A Hybrid Model of In-Person and Telemedicine Diabetes Education and Care for Management of Patients with Uncontrolled Type 2 Diabetes Mellitus: Findings and Implications from a Multicenter Prospective Study.

Background: Patients with uncontrolled type 2 diabetes mellitus (T2DM) require close follow-up, support, and education to achieve glycemic control, especially during the initiation or intensification of insulin therapy and self-care management. This study aimed to describe and evaluate the impact of implementing a hybrid model of in-person and telemedicine care and education on glycemic control for patients with uncontrolled T2DM (hemoglobin A1c [HbA1c] ≥9%) during the coronavirus disease pandemic. Methods: This prospective multicenter-cohort pre-/post-intervention study was conducted on patients with uncontrolled T2DM. This study included three chronic illness centers affiliated with the Family and Community Medicine Department at Prince Sultan Military Medical City in Riyadh, Saudi Arabia. A hybrid model of in-person (onsite) and telemedicine care and education was developed. This involved implementing initial in-person care at the physicians' clinic and initial in-person education at the diabetes education clinic, followed by telemedicine services of tele-follow-ups, support, and education for an average 4-month follow-up period. Results: Of the enrolled 181 patients, more than half of the participants were women (n = 103, 56.9%). The mean age of participants (standard deviation) was 58.64 ± 11.23 years and the mean duration of diabetes mellitus was 13.80 ± 8.55 years. The majority of the patients (n = 144; 79.6%) were on insulin therapy. Overall, in all three centers, the hybrid model had significantly reduced HbA1c from 10.47 ± 1.23% to 7.87 ± 1.59% (mean difference of reduction 2.59% [95% confidence interval (CI) = 2.34-2.85%], p < 0.001). At the level of each center, HbA1c was reduced significantly with mean differences of 3.17% (95% CI = 2.81-3.53%), 2.49% (95% CI = 1.92-3.06%), and 2.16% (95% CI = 1.76-2.57%) at centers A, B, and C, respectively (all p < 0.001). Conclusion: The findings showed that the hybrid model of in-person and telemedicine care and education effectively managed uncontrolled T2DM. Consequently, the role of telemedicine in diabetes management could be further expanded as part of routine diabetes care in primary settings to achieve better glycemic control and minimize nonessential in-person visits when appropriate.

Experience of establishing a lifestyle medicine clinic at primary care level- challenges and lessons learnt.

On an international level, for more than 30 years, Lifestyle Medicine (LSM) Practice has had a great impact on both health Promotion and disease prevention. A practice which on a national KSA level, we are in eager need to adopt, due to the high prevalence of chronic diseases and unhealthy lifestyles. The establishment of the LSM clinic inside the Wazarat Health Center (WHC) more than one and half year ago, was a great advancement towards offering very important preventive and promotive services for people in real high need to these underutilized main elements in Primary Health Care (PHC) features. We identified quality oriented Key Performance Indicators and the clinically important outcomes for our patients. Our initial data showed great achievement on both fronts. We are currently studying the satisfaction of our customers and working on improving their level of health awareness and help seeking behavior. Furthermore, we are looking to benchmark our results. From our pilot project in WHC, we are preparing for an expansion plan to branch out other Primary Care centers in the Riyadh area to serve more people, and we aim to share the experience with other similar services and within the PHC centers allover KSA.

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.

Prevalence of COVID-19 Infection among Patients with Diabetes and Their Vaccination Coverage Status in Saudi Arabia: A Cross-Sectional Analysis from a Hospital-Based Diabetes Registry.

Patients with diabetes have a higher risk of severe infection and mortality due to COVID-19. Considering the current limited effective pharmacological treatments, vaccination remains one of the most effective means to control the pandemic. The current study aimed to determine the prevalence of COVID-19 infection and the rate of COVID-19 vaccination coverage among patients with type 2 diabetes mellitus. The patients were identified from a diabetes hospital registry at Prince Sultan Military Medical City, Riyadh, Saudi Arabia in July 2021. The history of COVID-19 infection and the vaccination status were retrieved from the National Health Electronic Surveillance Network (HESN) program and the Seha platform, respectively. A total of 11,573 patients were included in this study (representing 99.5% of all patients in the registry). A total of 1981 patients (17.1%) had a history of confirmed COVID-19 infection. The rate of vaccination with a 1st dose was 84.8% (n = 9811), while the rate of full vaccination with the 2nd dose was 55.5% (n = 6422). The analysis showed that a higher proportion of male patients were fully vaccinated than female patients (61.0% versus 51.2%, p < 0.001). There were statistically significant differences among the age groups, with the full vaccination rate ranging from 59.0% for the 61-70-year-old age group to 49.0% for the > 80-year-old age group (p < 0.001). The patients with no previous history of COVID-19 infection were more likely to get fully vaccinated than those with a previous history of the infection (63.9% versus 14.6%, respectively, p < 0.001). The factors associated with a higher likelihood of unvaccinated status included the female gender (adjusted odds ratio (aOR) = 1.705 (95% confidence interval (CI): 1.528-1.902)), elderly patients in the age group of 61-70 (aOR (95% CI) = 1.390 (1.102-1.753)), the age group of 71-80 (aOR (95% CI) = 1.924 (1.499-2.470)) and the age group of >80 (aOR (95% CI) = 3.081 (2.252-4.214), and prior history of COVID-19 infection (aOR (95% CI) = 2.501 (2.223-2.813)). In conclusion, a considerable proportion of patients with type 2 diabetes had confirmed COVID-19 infection. Continued targeted efforts are needed to accelerate vaccination coverage rates among patients with diabetes in general and the particular subgroups identified in this study.

The attitude and prevalence of patient noncompliance toward chronic disease medications in Saudi Arabia.

BACKGROUND: Failure of patients' adherence to medications has been a big issue for both physicians and patients; not only it does affect the patients' health but also it affects the financial status of the hospital and the patient. OBJECTIVE: This investigation aims to explore the prevalence and the factors affecting the compliance of patients with chronic conditions to their medications. MATERIALS AND METHODS: An online survey was distributed to patients who had chronic conditions and lived in the main cities of Saudi Arabia. The questionnaire included sections about the patients' general characters, type of chronic disease, the pattern of prescribed medications' usage, and factors affecting compliance of patients toward their medications. Data was collected in a predesigned excel sheet, and analysis was executed through SPSS program version 26. RESULTS: 301 patients responded to this questionnaire. The lowest incidence of missing pills was among patients with heart failure, followed by chronic kidney disease, whereas the highest frequency of missing pills was among patients with vitamin D deficiency, followed by hyperlipidemia. 38.5% of the patients used mobile applications as reminders for the administration of their medications. 50% of the patients who use reminders take more than four pills a day. 48.2% of the patients stopped medications without consulting their doctors, where 20.9% stopped one medication for less than a month. 57.5% forgot to take drug doses in a year, with a mean of 8.55 ± 26.3 forgotten doses. Females, patients aging between 31 and 45 years old, obese, married, illiterate, self-employed, those who follow with military hospitals, exercising regularly, and ex-smoker all showed a higher incidence of noncompliance to medications. The main reason for noncompliance was forgetfulness in 60% of patients. 63.2% of the patients did not have a GP to help them with medications compliance. CONCLUSION: The compliance of Saudi patients toward their chronic medications requires improvement. Similar studies in other areas in Saudi Arabia are recommended.

Impact of Ramadan-focused diabetes education on hypoglycemia risk and metabolic control for patients with type 2 diabetes mellitus: A systematic review.

BACKGROUND: Ramadan fasting is regarded as a form of worship amongst Muslims. However, patients with a high risk of diabetic complications are advised to avoid fasting, as the practice is associated with significant impacts on several health factors for type 2 diabetic patients, including glycaemic control. Thus, a lack of focused education before Ramadan may result in negative health outcomes. AIM: To evaluate the impact of a Ramadan-focused diabetes education programme on hypoglycaemic risk and other clinical and metabolic parameters. METHODS: A systematic literature search was performed using Scopus, PubMed, Embase, and Google Scholar to identify relevant studies meeting the inclusion criteria from inception. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and guidelines were followed when performing the search and identification of appropriate studies. RESULTS: Seventeen studies were included in this systemic review; five of them met the criteria to compile for a meta-analysis. The included studies were with various study designs, including randomised controlled trials, quasi-experimental and non-randomised studies. Overall, the results revealed a significant reduction of hypoglycemia risk (81% reduction) for fasting patients in intervention groups who received Ramadan-focused education compared with patients receiving conventional care (OR 0.19, 95% CI: 0.08-0.46). Moreover, HbA1c significantly improved amongst patients who received a Ramadan-focused diabetes education intervention, compared with those receiving conventional care. CONCLUSION: Ramadan-focused diabetes education had a significant impact on hypoglycemia and glycaemic control, with no significant effect on body weight, blood lipids or blood pressure.

The Utilization of Complementary and Alternative Medicine among Saudi Older Adults: A Population-Based Study.

BACKGROUND: Complementary and alternative medicine (CAM) is an integral part of patients' therapeutic experience worldwide. Among Saudi older adults, less is known about CAM utilization. OBJECTIVES: To determine the prevalence, patterns, and factors associated with CAM utilization among SOA. METHODS: In the Saudi National Survey for Elderly Health (SNSEH), subjects were asked about CAM use during the last twelve months before the interview. CAM use was defined as any use of herbal products, acupuncture, bloodletting, cauterization, medical massage, bones manual manipulation, honey, or religious rituals. Demographic characteristics included gender, age, marital status, region, educational level, and residence area. In addition, multiple comorbidities were included as possible factors that may be associated with CAM use. Multivariable logistic regression was used to explore factors associated with CAM utilization. All statistical analyses were done using STATA v.14. RESULTS: Out of 2946 respondents, 50.4% were males, the mean age was 70.3 ± 8.3 years, and 70% were illiterate. CAM use was prevalent (62.5%). The most common CAM types were herbal products (25.4%), acupuncture (21.2%), bloodletting (12%), honey (9.5%), cauterization (7.4%), medical massage and bones manual manipulation (4%), and traditional bone setting (2.1%). In the multivariable regression, age, gender, and marital status did not have an impact on the odds of using CAM. Subjects from rural areas were 2.92 times more likely to use CAM compared with subjects in urban areas (OR = 2.92; 95%CI: 2.28-3.75). Subjects with metabolic disorders (OR = 0.50; 95% CI: 0.42-0.60) or kidney disease were less likely to use CAM (OR = 0.30; 95%CI: 0.14-0.64). About pain, CAM is used more in neck pain (OR = 1.69; 95%CI: 1.30-2.21) and also used in back pain (OR = 1.22; 95%CI: 1.03-1.46). CONCLUSIONS: CAM use was very prevalent among SOA. Clinicians and pharmacists must ask about CAM use among older adults as many of CAM may interact with patients medications.

The prevalence of benzodiazepines utilization and its association with falls among Saudi older adults; results from the Saudi national survey for elderly Health (SNSEH).

PURPOSE: First, to determine benzodiazepines prevalence (BDZs) among Saudi older adults (SOA); Second, to quantify the association between BDZs use and falls among SOA. Third, to determine falls effect on all-cause mortality among SOA. METHODS: This is a cross-sectional study that used the Saudi National Survey for Elderly Health; a nationally-representative, population-based survey. Participants were asked about BDZs use and falls history during the 12 months prior to the interview. Demographics, medications, comorbidities and housing conditions were used as covariates. Multiple imputation was used to impute missing data. Modified poisson multivariable regression was used to study the association between BDZs and falls. Cox- proportional hazard regression was used to determine falls effect on mortality over nine years period. RESULTS: Among 2946 SOA, BDZs prevalence was 4%. Around 13% reported falls. In the multivariable regression, relative risk (RR) of falls was 2 comparing BDZs users to non-users (95CI%: 1.02-3.99). Antidepressants (RR = 1.72; 95%CI: 1.10-2.74), laxatives (RR = 1.38; 95%CI: 1.11-1.7), low body mass index (RR = 1.94; 95%CI: 1.33-2.84), mild cognitive impairment (RR = 1.56; 95%CI: 1.21-2.03), high door steps (RR = 1.54; 95%CI: 1.23-1.93) and insufficient illumination (RR = 1.38; 95%CI: 1.11-1.71) increased falls risk. Lastly, the hazard ratio of falls on death was 1.48 (95%CI: 1.17, 1.89) over nine years. CONCLUSION: Despite the recommendation against BDZs use among older adults, still there were subjects who were prescribed these drugs. falls are common among SOA. Preventive strategies such medication therapy management, nutrition improvement, elderly-friendly housing structures can reduce the prevalence of falls and consequent increase in mortality among SOA.

Indications, retrieval rate, and complications of inferior vena cava filters: Single-center experience in Saudi Arabia.

BACKGROUND: Inferior vena cava (IVC) filter is indicated in patients with acute venous thromboembolism (VTE) in whom therapeutic anticoagulation is contraindicated. While prophylactic insertion of an IVC filter may be considered for patients at high risk of VTE, there are significant differences between clinical guidelines on the role of IVC filters. These discrepancies have arisen predominantly because of the paucity of data on the efficacy and safety of IVC filters. We, therefore, evaluated the indications for filter insertion, the rate of filter retrieval and complications in patients who received IVC filters at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. METHODS: A descriptive, retrospective review of electronic- and paper-based medical records was performed. Consecutive sampling was used to study all adult patients who received an IVC filter at KAMC between 2007 and 2016 and met the inclusion criteria. RESULTS: A total of 382 IVC filters were inserted. 113 patients (30%) had an acute VTE and a contraindication to anticoagulation while 53 patients (14%) received an IVC filter in the absence of VTE (i.e., prophylactic). Only 124 (32.5%) IVC filters were eventually retrieved. The most common reason for nonretrieval was the need for permanent filtration (155, 60%). Thrombotic complications developed in 72 (19%) patients; nine patients had fatal pulmonary embolism. CONCLUSION: The insertion of IVC filters in this cohort was associated with low retrieval rate and relatively high incidence of thrombotic complications. Follow-up of patients is required to detect IVC filter-related complications and to increase retrieval rate.