Surveillance of risk factors for diabetic foot ulceration with particular concern to local practice.

INTRODUCTION: Diabetes mellitus is a global health problem with rising prevalence worldwide. Diabetes mellitus is a multisystem disease affects many systems and tissues. Foot problems are not uncommon with diabetes and foot ulceration is one of theses problems. Risk factors for foot ulcerations may differ from community to community based on many factors. OBJECTIVES: To determine the risk factors for diabetic foot ulceration among Saudi diabetic patients with type 2 diabetes attending primary care center. METHODOLOGY: Cross sectional study was designed. Four hundred subjects were selected randomly. Inclusion criteria were settled. Three hundred and fifty subjects (350) were participated. Especial assessment form was designed. Data was collected and analyzed using SPPS ver 14. RESULTS: Three hundred and fifty subjects were participated (57% male and 43% female). The prevalence of peripheral vascular disease was 15%, hulux vulgus 22.5%, inappropriate foot wear 41%, peripheral neuropathy 47.5%. Peripheral neuropathy and inappropriate foot wear were the commonest risk factors for foot ulceration. CONCLUSION: Peripheral neuropathy and inappropriate foot wear were the commonest risk factors for foot ulceration.

Evaluation of risk factors for cardiovascular diseases among Saudi diabetic patients attending primary health care service.

BACKGROUND: Cardiovascular disease is currently the primary cause of morbidity and mortality in patients with diabetes. For each risk factor present, the risk of cardiovascular death is about three times greater in people with diabetes than people without diabetes. OBJECTIVES: To determine the risk factors for cardiovascular disease among patients with type 2 diabetes. To stratify the patients into risk categories to develop coronary arteries disease (CAD) based on the British Joint Societies risk chart. To assess the awareness and implementation of the risk assessment charts by primary care physicians SUBJECT AND METHODS: Cross sectional study was designed. Sixty six (66 patients) diabetic patients were selected randomly by simple selection, from them 29 were males and 37 were females. Patients' medical records were reviewed. The following parameters were detected; blood pressure, lipid profile, weight, height, smoking and degree of glycemic control. A questionnaire was designed and distributed to randomly selected physicians working in primary health care assessed their awareness and implementation of risk assessment charts was done. RESULTS: Uncontrolled diabetes was found to be the common risk factor followed by uncontrolled lipid profile, obesity, uncontrolled systolic blood pressure and smoking. Seven percent (7%) of male group felled in highest risk group in comparison with 1% in female group (P<0.05), while 31% in male group felled in mild risk group in comparison with 90% in female group (P<0.05). Sixty two percent (62%) in male group felled in high risk group in comparison with 9% in female group (P<0.05). Criteria for ranking in risk class differed between male and female group. Forty one physicians were contacted and received the questionnaire. Twenty nine (70.7%) physicians were responded to the questionnaire. Twenty two (22) informed that they were aware about risk assessment score systems. Fourteen (14) physicians informed that they were aware about the BJSs charts but only two informed that they had used it to assess their patients. CONCLUSION: Clustering of multi risk factors is a serious event which may raise the risk category of diabetic patients. For each risk category the risk factors may differed between male and female patients. More studies are recommended to study distribution of risk factors between male and female diabetic patients. Attention should be directed toward raising the awareness about the risk assessment scoring system and encouraging physicians to use it.

Intensive versus conventional glycemic control: what is best for patients with type 2 diabetes?

BACKGROUND: Recently a hot debate was raised to answer if intensive glycemic control aimed to reduce HbA1c to less than 6.5% is better than conventional therapy in terms of future outcomes. A lot of studies were conducted to explore that but few mega trials were conducted. OBJECTIVE: To evaluate the effect and safety of both intensive and conventional insulin therapy in patients with type 2 diabetes. METHODOLOGY: Traditional systematic review was conducted; criteria for studies selection were formatted. Studies selected were criticized. RESULTS: Three mega trials (3) randomized 23,182 participants with type 2 diabetes (11,591 to intensive glycemic control and 11,591 to conventional glycemic control) were included. Only diabetic nephropathy was noted to be delayed in onset or progression by intensive insulin therapy. CONCLUSION: There are no benefits from intensive glycemic therapy (target HbA1c<6.4%) versus conventional glycemic therapy (target HbA1c>6.4%) except for decrease the rate of new onset or progression of nephropathy.