosis in 39%, secondary to other illness in 47% and related to diabetes in pregnancy in 14%. Diabetes-related admissions contributed 54% of all hospital bed-days used by patients with DM and were for acute metabolic complications [and hence potentially avoidable] in only 10.6% of these admissions. These patients spent an average 3.26 days per year in hospital, which is double the published expected rates. Pregnancy-related admissions of females with diabetes are short in duration. When diabetes is a secondary diagnosis, the reasons for admission are mostly related to degenerative diseases similar to those in the nondiabetic population. Patients admitted to KKUH with DM are more likely to stay longer and be admitted more often than when DM is a secondary diagnosis. The majority of diabetes-related admissions are nonacute and potentially avoidable. Identification of risk factors for and prevention of lengthy recurrent admissions should be a priority in health care resource allocation