The impact of telemedicine on patients with uncontrolled type 2 diabetes mellitus during the COVID-19 pandemic in Saudi Arabia: Findings and implications.

INTRODUCTION: Routine diabetes care changed during the COVID-19 pandemic due to precautionary measures such as lockdowns, cancellation of in-person visits, and patients' fear of being infected when attending clinics. Because of the pandemic, virtual clinics were implemented to provide diabetes care. Therefore, we conducted this study to assess the impact of these virtual clinics on glycaemic control among high-risk patients with type 2 diabetes mellitus (DM). METHODS: A prospective single-cohort pre-/post telemedicine care intervention study was conducted on 130 patients with type 2 DM attending a virtual integrated care clinic at a chronic Illness center in a family and community medicine department in Riyadh, Saudi Arabia during the COVID-19 pandemic. RESULTS: The mean age of the participants was 57 years (standard deviation (SD) = 12) and the mean (SD) duration of diabetes was 14 (7) years. Over a period of 4 months, the HbA1c decreased significantly from 9.98 ± 1.33 pre-intervention to 8.32 ± 1.31 post-intervention (mean difference 1.66 ± 1.29; CI = 1.43-1.88; P <0.001). In addition, most in-person care visits were successfully replaced, as most patients (64%) needed only one or two in-person visits during the 4-month period, compared with typically one visit every 1-2 weeks in the integrated care programme before the pandemic for this group of high-risk patients. DISCUSSION: The current study found a significant positive impact of telemedicine care on glycaemic control among high-risk patients with DM during the COVID-19 pandemic. Moreover, it showed that telemedicine could be integrated into diabetic care to successfully replace many of the usual in-person care visits. Consequently, health policy makers need to consider developing comprehensive guidelines in Saudi Arabia for telemedicine care to, ensure the quality of care and address issues such as financial reimbursement and patient information privacy.

The Effect of COVID-19 Lockdown on Cerebrovascular Accidents, Acute Coronary Syndrome, and Diabetic Ketoacidosis Visits the Emergency Department: A Retrospective Study.

Objective This study aims to assess the effect of the COVID-19 lockdown on acute coronary syndrome (ACS), cerebrovascular accident (CVA), and diabetic ketoacidosis (DKA) visits the emergency department (ED). Methods We compared two groups of patients attending King Abdulaziz University Hospital (KAUH) ED diagnosed with one of the following ACS, CVA, or DKA; patients presenting from 21 December 2019 to 23 March 2020 and patients presenting from 23 March 2020 to 21 June 2020, representing COVID-19 pre-lockdown and during-lockdown period, respectively. The variables we analyzed were age, nationality (Saudi/non-Saudi), and gender. Results Our total sample size was 285 patient visits, ACS (n=130), CVA (n=98), and DKA (n=57). Results showed a statistically significant relationship between the number of patients with ACS and the period of visitation to ED (45.24% reduction, p-value <0.001), while CVA (18.5% reduction, p-value 0.312) and DKA (16% reduction, p-value 0.508) showed no statistically significant relationship. Conclusion A lockdown may be necessary to control a pandemic. However, it may carry potential collateral damage, such as a decrease and delay in the presentation of life-threatening conditions, which may lead to worsening outcomes. A clinical presentation of these conditions should warrant comprehensive evaluation by healthcare workers regardless of an ongoing pandemic while implementing infection control guidelines.

The Role of Digital Technology in Responding to COVID-19 Pandemic: Saudi Arabia's Experience.

INTRODUCTION: The novel coronavirus (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a single-chain ribonucleic acid (RNA) virus. As of March 25, 2021, the total number of positive cases and fatalities in the Kingdom of Saudi Arabia (KSA) had reached 386,300 and 6624, respectively, with a case fatality rate of 1.71%. The KSA was among the leading nations to heed the advice of WHO officials and put strict precautionary and preventive measures in place to curb the early spread of COVID-19 before it was declared a global pandemic. METHODOLOGY: This was an uncontrolled before-after study following a mixed-method approach for data collection. National and regional data were extracted from the Health Electronic Surveillance Network (HESN), a centralized public health collection system for quantitative and statistical data. Quantitative and qualitative methods have been utilized in studying data derived from tech media. RESULTS: The Saudi authorities utilized different technological tools to aid in managing and combating the COVID-19 pandemic. In the case of Al Madinah Al Mounawarah, after the implementation of several technologies, the most important being Tawakkalna, the number of active daily cases decreased by 61%. CONCLUSION: The use of the Tawakkalna application was proven to be a successful method in fighting the COVID-19 pandemic in the KSA. This vital and essential experience warrants the use of different digital technology that offers a personalized profile displaying the person's status (affected, vaccinated, or no history of infection). This application played and will continue to play a crucial and effective role in pandemic containment in Saudi Arabia.

Cost-effectiveness of telemedicine care for patients with uncontrolled type 2 diabetes mellitus during the COVID-19 pandemic in Saudi Arabia.

BACKGROUND AND AIM: Telemedicine could be used to provide diabetes care with positive clinical outcomes. Consequently, this study evaluated the cost-effectiveness of telemedicine for patients with uncontrolled type 2 diabetes mellitus (i.e. HbA1c >9). PATIENTS AND METHODS: This was a retrospective chart review of patients with uncontrolled type 2 diabetes attending an outpatient integrated care clinic. The study consisted of two arms, namely a telemedicine care model and a traditional care model with 100 patients in each. The clinical effectiveness (i.e. reduction in HbA1c) and the total cost in both arms were determined, and the incremental cost-effectiveness ratio was calculated. This study adopted propensity score matching. RESULTS: The patients in the telemedicine care model had a mean reduction in their HbA1c level of 1.82 (95% CI = 1.56-2.09, p < 0.001), while those in the traditional care model had a mean reduction of 1.54 (95% CI = 1.23-1.85, p < 0.001). Consequently, the incremental effect was 0.28 (95% CI = -0.194 to 0.546). The mean total costs were SAR 4819.76 (US$1285.27) and SAR 4150.69 (US$1106.85) for patients in the telemedicine and traditional care models, respectively. Consequently, the incremental cost was SAR 669.07 (US$178.42) [95% CI = SAR 593.7 (US$158.32)-SAR 1013.64 (US$270.30)]. The ICER was estimated to be SAR 2372.52 (US$632.67) per 1% reduction in the level of HbA1c. Moreover, the telemedicine care model resulted in a higher cost and better outcome (i.e. reduction in the HbA1c level) with an 81.80% confidence level. CONCLUSION: Telemedicine care is cost-effective in managing type 2 patients with poorly controlled diabetes. Consequently, we believe that telemedicine care can be further expanded and incorporated into routine diabetes care.

Risk factors for hospital admission among COVID-19 patients with diabetes. A study from Saudi Arabia.

OBJECTIVES: To elucidate the risk factors for hospital admission among COVID-19 patients with type 2 diabetes mellitus (T2DM). METHODS: This retrospective study was conducted at the Prince Sultan Military Medical City, Riyadh, Saudi Arabia between May 2020 and July 2020. Out of 7,260 COVID-19 patients, 920 were identified as T2DM. After the exclusion process, 806 patients with T2DM were included in this analysis. Patients' data were extracted from electronic medical records. A logistic regression model was performed to estimate the risk factors of hospital admission. Results: Of the total of 806 COVID-19 patients with T2DM, 48% were admitted in the hospital, 52% were placed under home isolation. Older age between 70-79 years (OR [odd ratio] 2.56; p=0.017), ≥80 years (OR 6.48; p=0.001) were significantly more likely to be hospitalized compared to less than 40 years. Similarly, patients with higher HbA1c level of ≥9% compared to less than 7%; (OR 1.58; p=0.047); patients with comorbidities such as, hypertension (OR 1.43; p=0.048), cardiovascular disease (OR 1.56; p=0.033), cerebrovascular disease (OR 2.38; p=0.016), chronic pulmonary disease (OR 1.51; p=0.018), malignancy (OR 2.45; p=0.025), chronic kidney disease (CKD) IIIa, IIIb, IV (OR 2.37; p=0.008), CKD V (OR 5.07; p=0.007) were significantly more likely to be hospitalized. Likewise, insulin-treated (OR 1.46; p=0.03) were more likely to require hospital admission compared to non-insulin treated patients. CONCLUSION: Among COVID-19 patients with diabetes, higher age, high HbA1c level, and presence of other comorbidities were found to be significant risk factors for the hospital admission.

Stress and psychological resilience among general surgery residents during COVID-19 pandemic.

OBJECTIVES: To evaluate the impact of coronavirus-19 (COVID-19) pandemic and its consequences on general surgery residents. Methods: Cross-sectional, survey based study including surgical residents in Kingdom of Saudi Arabia and Kingdom of Bahrain. RESULTS: Surgical trainees who participated in our survey (n=234) were young (mean age 28), single (53.8%), and males (65.8%). Approximately half (50.4%) have been deployed to cover the staff shortage in intensive care units (ICUs) or emergency departments (EDs). Half of our trainees (117) scored positive in the screening tool of generalized anxiety disorder (GAD). There was a significant association between experiencing anxiety and male gender (p=0.055), level of training (p=0.002), deployment to cover ICUs (p=0.050), testing positive for COVID-19 (p=0.054) and having an infected family member (p=0.004). CONCLUSION: Coronavirus-19 pandemic has a serious effect on all healthcare workers and surgical residents have experienced a considerable amount of stress. Accordingly, this psychological burden should be appropriately addressed in organizations planning strategies. We suggest formulating guidelines to help surgical trainees to continue their learning process with least psychological burden.

Increasing the efficiency of mechanical ventilators during pandemics through additive manufacturing.

The COVID-19 pandemic tested medical facilities' readiness in terms of the number of available mechanical ventilators. Most countries raced to stock up on ventilators, which created a surge in demand and short in supply. Furthermore, other means of coping with the demand were proposed, such as using additive manufacturing. The purpose of this paper was to test whether the addition of 3D-printed splitters would help deliver required tidal volume to each patient, while supporting four patients on a single ventilator for 24 hours on pressure mode at 25-cm H2O, and to determine whether a fifth patient can be ventilated. The ventilation of four human lungs was simulated using 3D printed parts, a single ventilator, four test-lungs, and standard tubing. Peak pressure, positive end-expiratory pressure, total tidal volume, individual tidal volume, total minute volume, and individual tidal volume data were collected. Usage of a 3D printed small size splitter enabled a 26% increase in individual tidal volume compared to standard tubing and a series of two-way splitters. The ventilator was able to supply the required pressure and tidal volume for 24 hours. A single ventilator with a four-way splitter can ventilate four patients experiencing respiratory failure for at least 24 hours without interruption. The equipment cannot sustain ventilating a fifth patient owing to minute volume limitation. This study expands on an earlier study that tested similar circuitry and reveals that the desired individual tidal volume is achieved. However, further research is required to provide the monitoring ability of individual patient parameters and prevention of cross-contamination.