The changeable dynamics between glycaemic control and neuropathy risk across the lifespan of Saudi diabetic patients; A survey in diabetes healthcare facility.

Background and Aims: Peripheral neuropathy is a common diabetic complication. It is linked to poor glycaemic control and longer duration of diabetes. We explored the association between HbA1c and neuropathy risk considering the duration of diabetes in a sample of Saudi diabetic patients. Method: We conducted a monofilament test on 343 diabetic patients referred to our specialist diabetology centre in Saudi Arabia. We utilized a multiple generalized logistic regression model with a binary outcome related to neuropathy complications. Results: We found that over four out of every five patients have peripheral neuropathy. The interaction between HbA1c and duration was significant (estimate = -0.02802, P = 0.00534), a positive association between neuropathy and both HbA1c (increased risk by 46.2%, P = 0.03222) and DM duration (increased risk by 19.6%, P = 0.04497). Conclusions: The shorter the duration of diabetes, the more positive the relationship between HbA1c and peripheral neuropathy. In patients living for over 40 years with diabetes, HbA1c was higher among those who did not have peripheral neuropathy. It could be argued that this is an artefact of survival as poorer glycaemic control will likely result in higher mortality in earlier years of the diabetes career.

Hyperglycaemic and hypoglycaemic emergencies among patients with diabetes mellitus who participated in pilgrims of the 2019/1440H Hajj season.

Background: Diabetic emergencies are serious acute life-threatening complications of diabetes mellitus (DM). The Hajj season requires the health system in Saudi Arabia to prepare efficiently for the healthcare of millions of pilgrims, particularly for diabetic emergencies. Thus, diabetic emergencies need rapid recognition, diagnosis and treatment. This study aimed to explore the frequency and associated factors of diabetic emergencies among the pilgrim's patients with DM during Hajj, Mecca 2019. Methods: This is a prospective study which was conducted on 153 patients with DM. They were selected from three major healthcare-providing facilities during Hajj, which are Arafat, Muzdelefah and Muna healthcare centres. The study was conducted from Aug 5 to 12, 2019. All the patients who presented with any of the hypoglycaemic or hyperglycaemic emergencies had their demographic and clinical characteristics recorded to estimate the prevalence of each emergency and identify its significant associated factors. Result: More than 90% of the study participants were patients with type 2 diabetes mellitus (T2DM), while around 7% had type 1 diabetes mellitus (T1DM). Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) and hypoglycaemia were presented in (n = 11, 7.2%), (n = 19, 12.4%) and (n = 28, 18%), respectively, of the participants. Moreover, the study found that "younger age" (odds = 30.4, P = 0.0115) and "type of medication" are significantly associated with DKA. Furthermore, "older age", "type of medication", "having Cardiovascular Disease (CVD)" and "diabetes duration" were found to have a significant association with HHS. Moreover, hypoglycaemia was associated with neuropathy complication (odds = 3.54948, P = 0.0187). Conclusions: Among the pilgrims with diabetes participating in Hajj, a considerable proportion with a range of diabetic emergencies present to the onsite medical facilities. Preparation is required in terms of logistics and health education about diabetic emergencies to meet the needs of pilgrims with DM, especially those who use insulin and have longstanding diabetes. Further research on DM and the creation of guidelines for health providers and patients with DM during Hajj are important focuses for the future.