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.

Evaluation of adjunctive systemic doxycycline with non-surgical periodontal therapy within type 2 diabetic patients

To evaluate the effects of systemic doxycycline on clinical and microbiological parameters of diabetic subjects with chronic periodontitis. This 9-month multi-center, randomized, parallel, single-blinded study was conducted from different hospitals in Riyadh, Saudi Arabia between April 2010 and December 2010. A total of 76 diabetic subjects with chronic periodontitis were randomized into 2 groups: control group [CG] received only scaling and root planing [SRP], and the treatment group [TG] receiving systemic doxycycline during the reevaluation visit 45 days after the completion of SRP. Probing pocket depth, clinical attachment level, gingival index, plaque index, and bleeding on probing were collected at baseline, 45 days after SRP, and one, 3, and 6 months after the use of systemic doxycycline. Microbiological analysis comprised the detection of Tannerella forsythia [Tf], Aggregatibacter actinomycetemcomitans [Aa], Porphyromonas gingivalis [Pg], and Prevotella intermedia [Pi] by polymerase chain reaction method. Sixty-eight [33 CG and 35 TG] subjects completed the study. Greater reduction in the population of Tf, Pg, and Pi were observed in TG compared with CG in the first month after the administration of systemic doxycycline. The TG showed a significant improvement in gingival index scores compared with the CG [p<0.05] by the end of the first and 6 months after the administration of doxycycline. Adjunct systemic doxycycline can be associated with a reduction of Tf, Pg, and Pi in the first month after the administration of doxycycline with an improvement in the GI

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

Alexithymia among Arab mothers of disabled children and its correlation with mood disorders

To study alexithymia among mothers with disabled children in Saudi Arabia, and to explore if alexithymia is associated to their mood difficulties, and certain demographic variables. We conducted a prospective study during January 2011 to April 2012, on 86 mothers [study group] caring for children with physical, mental, or sensory disabilities treated at a major tertiary rehabilitation hospital in Riyadh, Saudi Arabia. A total of 32 mothers [control group] with healthy children were also included. The Hospital Anxiety and Depression Scale [HADS] was used to measure the mood symptoms of mothers. The Toronto Alexithymia Scale [TAS-20] was administered to assess the degree of alexithymia. The demographic data of mothers and children were also collected. The mean age of children with a disability was 5.6. +/- 3.1, and for healthy children was 6.3 +/- 3.7 [range 1-14] years. The mean age of mothers in the study group [n=86] was 33.9 +/- 6.1, and in the control group [n=32] was 35.2 +/- 7.3 years. Mothers of children with disabilities had a significantly higher degree of alexithymia [p=0.001] and a significantly higher mean score of HADS-anxiety [p=0.042] and HADS depression [p=0.021]. Alexithymia had a significant correlation with mother's depression [p=0.0001] and anxiety [p=0.0001]. No significant correlations were found between alexithymia and child's age [p=0.303], duration of disability [p=0.0941], and mother's age [p=0.235]. Mothers caring for disabled children have higher features of alexithymia, and this is correlated to their elevated mood problems. Clinical implications are discussed

analysis of the length of stay in traumatic and non-traumatic spinal cord injured patients. a rehabilitation unit experience in Saudi Arabia

To determine and analyze the influence of age, gender, type of injury, and ethnicity in the length of stay [LoS] of in-patient rehabilitation unit patients after traumatic spinal cord injury [TSCI] and non- traumatic spinal cord injury [NTSCI]. We conducted a retrospective study of all patients who completed the TSCI and NTSCI rehabilitation program at Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia from January 2005 to October 2008. Admission records of 495 traumatic spinal cord injured [male 404, female 91; mean age 34.3 +/- 0.68 years] and 126 non-traumatic spinal cord injured patients [male 81, female 45; mean age 45 +/- 1.56 years] were identified. We excluded patients aged /=81 years due to the small proportion. The influence of age, gender, type of injury, and ethnic differences in the LoS were analyzed. Compared with TSCI, patients with NTSCI had a significantly [p=0.035] shorter LoS [58.8 +/- 1.68, 46.2 +/- 2.1]. The frequency of the TSCI was higher in the 21-30 age groups and lower in the 71-80 age group. Compared with TSCI, the frequency of NTSCI was less in all age groups. The LoS of male was longer than the female in all age groups. The LoS of Saudi patients were higher in TSCI [p=0.021] and NTSCI rehabilitation program compared with the non-Saudis. The results of the study suggest that the gender, types of injury, and ethnicity differences were influencing factors of LoS of traumatic and non traumatic spinal cord injured patients

Determinants of periodontopathogens in microbiological monitoring of diabetic patients with periodontitis

To determine and analyze the frequency of periodontopathogens in microbiological monitoring of diabetic patients with periodontitis. This cross-sectional study included 352 diabetic patients with periodontitis who were registered at Riyadh Armed Forces Hospital, King Faisal Specialist Hospital and Research Centre, King Abdul Aziz Medical City, Naval Base Hospital, and Sultan Bin Adulaziz Humanitarian City, Riyadh, Kingdom of Saudi Arabia from July 2004 to August 2008. Microbiological analysis comprised the detection of Bacteroides forsythus [Bf], Aggregatibacter actinomycetemcomitans [Aa], Porphyromonas gingivalis [Pg], and Prevotella intermedia [Pi] by polymerase chain reaction method. The mean age of patients was 54.4 +/- 0.67 [range: 21-80 years]. There were 214 [61%] males and 138 [39%] females. Among the study population, 36 [10%] had type 1, and 316 [90%] patients had type 2 diabetes. The results showed that 55.6% of patients had Bf, 51.7% had Az, 63.7% had Pg, and 6.1% had Pi. The frequencies of periodontopathogens were higher in males than females in all age groups. The risk of periodontopathogens Bf were found higher level in 41-50 age group, Aa in 51-60, Pg in 51-60, and Pi in 31-40 age groups. This study found that the frequencies of periodontal pathogens Bf, Aa, and Pg were higher than Pi in diabetic patients with periodontitis

Profile of diabetic foot complications and its associated complications--a multicentric study from India.

AIM: The aims of this study were to determine. The prevalence of foot complications such as neuropathy, peripheral vascular disease (PVD), amputations and infections and the associated diabetic complications and practice of foot care among these subjects. METHODS: A total of 1319 type 2 diabetic patients, were selected from four different centres across India. The centres were Diabetes Research Centre (DRC), Chennai, Government Rajaji Hospital (GRH), Madurai, Christian Medical College (CMC), Vellore and All India Institute of Medical Science (AIIMS), Delhi. Details were collected regarding foot problems and associated complications. RESULTS: The prevalence of neuropathy was 15% (n=193) and PVD was 5% (n=64). Infections were present in 7.6% (n=100) of patients. The infection rate varied from 6-11% in the different centres. Nearly 3% of subjects had undergone a minor or major amputation. DISCUSSION: This study found that the prevalence of infection was 6-11% and prevalence of amputation was 3% in type 2 diabetic patients. Neuropathy (15%) was found to be an important risk factor for diabetic foot infections. Effective foot care advice should be propagated to reduce the burden imposed by diabetic foot complication particularly in developing countries like India.