Glycemic Control in Patients with Type 1 Diabetes: Comparison of Holidays versus Schooldays.

BACKGROUND AND AIMS: To examine the influence of school life in children and adolescents with type 1 diabetes (T1D) by comparing the glycemic control and Ambulatory Glucose Profile (AGP) between the holidays and schooldays. METHODS: This is a retrospective study conducted on 147 patients with T1D (14-19 years) who used an intermittently scanned Continuous Glucose Monitoring (isCGM) system to self-test their glucose levels during the periods of school time and holiday time. A record was maintained of the Continuous Glucose Monitoring (CGM) metrics i.e., Glucose Variability (GV) (%), mean Time in Range (TIR), Time above Range (TAR), Time below Range (TBR), and average time period of the hypoglycemic events during schooldays and the holidays. RESULTS: The study revealed differences between the recorded values during the holidays and schooldays, in % in target 70-180 mg/dL (38.2 vs 49.5; p = 0.039), mean glucose (194 vs 185; p = 0.048), frequency of low glucose events (9.2 vs 5.1; p = 0.036), mean duration of low glucose levels (117 vs 65; p = 0.021), % TBR below 70 mg/dL (2.9 vs 1.45; p = 0.023), % TBR below 54 mg/dL (1.1 vs 0.51; p = 0.031), TAR 181-250 mg/dL (21.1 vs 16.5; p = 0.037) and TAR >250 mg/dL (8.9 vs 6.5; p=0.043). On comparing the HbA1c levels of the study population recorded during the holidays (8.34%) with those recorded during the schooldays (8.13%), the HbA1c values during the school days were observed to be lower; however, no significant changes were noted in the HbA1c level between the holidays and schooldays. Concerning the FreeStyle Libre (FSL) scanning, the frequency during the holidays (n=6.2) was significantly lower than during the schooldays (n=9.5) (p=0.042). CONCLUSION: From the findings, it appears that children with T1D have good diabetes control during schooldays rather than during the holidays. To improve their glucose control during the holidays, these patients may also benefit from receiving greater attention and guidance.

Assessment of Patient-reported Satisfaction and Metabolic Outcomes Following Initiation of the Second Generation of Flash Glucose Monitoring in Patients with Type 1 Diabetes

BACKGROUND AND AIMS: This study aims to assess patient-reported satisfaction and metabolic outcomes following the initiation of the second generation of the Freestyle Libre 2 (FSL2) system in patients with type 1 diabetes (T1D). METHODS: This non-randomized single-arm observation study was conducted on 86 patients with T1D living in Saudi Arabia, who were asked to wear the FSL2 for 12 weeks. The demographic data were collected at baseline, while the continuous glucose monitoring (CGM) metrics were gathered, i.e., Glucose Variability (GV) (%), mean Time in Range (TIR), Time Above Range (TAR), Time Below Range (TBR), and average duration of hypoglycemic events were collected at baseline, 6th week and 12 weeks. Further, the Continuous Glucose Monitoring Satisfaction (CGM-SAT) was collected at the end of the follow-up RESULTS: Compared to the 6th week, significant differences were observed in the low glucose events (p = 0.037), % TIR (p = 0.045), and % below 70 mg/dL (p = 0.047) at 12 weeks. Improvement was seen in the other glucometric variables, but no significant changes were evident (p > 0.05). On completion of the study period, the ambulatory glucose profile (AGP) metrics showed a 74.3 ± 5.01 (mg/dL) FSL2 hypoglycemia alarm threshold and a 213 ± 38.1 (mg/dL) hyperglycemia alarm threshold. A majority of the patients stated that CGM-SAT had benefits (mean score > 3.58), although they felt FSL2 had 'additional benefits. With regard to the problems with the use of FSL2 majority of the patients stated that FSL2 has minimal discomfort. CONCLUSION: Using second-generation FSL2 in patients with T1D is positively associated with patient-reported satisfaction and metabolic outcomes.

Factors Associated With Self-Efficacy of Foot Self-Care Among Patients With Diabetes Attending a Tertiary Care Center in Saudi Arabia.

Several reports have shown self-efficacy to be a reliable way of predicting foot self-care behavior in patients with diabetes. However, at a global level in general, and in Saudi Arabia in particular, investigation of the factors related to self-efficacy in executing foot self-care continues to remain inadequate. This study endeavors to identify the factors associated with the self-efficacy of foot self-care among patients with diabetes in Saudi Arabia. From a tertiary diabetes care center in Saudi Arabia, 175 patients with diabetes were selected to participate in this cross-sectional study. Employing the Arabic version of the Foot Care Confidence Scale (FCCS), the principal end results and the sociodemographic, clinical, and psychosocial independent variables were collected and assessed. From the total reported FCCS score, the mean was found to be 28.1 ± 8.2. Multiple linear regression analysis indicated 2 independent factors were positively associated with a higher reported FCCS score; being middle-aged (< 60 years old) (ß=0.31, P< .01) and having a higher score on the Foot Care Outcome Expectations Scale (FCOES) (ß=0.36, P< .01). In conclusion, patients with diabetes in Saudi Arabia have a mild level of self-efficacy to perform the needed foot self-care. Therefore, this has turned the spotlight on the young or middle-aged < 60-year-old Saudi population with diabetes as the target group, making them the priority for future self-efficacy promotion programs to upgrade the level of foot self-care.

Prevalence and Risk Factors for Diabetic Peripheral Neuropathy among Patients with Type 2 Diabetes in Saudi Arabia: A Cross-sectional Study.

BACKGROUND AND AIMS: Neuropathy is the most prevalent among diabetes-related microvascular complications, of which distal symmetric polyneuropathy is very extensive. This study aimed to evaluate the frequency and risk factors for Diabetic Peripheral Neuropathy (DPN) among Type 2 Diabetes (T2D) in Saudi Arabia. METHODS: This study included 238 patients with T2D, between 18 and 80 years of age. Using a structured questionnaire, data on the sociodemographic characters of the study group and laboratory tests were collected. Distal symmetrical peripheral neuropathy in patients with diabetes was identified using the Michigan Neuropathy Screening Instrument (MNSI). RESULTS: In this cohort, 66 patients (27.7%) had positive MNSI questionnaire scores (≥ 7) and 90 (37.8%) patients had positive examination scores (≥ 2.5). From the patient's perception, patients on oral plus insulin treatment exhibited a higher risk for DPN (OR 2.95; p = 0.018) than those who received only oral treatment and an ulcer in an earlier period exhibited a higher risk for DPN (OR: 3.25; p = 0.005). From the health professionals' perception, more females than males showed a high risk for DPN (OR: 3.92; p = 0004). Likewise, compared to the patients in the age group of <50 years, those in the age group of ≥50 years revealed a high risk for DPN (OR 6.30; p = 0.009). Further, patients on oral and insulin treatments were at greater risk for DPN (OR: 3.71; p = 0.024); patients experiencing complications like prior ulcers, and high-density lipoprotein also exhibited higher risk than the patients who lacked them. CONCLUSION: Diabetes neuropathy is one of the most common complications of microangiopathy experienced by patients with T2D in Saudi Arabia. The risks for DPN among patients with T2D can be reduced with the implementation of focused and evidence-based interventions.

Anxiety, Depression, and Fear among People with and without Diabetes During the Transmission of SARS-CoV-2 Omicron Variant.

BACKGROUND AND AIM: The present study aimed to evaluate the anxiety, depression, and fear in people with and without diabetes during the transmission of the SARS-CoV-2 Omicron variant. METHODS: In this comparative study (n= 353), people with diabetes (n= 121) and those without diabetes (n= 232) were investigated for physiological aspects of COVID-19 during the SARS-CoV-2 Omicron variant outbreak. This study was performed at the Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia. On request, the participants responded to the survey questionnaires, providing data on demographics, Generalized Anxiety Disorder (GAD-7), and Patient Health Questionnaire-2 (PHQ-2) to screen for anxiety, depression, and COVID-19-related fears. RESULTS: The GAD statement revealed a significantly higher degree of nervousness and anxiety among people with diabetes when compared to people without diabetes (P = 0.001). For the other GAD statements, no statistical difference was observed between the responses of people with and without diabetes, including the overall GAD-7 (P = 0.091). The PHQ-2 statement, concerning a feeling of depression or hopelessness noted a significant escalation among diabetes compared to nondiabetes (P = 0.004). Furthermore, in the overall PHQ-2, a significant escalation (P = 0.011) was noticed among people with diabetes compared to nondiabetes. In addition, people with diabetes had a significantly high (P = 0.037) COVID-19-related fear reported, compared to people without diabetes. CONCLUSION: The need for comprehensive research is urgent, as it will facilitate a better understanding of the physiological aspects of COVID-19 for patients with diabetes.

Flash Glucose Monitoring System facilitates sustainable improvements in glycemic control in patients with type 1 diabetes: A 12-month follow-up study in real life.

BACKGROUND AND AIMS: Examine the glycemic control on Type 1 Diabetes (T1D) wearing the Flash Glucose Monitoring (FGM) system for a one-year period of time. METHODS: This prospective study done using 187 patients with T1D (14-40yrs) who self-tested their glucose levels by FGM. Continuous glucose monitoring (CGM) metrics were gathered i.e., Glucose Variability (GV) (%), mean Time in Range (TIR), Time Above Range (TAR), Time Below Range (TBR), and average duration of hypoglycemic events at the 3, 6, and 12 month time periods. RESULTS: At 6th, 9th and 12th months, for values of GV, % in target, TAR and %>250 mg/dL, no significant changes (p > 0.05) were noted compared to 3 months. However, significant changes from the baseline were evident for the values of the mean glucose level at the 3rd (p = 0.028), 9th (p = 0.048) and 12th months (p = 0.022). When the mean glucose value at 3 months was compared to the same at 6, 9, and 12 month period, no significant changes (p > 0.05) were seen. When compared with baseline values, low glucose events at 3 months (p = 0.028), 6 months (p = 0.048), 9 months (p = 0.022) and 12 months (p = 0.038) showed significant changes. However, the percentage below 70 mg/dL (barring the value at 12 months, p = 0.046), no significant changes were observed. The HbA1c revealed significant drop in 3, 6, 9 and 12 months compared to baseline values. CONCLUSION: Significant improvement was noted in CGM metrics when patients switched from conventional finger pricking method over to FGM system, and the effect was observed during the entire study period.

Evaluation of Patient Reported Satisfaction and Clinical Efficacy of Insulin Glargine 300 U/mL Versus 100 U/mL in Patients With Type 1 Diabetes Using Flash Glucose Monitoring System.

Background and Aims: To analyze patient-reported satisfaction and clinical effectiveness of concentrated insulin glargine 300 U/mL (Gla-300) among patients with type 1 diabetes (T1D) using a flash glucose monitoring (FGM) system. Methods: This comparative study was conducted among 86 patients with T1D (aged 14-40 years), who were treated with Glargine 100 U/mL (Gla-100) and switched to Gla-300 at day 1 (baseline). The following data were collected from each patient: demographic information, clinical parameters, and glycemic control markers. All patients completed the Diabetes Treatment Satisfaction Questionnaire (Arabic version), first at baseline and then after 12 weeks. A comparison was done for all the data recorded at baseline (on Gla-100) and after 12 weeks (on Gla-300) and subjected to analysis. Results: Compared to patients treated with Gla-100, significant improvements were observed in the Gla-300 group, in terms of the ambulatory glucose profile (AGP) markers, such as percentage of time spent within the target range of the glucose levels (70-180 mg/dL) (P = .037), percentage which fell below the target (<70 mg/dL) (P = .027), and percentage of time spent (<54 mg/dL) (P = .043). Compared to Gla-100, patients treated with Gla-300 experienced significant improvements in the current treatment satisfactions (P = .047), convenient finding treatment recently (P = .034), and flexible finding treatment recently (P = .041), recommend the current treatment (P = .042) and satisfied to continue the current treatment (P = .035). Conclusion: Compared to the patients on Gla-100, patients treated with Gla-300 exhibited significant improvements in the AGP markers and degree of treatment satisfaction.

Evaluating the impact of Ramadan fasting on ambulatory glucose profile among patients with type 1 diabetes using Flash Glucose Monitoring System: A comparative study.

BACKGROUND AND AIMS: Evaluating the impact of Ramadan fasting on Ambulatory Glucose Profile (AGP) among Patients with Type 1 Diabetes (T1D) using Flash Glucose Monitoring (FGM) System. METHODS: The present study is a comparative study, performed using 87 patients with T1D, whose health status permitted them to fast, based on the risk stratification adopted by Diabetes and Ramadan (DAR Guidelines). Besides the demographic data, other data connected with the glycemic profile such as the mean Time in Range (TIR), mean Time Above Range (TAR), mean Time Below Range (TBR), mean glucose level, hemoglobin A1c (HbA1c), Glucose Variability (GV), and Glucose Monitoring Indicator (GMI %), were recorded at three specific periods, namely, pre- (prior to), during and post Ramadan. RESULTS: The mean age of the study population was 21.3 ± 8.2 years, and 52.9% of this population was female. Compared to the pre-Ramadan data, no significant alterations (p > 0.05) were noted in terms of the low glucose events, percentage of glucose level below 70 mg/dL, the average duration of hypoglycemic events, and percentage of glucose level below 54 mg/dL, from the values observed during and post-Ramadan. In comparison with the pre-Ramadan data, no significant changes appeared (p > 0.05) concerning the GV, average glucose, GMI, percentage within target, TAR (181-250 mg/dL), and percentage >250 mg/dL), for the periods during and post-Ramadan, except scanning of FreeStyle Libre (p = 0.042) during Ramadan month compared to pre-Ramadan. CONCLUSION: Fasting during Ramadan was achievable in patients with T1D who received adequate counseling and support.

Effectiveness of the freestyle libre 2 flash glucose monitoring system on diabetes-self-management practices and glycemic parameters among patients with type 1 diabetes using insulin pump.

AIMS: To determine the effectiveness of Freestyle Libre 2 (FSL2) on diabetes-self-management (DSM) practices and glycemic parameters among patients with type 1 diabetes (T1D) using insulin pump. METHODS: This prospective study was performed among 47 patients with T1D (13-21yrs) who self-tested their glucose levels by the conventional finger-prick method using blood glucose meters (BGM). Data related to glycemic profile i.e., mean time in range (TIR), mean time above range (TAR) mean time below range (TBR), mean glucose level, hemoglobin A1c (HbA1c), total daily dose of insulin (TDDI), frequency of glucose monitoring and DSM responses were collected at baseline and 12 weeks. RESULTS: The mean TIR was 59.8 ± 12.6%, TAR 32.7 ± 11.6%, TBR 7.5 ± 4.3%, mean glycemic variability, standard deviation 63.2 ± 12.5 mg/dL, and the coefficient of variation 41.3 ± 11.4% at 12 weeks. At baseline, the HbA1c level was 8.3%, and at 12 weeks, it dropped to 7.9% (p = 0.064). Baseline glucose monitoring frequency through BGM was 2.4/day; however, after the patients employed the FSL2, a higher degree of frequency of glucose monitoring was evident at 12 weeks as 8.2/day (p < 0.001). Significant improvements were observed in all the DSM subscales at 12 weeks. CONCLUSION: Using FSL2 was found to raise the patients' DSM levels and improved metabolic control.

COVID-19 among people with diabetes mellitus in Saudi Arabia: Current situation and new perspectives.

BACKGROUND AND AIM: This review aims to report the current status of COVID-19 among people with diabetes, newly diagnosed diabetes, diabetic ketoacidosis, and programmatic efforts including vaccinations. METHODS: We conducted a literature search using PubMed, Google, and Scopus until July 15, 2021. RESULTS: In Saudi Arabia, most studies have reported diabetes as one of the highly prevalent comorbidities among patients with COVID-19. Currently, there are limited studies from Saudi Arabia on the newly diagnosed diabetes and diabetic ketoacidosis caused by COVID-19. The Saudi ministry has taken several measures to control the impact of COVID-19 among people with diabetes, including comprehensive guidelines and prioritized vaccinations. During the COVID-19 pandemic, the use of telehealth services dramatically increased in diabetes clinics in Saudi Arabia. CONCLUSIONS: Focused and evidence-based interventions are essential to control the impact of COVID-19 among people with diabetes.

Cardiovascular Disease among Patients with Diabetes: The Current Scenario in Saudi Arabia.

One of the well-recognized conditions linked to diabetes mellitus (DM) is cardiovascular disease (CVD). Those affected by DM face greater risk for early onset of CVD. Although huge strides have been made in cardiovascular therapy and prevention, with striking results in decreasing diabetesrelated coronary mortality in developed countries, the morbidity and mortality due to CVD continue to remain high among patients with diabetes. While there is an increasing incidence of cardiovascular event survivors with DM across the world, the number of DM patients with higher cardiovascular risk is predicted to soar, presenting a massive challenge for health care systems globally, including Saudi Arabia. A report of the Saudi Scientific Diabetes Society indicates that more than 50% of patients with DM die due to cardiovascular causes. In fact, Saudi Arabia globally ranks among the top 10 countries in the prevalence of diabetes. However, the incidence of CVD and its risk factors among patients with diabetes in Saudi Arabia have not yet been well documented. This review aims to present an overview of CVD among patients with DM in Saudi Arabia, through a comprehensive review of currently available published literature. The findings indicate that diabetes linked CVD burden in Saudi Arabia is expected to exponentially increase to a very high degree unless a wide-ranging epidemic control program is initiated. The findings emphasize the need for maintenance of a healthy diet accompanied by exercise, an active lifestyle and weight control measures among the population. It is essential that the health care system focus on raising awareness among the population, and implement appropriate measures for prevention, early detection and suitable management of CVD among patients with DM.

COVID-19 in People with Diabetes: Epidemiological Perspectives and Public Health Actions in the Middle East and North Africa (MENA) Region.

It is evident that COVID-19 and diabetes have a significant influence on population health across the world, including the Middle East and North Africa (MENA) region. COVID-19 patients with diabetes have been observed to be more prone to developing severe infections and higher risk of mortality compared to non-diabetics. As diabetes is one of the major health issues, widely prevalent in the MENA countries, the current review focused on understanding the epidemiology of COVID-19 in people with diabetes, and the interventions implemented by the governments to minimize the impact of it. Considering the importance and need, the MENA countries have enforced several prevention and control measures to mitigate the impact of the pandemic. Though there has been a considerable amount of research on COVID-19, only a few countries from the MENA region focused on the epidemiology of COVID-19 among patients with diabetes and its effects. Hence, we emphasize the need for intensive research which is an urgent need to have a clear understanding of COVID-19 and its association with diabetes to develop and implement evidence- based programs and policies in the MENA region.

Current Status of Knowledge and Awareness of Diabetes Mellitus in Saudi Arabia.

Diabetes Mellitus (DM) is a chronic disease, and the complications may be life-threatening; however, with proper treatment and control measures, it can be very well-managed. Self-management training and education of diabetes are critical in diabetes care and management. It is essential that patients with diabetes must have a comprehensive understanding of the nature of the disease, risk factors, complications, and possible treatment modalities to attenuate the complications. Over the last few years, DM in Saudi Arabia has been rapidly growing at an alarming rate. It has affected around one-fifth of the adult population, and by 2030, the numbers are predicted to rise further and exceed more than double the present number. An estimated tenfold increase has been reported over the past three decades in Saudi Arabia. However, there has not been much research focusing on understanding the knowledge and awareness of DM in Saudi Arabia as compared to developed nations. This review aims to present an overview of the current knowledge and awareness level of DM among the population of Saudi Arabia through an extensive review of the currently available literature. The review findings could be of immense assistance to the government, healthcare systems, educational institutions, and researchers to develop evidence-based programs, policies, and guidelines towards increasing the knowledge and awareness about diabetes and its management, so that early detection and management can be ensured to control the escalating burden of diabetes in Saudi Arabia.

COVID-19 in People with Diabetes: Perspectives from Saudi Arabia.

Coronavirus disease 2019 (COVID-19) and diabetes have major impacts on the health of the population across the world. Since the beginning of the COVID-19 pandemic, people with diabetes have been identified to be more vulnerable to infection and at greater risk for hospitalization. As diabetes is one of the major health issues in Saudi Arabia, the current study describes the perspectives of COVID-19 in people with diabetes and the steps taken by the government to minimize its impact. Most patients with COVID-19 in Saudi Arabia experience mild illness, while people with diabetes are at increased risk of disease severity and mortality. The government of Saudi Arabia has taken several measures to control and mitigate the effect of the pandemic, as the Saudi population is gradually returning back to normal life. However, currently, there are limited studies from Saudi Arabia on COVID-19 among people with diabetes and the effectiveness of interventions. We emphasize the necessity for comprehensive research, which would provide a better understanding of the incidence of COVID-19 and its association with diabetes to develop evidence- based programs and policies in the country.

Microvascular complications among patients with diabetes: An emerging health problem in Saudi Arabia.

Diabetes mellitus, besides disrupting the carbohydrate metabolism process, also induces vascular disease and impacts nearly all the types and sizes of blood vessels. In fact, vascular complications cause majority of the morbidity, hospitalizations and mortality of patients with diabetes mellitus. Retinopathy, nephropathy and neuropathy (microvascular complications) impact hundreds of millions of diabetics and normally target those having long-term or uncontrolled forms of the disease; however, these disorders can also exist at the time of diagnosis or in those yet to be diagnosed. The Kingdom of Saudi Arabia is the biggest country in the Middle East that occupies around four-fifths of the Arabian Peninsula supporting a population of more than 33.3 million people. The prevalence of diabetes mellitus is increasing at an alarming rate in Saudi Arabia. Over 25% of the adult population is suffering and that figure is projected to more than double by 2030. In fact, diabetes mellitus has approximately registered a 10-fold upsurge in the past three decades in Saudi Arabia. However, the prevalence and risk factors of microvascular complications in diabetes mellitus patients have not yet been clearly documented in Saudi Arabia. Hence, in this review, we aim to provide an overview of the microvascular complications among patients with diabetes in Saudi Arabia, utilizing data from the currently available published literature. This is an attempt to facilitate the government and healthcare systems aware of the enormous worth of prevention, early detection and appropriate management of such microvascular complications.

Evaluation of Risk Factors Associated with Diabetic Foot Ulcers in Saudi Arabia.

BACKGROUND AND AIMS: Considering that diabetic foot ulceration is one of the major health issues globally, we aimed to evaluate the risk factors associated with foot ulcers in patients with type 2 diabetes mellitus (T2DM). METHODS: A total of 81 T2DM patients (age range: 40-80 years) registered at the Diabetes Treatment Center, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia between April and September 2015 were included in this cross-sectional study after purposive selection and assigning of patient numbers. The selected participants were interviewed and examined, and their medical records were reviewed for sensory, vibratory, and painful neuropathies; vascular insufficiency; retinopathy; and dermatological variations. The Wagner's classification system was employed to evaluate the stage of patients' foot ulcers. RESULTS: Among the study participants [mean age range: 56.4 ± 6.72 years; 53 males (65.4%)], cases of loss of protective sensation, foot deformity, amputation history, and dermatological abnormalities were notable. The Wagner gradation value of ulcers were grade 0 for 16% study population, grade 1 for 35.8%, grade 2 for 45.7%, grade 3 for 2.5%, and grades 4 and 5 for 0%. Approximately 19% of the patients had a previous case of amputation and 29.6% had nail disease. The most common footwear reported to be used by the patients was sandals shoes (46%). CONCLUSION: The issues of loss of protective sensation, vascular insufficiency, deformity, previous amputations, and dermatological abnormalities of the lower limbs were found to be most common among the foot ulceration patients. The study findings thus recommend regular foot examination, following basic hygiene habits, encouragement of the use of appropriate footwear, patient education about foot ulcers, and prompt treatment for minor injuries to prevent further ulceration in DM patients.

Common Pathogens and Antibiotic Sensitivity Profiles of Infected Diabetic Foot Ulcers in Saudi Arabia.

We sought to define the type and antibiotic sensitivity response of pathogens isolated from diabetic foot ulcers based on ulcer location and Wagner classification. This retrospective analysis was done among 126 patients between 40 and 70 years of age at the Prince Sultan Military Medical City, Riyadh, Saudi Arabia, using the swab culture method for microbiological assessment. Data on demographic variables, ulcer sites (location), and depth of ulcer (Wagner classification) were also collected. A total of 134 pathogens were isolated from 126 patients. The most common gram-negative pathogen identified was Pseudomonas aeruginosa (15.6%), followed by Klebsiella spp (6.7%). The most common gram-positive pathogen was Staphylococcus aureus (35%), followed by Streptococcus (8.9%). The most widely accepted antibiotic to which the gram-negative bacteria were sensitive was gentamycin (20.1%), followed by ciprofloxacin (19%). The most routinely used antibiotic in the treatment of the gram-positive bacteria was erythromycin (16%), with trimethoprim-sulfamethoxazole (14.1%) being the next most effective. In conclusion, Pseudomonas aeruginosa, Klebsiella spp, Staphylococcus aureus, and Streptococcus were the most common causes of diabetic foot infections. However, the frequency of encountered pathogens and respective sensitivity to antibiotic therapy may be influenced by the location site and severity of the ulceration.

Thyroid Nodule Management: Thyroid-Stimulating Hormone, Ultrasound, and Cytological Classification System for Predicting Malignancy.

BACKGROUND/OBJECTIVES: Thyroid nodule (TN) is a common thyroid disorder globally, and the incidence has been increasing in recent decades. The objective of this study was to determine the contribution of thyroid-stimulating hormone (TSH), ultrasound (US), and cytological classification system for predicting malignancy among the surgically excised nodules. DESIGN AND METHODS: A retrospective analysis was performed between January 2012 and December 2014, using data drawn from 1188 patients (15-90 years), who had 1433 TN and fine-needle aspiration in Prince Sultan Military Medical City, Saudi Arabia. After reviewing all the thyroid cytopathological slides and US reports, classification was done based on the Bethesda System for Reporting Thyroid Cytology and the Thyroid Imaging Reporting and Data System (TI-RADS). RESULTS: A total of 1188 patients' medical records were reviewed for this study, among them 311 patients had undergone surgical intervention (253 patients had single nodule and 58 had 2 nodules), with a total of 369 nodules. However, as 54 nodules on the US were either unavailable or unclear, the 315 remaining nodules were analyzed, revealing 30.2% (n = 95) malignancy overall. Patients with TSH values of >4.5 mIU/L (38.2%), TN <1 cm (48.8%), TI-RADS category 5 (75.6%), and Bethesda category VI (88.9%) revealed a higher percentage of malignancy. From the univariate analysis using the χ2 test, significant relationship between the TSH, nodule size, TI-RADS, and the Bethesda category between the malignant and benign nodules emerged. The regression analysis showed that patients with a TSH value of 0.5 to 4.5 mIU/L (odds ratio [OR]: 2.96), TSH >4.5 mIU/L (OR: 6.54) had higher risk for malignancy than those with a TSH value of ≤0.4 mIU/L. Thyroid nodules with sizes of 1 to 1.9 cm (OR: 1.12), 2 to 2.9 cm (OR: 0.74), 3-3.9 cm (OR: 1.21), and ≥4 cm (OR: 0.52) were found to have no association with the risk of malignancy. Compared with TI-RADS 2 patients, those with categories 4B (OR: 1.35) and 5 (OR: 2.3) were found to be at higher risk of malignancy. Similarly, Bethesda IV (OR: 2.72), V (OR: 8.47), and VI (OR: 20; P < .02) category patients had a higher risk for malignancy than those in Bethesda class I. Among the study population, the papillary thyroid carcinoma was the most common type of thyroid cancer (86, 90.5%) followed by 7.4% (n = 7) of follicular thyroid carcinoma, 1.05% (n = 1) of anaplastic carcinoma, and 1.05% (n = 1) of medullary thyroid carcinoma. CONCLUSIONS: A predictive model for risk of malignancy using a combining characteristic of the TSH, US, and cytological classification systems could assist the clinicians in minimizing exposing the patients with TNs to nonessential invasive procedures.

Reproductive disturbances among Saudi adolescent girls and young women with type 1 diabetes mellitus.

AIM: To identify reproductive disturbances among adolescent girls and young women with type 1 diabetes mellitus (T1DM) in Saudi Arabia. METHODS: This cross sectional study was conducted among 102 female with T1DM, (aged 13-29 years) who attended the Diabetes Clinic at Diabetes Treatment Center, Prince Sultan Military Medical City, Saudi Arabia between April 2015 to March 2016. Clinical history, anthropometric characteristics and reproductive disturbance were collected through a questionnaire. RESULTS: Of 102 patients included in this analysis, 26.5% (27/102) were reported that they experienced an irregular menses. Of these patients, when compared to whose diabetes was diagnosed before menarche (35.4%, 17/48), patients diagnosed with diabetes after menarche (18.5%, 10/54) showed significantly less irregular menses (difference 16.9%, P = 0.04). Similarly, compared to patients diagnosed with diabetes prior to menarche (mean age 12.9 years; n = 48), patients diagnosed with diabetes after menarche (mean age 12.26 years; n = 54) were found to have 0.64 years delay in the age of menarche (P = 0.04). Among the studied patients, 15.7% (16/102) had polycystic ovary syndrome (PCOS). Of these PCOS patients, 37.5% (6/16) had irregular menses, 6.3% (1/16) had Celiac disease, 37.5% (6/16) had Hashimoto thyroiditis and 18.7% (3/16) had acne. CONCLUSION: More than one fourth of the study population with T1DM experiencing an irregular menses. Adolescent girls and young women diagnosed with diabetes prior to menarche showed higher menstrual irregularity and a delay in the age of menarche.

Assessment of Hypogonadism in Men With Type 2 Diabetes: A Cross-Sectional Study From Saudi Arabia.

BACKGROUND/OBJECTIVES: A high incidence of hypogonadism in men with type 2 diabetes (T2D) has been globally reported. This study aimed to determining the frequency of hypogonadism and related risk factors among men with T2D in a single-site hospital in Saudi Arabia. DESIGN AND METHODS: A cross-sectional study was performed on 157 men with T2D (between 30 and 70 years of age). Using a prestructured questionnaire, the demographic features of these patients were gathered and their medical records were referred to gather information regarding the duration of the diabetes, smoking habits, and the presence of retinopathy, neuropathy, and nephropathy. Besides these, the biochemical parameters, total testosterone (TT), free testosterone, sex hormone-binding globulin, follicle-stimulating hormone, luteinizing hormone, prolactin, serum lipids, and glycosylated hemoglobin were also recorded. All the patients submitted the fully completed Androgen Deficiency in Aging Male (ADAM) questionnaire. The combination of symptoms (positive ADAM score) plus a TT level ⩽8 nmol/L constituted the condition of hypogonadism. RESULTS: The total frequency of hypogonadism was 22.9% (36/157). Of the 157 total patients, 123 (78.3%) were shown to be ADAM positive, and of these, 90 (73.2%) exhibited decreased libido, 116 (94.3%) had weak erections, and 99 (80.5%) reported more than 3 symptoms of ADAM. Of these hypogonadic patients, 22.2% (n = 8) revealed primary hypogonadism, whereas 77.8% (n = 28) showed secondary hypogonadism. From the univariate analysis conducted, significant relationship was observed between treatment type, body mass index (BMI), and hypogonadism. The regression analysis showed BMI acting an independent risk factor of hypogonadism. CONCLUSIONS: Saudi men with T2D revealed a high incidence of hypogonadism. Body mass index was identified as an independent risk factor for hypogonadism.