Risk for obstructive sleep apnea among people with diabetes

The aim of this study is to identify people at high risk for Obstructive Sleep Apnea [OSA] and to evaluate the impact of OSA on the control of cardiovascular risk factors. Design: A Cross-Sectional Study. Setting: Four Primary Health Care Centers. Method: Patients attending diabetes clinics in four health centers were screened for OSA by using the Berlin questionnaire. In addition, patients' medical records were reviewed for age, sex, body mass index [BMI], blood pressure, glycated hemoglobin, lipid profile, antihypertensive, hypoglycemic agents and previous OSA diagnosis. Result: A total of 455 questionnaires were analyzed. All patients included were type 2. The mean age was 56.6 years. High risk for OSA was present in 173 [38%] patients. It was more common among females [P=0.013]. There was no significant age difference [P=0.75]. The risk of OSA increased significantly with BMI >/= 35 [P<0.001]. No significant difference was found between low and high risk in the control of glycated hemoglobin, lipid profile, and the number of drugs used. Three [1.7%] patients from the high OSA risk and 2 [0.71%] from the low risk [282] had previous OSA diagnosis. Conclusion: More than one-third of our patients were high risk for OSA. Screening for OSA among diabetics is lacking despite the presence of high number of at risk patients. Increasing awareness of the treating physicians is needed

Risk factors for diabetic retinopathy in patients attending primary care settings

To identify risk factors for diabetic retinopathy [DR] among patients with diabetes attending primary care health centers and to assess level of control. Case control study. Twenty-two health centers. The medical records of patients with diabetes who were screened for retinopathy during the year 2011 were reviewed. The following were documented: age, sex, duration of diabetes, glycated hemoglobin [A1C], blood pressure [BP], lipid profile, smoking status, presence or absence of chronic kidney disease and guardian drugs [Angiotensin Converting Enzyme Inhibitors [ACEi], Angiotensin Receptor Blockers [ARBs], Statins and Aspirin] used. In addition, patients with diabetes who were screened as normal [no DR] from 4 health centers were randomly selected and their medical records were reviewed to compare the above mentioned risk factors between those with and those without DR. A total of 1,508 retinal screening forms were reviewed, 112 patients were diagnosed with DR. A total of 263 screened but had no DR were reviewed in the selected 4 health centers. In DR, uncontrolled A1C was found in 81 [72.3%] patients, high BP in 69 [61.6%] and Low Density Lipoprotein in 81 [72.3%]. There was statistically significant association between A1C >/= 53mmol/mol [P=0.000], increased diabetes duration [P=0.000], total cholesterol >/= 5.2mmol/l [P=0.008], LDL >/= 2.6mmol/l [P=0.002] and the presence of DR. There was no significant association between age, sex, BP, and triglycerides level >/= 1.7mmol/l and presence of DR. The use of statins, ARBs, fibrates and aspirin was significantly higher in patients with DR. Control of the identified modifiable risk factors is suboptimal. The burden of DR can be reduced by more intensive control of these factors through effective use of the currently available guardian drugs

Prevalence of peripheral arterial disease among people attending diabetes clinics at primary care settings

The aim of this study is to use ankle-brachial index [ABI] to evaluate the prevalence of peripheral arterial disease [PAD] in diabetic patients and to identify the associated cardiovascular risk factors and their level of control. Cross-sectional Study. Four primary healthcare centers. Four health centers were chosen randomly. People attending diabetes clinics were screened for PAD by measuring their ABI. ABI /= 3 CKD [P=0.014]. Use of statins was lower in patients with PAD when compared with patients with normal ABI [P=00]. The study revealed that PAD is highly prevalent among people with diabetes. Control of cardiovascular risk factors was poor in general, but was worse in patients with PAD. The use of guardian drugs was suboptimal

Primary care physicians' attitude and practice in managing geriatric depression

To evaluate the diagnosis and management of depression among elderly in primary care. All the local health centers in Bahrain were included for the assessment of the physicians' practice. A cross-sectional study. A self-administered questionnaire was distributed to physicians in all health centers. It examined the current practice of physicians in detecting and managing elderly depression and the most important obstacles facing them. It also explored the needs for physicians to have training and clinical guidelines to manage elderly depression. This study included 132 physicians. Hundred and four [79%] physicians did not receive any formal training or course in geriatric psychiatry. Fourteen [10.6%] physicians were routinely screening patients for depression; hundred and one physicians [76.5%] were screening on occasional basis and 13 [9.8%] never had screened for depression. Thirty-nine [29.5%] physicians referred the cases immediately once they were identified. Ninety-six physicians [72.7%] felt competent but seventy-three physicians [55.3%] did not feel confident in treating late life depression. Seventy- six physicians [57.6%] had no time to discuss any psychological issues with the elderly. Hundred and fourteen physicians [86.4%] wished to have a specific guideline for the management of elderly depression and hundred and twelve [85%] felt the need to adopt a specific scale to screen for depression in primary care settings. Hundred and nine physicians [82.6%] thought that they need more training on the identification and management of old age depression. Screening for depression among elderly patients in primary care is not sufficient leading to low detection rate of cases. Lack of training in geriatric psychiatry, short consultation time, and the absence of clear guideline were identified in this study as barriers to proper diagnosis

Incidence of depression among elderly attending primary health care centers

To estimate the incidence of depression among Bahraini elderly attending primary health care services. A cross-sectional study. Four Primary Health Care Centers, Bahrain. The study was performed from July to August 2006. One health center was randomly selected from each of the four geographical regions of Bahrain. Two hundred and seventy Bahraini patients aged 60 years and older attending the local health centers during that period were included. The shorter version of the Geriatric Depression Scale [GDS-15] was used to screen for depression among the study participants. Two hundred and seventy Bahraini patients were included. Hundred and forty- six [54%] were women and hundred and twenty-four [46%] were men. The mean age for male participants was 68.65 +/- 6.3 and the mean age for females was 68.36 +/- 7 years. Hundred and twelve patients [41.5%] were diagnosed with depression. The mean depressive score for men was 3.67 +/- 3.07 and for women it was 5.86 +/- 3.62. Severe depressive symptoms were reported by 3.2% of men and 7.5% of women. The risk of depression was significantly more among women than among men with an odds ratio [OR] of 4.3 [95% CI = 2.54-7.32]. Depressive symptoms are prevalent among Bahraini elderly attending the local health centers. Family physicians should be trained to screen for and to manage depression in highly susceptible groups

Prevalence of depression among people with diabetes attending diabetes clinics at primary health settings

To study the prevalence of depression among diabetics and to examine the relationship between depression and socio-demographic factors, metabolic control and diabetes complications. A Cross-Sectional Retrospective Clinical Study. Four Primary Health Care Centers. Two hundred and sixty-four patients were surveyed for the presence of depressive symptoms using Beck Depression Inventory [BDI] scale. In addition, patients' records were reviewed to abstract the following data: socio-demographic characteristics including: age, sex, marital status, level of education, smoking status, Body Mass Index [BMI], duration of diabetes, control of diabetes, use of insulin, presence of diabetic complications, presence of co-morbid conditions including hypertension and hyperlipidemia and the use of antidepressant[s]. Eighty-eight patients [33.3%] scored 16 or more on BDI scale. One hundred and sixty patients [60.6%] of the total sample were females. Statistical significant association was found between high BDI score [>/= 16] and sex, obesity [BMI >/= 30kg/m[2]], nephropathy, ischemic heart disease, and the use of insulin. No significant association between BDI score and metabolic control, duration of diabetes, other socio-demographic factors and diabetic complications was found. It was found that only 6 [2.3%] patients were on antidepressants. Although about one third of the screened patients were potential cases of depression, the great majority were under-recognized and undertreated. Hence, psychosocial assessment should be part of initial and ongoing evaluation of these patients to improve their quality of life and decrease adverse outcomes