Effect of an intervention to improve the management of patients with diabetes in primary care practice

To assess the effect of an intervention targeted at primary care physicians [PCPs] in order to improve their management of diabetic patients. Diabetic patients seen by PCPs in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia from January 2008 to July 2009 were included in this prospective cohort study. The PCPs were divided into intervention and control groups. The intervention group with the help of an assistant, utilized a customized designed computer program generating a checklist for the PCPs. The list included clinical and biochemical screening tests needed for the patient's current visit, according to evidence-based diabetes guidelines. For the control group, no assistant was used. At the end of one year, an independent reviewer evaluated the patients' files in both groups to assess the adherence to diabetes guidelines. We enrolled 162 patients in the control group and 517 patients in the intervention group. The intervention significantly improved the percentage of patients being screened for diabetic complications; retinopathy from 24.7-98.5%, neuropathy from 25.9-92%, and nephropathy from 37.8-73.7%. There was no improvement in glycemic control in both groups and glycosylated hemoglobin level [HbAlc] values were still above the 7% target. Management of diabetic patients in the primary care clinics is below standard. The intervention applied was effective in promoting better adherence to evidence-based diabetes guidelines

Apolipoprotein B/apolipoprotein A-I ratio in relation to various definitions of metabolic syndrome among Saudi patients with type 2 diabetes mellitus

To assess if the apolipoprotein Apo B/Apo A-I ratio in Saudi patients with type 2 diabetes mellitus T2DM is associated with metabolic syndrome MetS. This cross-sectional study was conducted on 250 patients with T2DM, above 40 years of age, at King Abdulaziz University Hospital Diabetes Center in Riyadh, Saudi Arabia, between January and December 2006. Metabolic syndrome was defined, and compared according to 3 criteria, namely, National Cholesterol Education Program Adult Treatment Panel III, International Diabetes Federation, and World Health Organization. In the 250 patients studied, all 3 definitions demonstrated significant increase in the Apo B/Apo A-I ratio, in Saudi type 2 diabetics with the MetS. There was a strong positive correlation between the Apo B/Apo A-I ratio and triglycerides, low-density lipoprotein cholesterol, and total cholesterol r=0.43-0.54, p<0.0001, and a weak, yet significant, correlation r=0.14-0.21, p<0.05 with waist circumference, waist-hip ratio, fasting glucose, and hemoglobin A1c, however, not with body mass index r=0.01, p=0.88. In contrast, the ratio showed strong negative correlation with high-density lipoprotein cholesterol r = -0.7, p < 0.0001. Apolipoprotein B/apolipoprotein A-I ratio is significantly associated with MetS in Saudi patients with T2DM, similar to observations made in other ethnic groups

Circulatory neutrophil chemokines in statin-treated diabetic patients

To assess the effect of statins on the circulatory levels of neutrophil chemokines, namely, granulocyte chemotactic protein-2 [GCP-2], growth regulated oncogene-alpha [GRO-alpha] and epithelial-cell-derived neutrophil-activating peptide-78 [ENA-78] in patients with diabetes. We studied 91 diabetic patients [46 were statin-treated and 45 were not] and 28 healthy subjects. We measured the levels of GCP-2, GRO-alpha, and ENA-78 in the serum for the 3 groups using an enzyme linked immunosorbent assay. This cross-sectional study was conducted at King Khalid University Hospital [KKUH], Riyadh, Kingdom of Saudi Arabia, from January 2006 to July 2007. Circulating levels of GCP-2, ENA-78, and not GRO-alpha, were significantly higher in diabetic patients as compared to healthy subjects [p<0.05]. Statins dropped the levels of both GCP-2 and GRO-alpha. The ENA-78 levels were not affected by statin therapy. There was no correlation between the levels of these chemokines with the body mass index and glycemia in the population studied. Diabetes is associated with an elevation of GCP-2 and ENA-78, and not GRO-alpha. Statins have a significant role in reducing the level of GCP-2