The long-term growth, cost-effectiveness, and glycemic effects of growth hormone therapy on children born small for gestational age over 10 years: a retrospective cohort study.

OBJECTIVES: We aimed to report our 10-year experience of treating short children born small for gestational age (SGA) by comparing the long-term growth, metabolic safety, and cost-effectiveness of recombinant human growth hormone (rhGH) therapy in short children born SGA with those in rhGH-treated children with growth hormone deficiency (GHD) and Turner syndrome. METHODS: We performed a 10-year retrospective cohort study at King Saud University Medical City. We included children aged 3-16 years who received rhGH for GHD, SGA, or Turner syndrome for >1 year. RESULTS: A total of 166 children received rhGH therapy for GHD, 58 for SGA, and 16 for Turner syndrome. During the last study visit, the average height change was 21 cm for GHD children and 14 cm for children born SGA (p-value <0.001). The height SDS change was 0.84 for GHD children and 0.55 for SGA children (p-value=0.004). The average cost-effectiveness ratios for treating GHD and SGA children were USD 1,717.22 and USD 1,157.19 per centimeter gained, respectively. Moreover, the mean incremental cost-effectiveness ratio for GHD vs. SGA patients was USD 2,820.39 per centimeter gained. Dysglycemia developed in 70 patients: 43 (36.44%), 22 (40.74%), and 5 (13%) in the GHD, SGA, and Turner syndrome groups, respectively. CONCLUSIONS: rhGH is effective in height improvement of short children. However, pursuing rhGH treatment for children born SGA requires a shared decision-making approach to balance the modest benefit of final adult height gain with the long-term metabolic effects, considering the acceptable costs on the Saudi healthcare system.

School practice and preparedness in caring for children with type 1 diabetes: A Saudi nationwide cross-sectional study.

AIM: We aimed to identify gaps in school care and support required for students with type 1 diabetes mellitus (T1DM) in Saudi Arabia. METHODS: We performed a cross-sectional nationwide study using self-administered surveys that targeted teachers and parents of students with T1DM in Saudi Arabia from August to December 2019. RESULTS: We collected surveys from 632 parents and 983 teachers. Responses were received from all 13 regions in Saudi Arabia, with the majority representing governmental schools. Results showed that 172 students (27.3%) had no available help at school to perform blood glucose measurement, 178 students (28.3%) were left with no hypoglycemia treatment, 374 students (59.6%) took their insulin dose for breakfast at home, and 40.0 (6.4%) students omitted insulin. Overall, school admission refusal was reported by 73 students (11.7%). Students with no available help to manage their hypoglycemia or to inject insulin at school had a higher hemoglobin A1c and poorer academic performance. CONCLUSION: Our study revealed a significant gap between schools' local practices and international recommendations, which impacted students' safety, diabetes control, and school achievement. Our study findings will support the creation of the Saudi T1DM school practice guidelines necessary to improve the care of students with T1DM.