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Zhang C, Luo X. The increase in diabetes in children from underdeveloped countries. Curr Opin Pediatr 2024; 36:467-472. [PMID: 38832684 PMCID: PMC11224563 DOI: 10.1097/mop.0000000000001366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
PURPOSE OF REVIEW The incidence of type 1 diabetes (T1D) in children and adolescents has been increased over decades worldwide. Recent studies showed that the trend of T1D incidences were different between developed and underdeveloped countries. This review aimed to summarize the changes of childhood T1D incidences in underdeveloped countries over the past decade. RECENT FINDINGS Majority of the underdeveloped countries lacked of nationwide population-based studies on childhood T1D. We reviewed the trend of childhood T1D in important underdeveloped countries with available data in recent years. The incidences of childhood T1D in underdeveloped countries were low decades ago, but it increased significantly recently, particularly in the sub-Saharan African, Middle East and North African regions. SUMMARY The incidences of childhood T1D increased significantly in underdeveloped countries, especially in the sub-Saharan African, Middle East and North African regions. T1D registry and population-based studies are helpful to understand the situation and characteristic of childhood T1D in underdeveloped countries.
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Affiliation(s)
- Cai Zhang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Pediatric Genetic Metabolic and Endocrine Rare Diseases
| | - Xiaoping Luo
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Pediatric Genetic Metabolic and Endocrine Rare Diseases
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Muhammed Elamin S, Muhamad Arshad NF, Md Redzuan A, Abdul Aziz SA, Hong J, Chua XY, Bin-Abbas BS, Alsagheir A, Mohamed Shah N. Information needs on type 1 diabetes mellitus (T1DM) and its management in children and adolescents: a qualitative study. BMJ Open 2024; 14:e079606. [PMID: 38569693 PMCID: PMC10989179 DOI: 10.1136/bmjopen-2023-079606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/26/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE The objective of this study is to explore the information needs related to insulin therapy in children and adolescents with type 1 diabetes mellitus (T1DM) from the children's perspectives as well as their caregivers. DESIGN Qualitative study; semistructured interviews. To identify emerging themes relating to information needs, open coding and thematic analysis were employed. SETTING Participants were recruited from a tertiary care children's hospital in Kuala Lumpur, Malaysia and a specialist hospital in Riyadh, Saudi Arabia. PARTICIPANTS Thirty one children with a mean age of 11.5 years (SD=1.9) and their caregivers were interviewed. Seventeen participants were from Malaysia and 14 were from Saudi Arabia. RESULTS Four themes of information emerged from the interviews, including information related to (1) hypoglycaemia and hyperglycaemia, (2) insulin therapy, (3) injection technique and (4) other information needs pertaining to continuous glucose monitoring, access to peer groups and future advances in insulin therapy. CONCLUSION This study provided valuable insights into the information needs related to T1DM and insulin therapy among children and adolescents with T1DM that should be considered by stakeholders in the development of age-appropriate education materials. Such materials will assist children and adolescents to better manage their life-long T1DM condition from adolescence until adulthood.
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Affiliation(s)
| | | | - Adyani Md Redzuan
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Joyce Hong
- Department of Pediatric, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Xin Yun Chua
- Department of Pharmacy, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Bassam Saleh Bin-Abbas
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Afaf Alsagheir
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Al Hayek A, Robert AA, Alzahrani WM, Al Dawish MA. Assessment of Patient-reported Satisfaction and Metabolic Outcomes Following Initiation of the Second Generation of Flash Glucose Monitoring in Patients with Type 1 Diabetes. Curr Diabetes Rev 2024; 20:e100823219628. [PMID: 37563819 DOI: 10.2174/1573399820666230810123504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/30/2023] [Accepted: 07/02/2023] [Indexed: 08/12/2023]
Abstract
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.
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Affiliation(s)
- Ayman Al Hayek
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Asirvatham Alwin Robert
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Wael M Alzahrani
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohamed Abdulaziz Al Dawish
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Smudja M, Milenkovic T, Minakovic I, Zdravkovic V, Mitic S, Milutinovic D. Determinants of health-related quality of life in children and adolescents living with type 1 diabetes mellitus during the COVID-19 pandemic. Nurs Open 2023; 10:7394-7410. [PMID: 37688291 PMCID: PMC10563408 DOI: 10.1002/nop2.1993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 05/27/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
AIM To identify the determinants of self-reported health-related quality of life in children and adolescents with type 1 diabetes mellitus during the coronavirus pandemic. DESIGN A cross-sectional study. METHODS The study sample included 182 children and adolescents who had been diagnosed with type 1 diabetes mellitus at least 3 months prior. Data collection instruments included sociodemographic and glycaemic control protocol adherence questionnaires, documentation sheet for recording clinical data, and Serbian versions of the EuroQol-5D-Y and KidScreen27 questionnaires, which were used to assess health-related quality of life. RESULTS Glycaemic control adherence, presence of comorbidities, level of metabolic control, and type of insulin therapy were identified as key determinants of self-reported health-related quality of life. PATIENT OR PUBLIC CONTRIBUTION No patient or public contributions.
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Affiliation(s)
- Mirjana Smudja
- Academy for Applied Studies BelgradeDepartment of Higher Medical SchoolBelgradeSerbia
- Faculty of MedicineUniversity of Novi SadNovi SadSerbia
| | - Tatjana Milenkovic
- Department of EndocrinologyMother and Child Health Care Institute of Serbia "Dr. Vukan Cupic"BelgradeSerbia
| | - Ivana Minakovic
- Faculty of MedicineUniversity of Novi SadNovi SadSerbia
- Health Center Novi SadNovi SadSerbia
| | - Vera Zdravkovic
- University Children's Hospital BelgradeBelgradeSerbia
- Faculty of MedicineUniversity of BelgradeBelgradeSerbia
| | - Sandra Mitic
- Specialized Hospital "Bukovicka banja" ArandjelovacArandjelovacSerbia
| | - Dragana Milutinovic
- Faculty of MedicineDepartment of NursingUniversity of Novi SadNovi SadSerbia
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AlAteeq MA, AlHusaini A, AlMalahi A, AlOtay F, AlTurki A, Alghafis A. Glucose and Lipid Profiles of Overweight and Obese Children in Riyadh, Saudi Arabia. Cureus 2023; 15:e38902. [PMID: 37313072 PMCID: PMC10259743 DOI: 10.7759/cureus.38902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Obesity is a prevalent issue worldwide, affecting both children and adults and posing significant health risks. Obesity and overweight are known to be associated with metabolic abnormalities among children and adolescents. This study aims to determine the metabolic profiles, identifying any abnormalities and related factors among overweight and obese children in Saudi Arabia (SA). METHODS This study conducted a cross-sectional, descriptive, and analytical analysis on 382 overweight and obese children between the ages of seven and 14 years. The subjects were visitors to pediatric endocrinology clinics and primary healthcare clinics in King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. Data from the electronic medical records between 2018 and 2020 were examined, focusing on total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and fasting blood sugar (FBS). RESULTS Among the study sample, 8% were found to have high TC, 19% had high LDL-C, 27% had low HDL-C, 12% had high TG, and 8% had high FBS. Overweight children had higher HDL levels, while obese children had higher TG levels. There was no significant difference between males and females or between different age groups in metabolic profiles. CONCLUSION This study uncovered a low prevalence of abnormal lipid and FBS profiles among overweight and obese children and adolescents. Detecting and managing the early onset of dyslipidemia and hyperglycemia can prevent long-term consequences and safeguard children from the risk of future cardiovascular injuries and deaths.
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Affiliation(s)
- Mohammed A AlAteeq
- Family Medicine, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, SAU
| | - AbdulAziz AlHusaini
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, SAU
| | - AbdulAziz AlMalahi
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, SAU
| | - Faisal AlOtay
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, SAU
| | - Azzam AlTurki
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, SAU
| | - AbdulAziz Alghafis
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, SAU
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Al-Dubayee M, Babiker A, Alkewaibeen A, Alkhalifah A, Alanazi T, Nogoud M, Alotaibi A, Alotaibi F, Almetairi F, Alrowaily MA, Masuadi E, Nasr A. Correlation analysis between cytokines' profile, autoimmune antibodies and the duration of type 1 diabetes: A case control study in a specialized children's centre in Riyadh. Int J Immunopathol Pharmacol 2023; 37:3946320231209821. [PMID: 37953627 PMCID: PMC10644762 DOI: 10.1177/03946320231209821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/06/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVE The aim of this study was to investigate the role of cytokines in children with T1D living in Saudi Arabia and their correlation with disease duration and autoimmune antibody markers. METHODS A case-control study was conducted in the endocrine clinic of King Abdullah Specialized Children's Hospital in Riyadh. A total of 274 T1D and healthy control children were enrolled in the study. 5 mL of venous blood samples were collected in the morning after 9 to 12 h of fasting in BD Vacutainer® EDTA tubes and centrifuged at 250g for 15 min at. Plasma was then stored at -20°C for detection of anti-islet, anti-GAD antibodies (Abs), and C-peptide using commercial ELISA kits from Thermo Fisher Scientific. The levels of cytokines were measured using commercial sandwich ELISA kits from Abcam. RESULTS Median differences in cytokine levels (IFN-γ, TNF-α, IL-1β, IL-2, IL-4, IL-6, IL-10, IL-13, IL-18, IL-21, IL-35, and IL-37) were significantly higher in T1D patients compared with healthy controls (p-value < .001). Spearman's Rho correlation indicated that TNFα, IL-1β, IL-4, IL-10, IL-13, and IL-21 correlated significantly with T1D Abs (p-value = .01). HbA1C correlated negatively with IL-35 and IL-37, and positively with IL-18 (p-value = .01). Linear regression analysis showed a significant increase in anti-glutamic acid antibodies (GAD) in patients with >3 years of T1D duration. CONCLUSION Autoantibodies remained positive at high levels in our patients over a 3-year duration of the disease and correlated with specific cytokines. The clear correlations with disease duration and profile of specific cytokines could be targets for future therapeutic interventions.
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Affiliation(s)
- Mohammed Al-Dubayee
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Ministry of National Guard-Health Affairs (MNGHA), King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Amir Babiker
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Ministry of National Guard-Health Affairs (MNGHA), King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz Alkewaibeen
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Ministry of National Guard-Health Affairs (MNGHA), King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - Abdulrahman Alkhalifah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Ministry of National Guard-Health Affairs (MNGHA), King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - Tammam Alanazi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Ministry of National Guard-Health Affairs (MNGHA), King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - Maysa Nogoud
- Ministry of National Guard-Health Affairs (MNGHA), King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - Anas Alotaibi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Ministry of National Guard-Health Affairs (MNGHA), King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - Faisal Alotaibi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Ministry of National Guard-Health Affairs (MNGHA), King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - Firas Almetairi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Ministry of National Guard-Health Affairs (MNGHA), King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - Mohammed A Alrowaily
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Emad Masuadi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Amre Nasr
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Ministry of National Guard-Health Affairs (MNGHA), King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Yacoub M, Rosengren K, D’emeh W. Experience and Educational Needs of Arab Parental Caregivers Regarding their Children Newly Diagnosed with Type 1 Diabetes in Saudi Arabia: A Qualitative Study. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223221134129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Type 1 diabetes (T1DM) is a common chronic health condition in children that necessitates close monitoring and care. Parents face numerous challenges when caring for children with T1DM, particularly at home owing to self-care. There is little information available about Arab parents’ experiences and educational needs when caring for children with TIDM. The purpose of this study was to explore the experiences and educational needs of Arab parental caregivers in Saudi Arabia who live with and care for children diagnosed with T1DM. An inductive qualitative descriptive design was used in this study. The data were amassed over a 4 month period through audio-recorded semi-structured interviews with 16 Arab parents of children aged 18 years and under who had been diagnosed with T1DM within the previous 6 months. Data were analyzed through a qualitative content analysis. The results could be classified into 3 categories related to the parents’ experience of caring for a child newly diagnosed with T1DM and their educational needs and can be described as follows: (1) management of uncertainty regarding T1DM; (2) management of new daily life situations; and (3) self-care management within the family. The Arab parents of children with T1DM accentuated the need for continuous professional support to manage uncertainty due to changes in everyday life situations. The findings confirmed the significance of culturally and contextually relevant education regarding T1DM for parents, children, and school personnel. Educational interventions and support in the community are recommended to improve daily life situations for families and children with T1DM.
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Affiliation(s)
| | - Kristina Rosengren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Department of Internal Medicine, Mölndal, Sweden
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Al-Qahtani MH, Bukhamseen FM, Al-Qassab AT, Yousef AA, Awary BH, Albuali WH, Alkhalifa ZM, Yousef HA. The Impact of COVID-19 Lockdown on the Incidence of Type 1 DM and the Glycemic Control of Diabetic Children: Findings from a Teaching Hospital, Saudi Arabia. Rev Diabet Stud 2022; 18:152-156. [PMID: 36309774 PMCID: PMC9652708 DOI: 10.1900/rds.2022.18.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE: We evaluated glycemic control among T1DM pediatric patients attending the endocrinology pediatrics clinics at King Fahd Hospital of the University (KFHU) prior to and during COVID-19 restraining regulations. In addition, we assessed the trends and variations in the incidence of T1DM during 2017-2021, including the COVID-19 years by identifying newly diagnosed patients presenting to pediatrics emergency department (ED) in KFHU. METHODS: To estimate the effect of COVID-19 on the incidence of T1DM, we identified newly diagnosed cases of T1DM among pediatric patients attending the ED during the years 2017- 2021. The participants' data were collected through electronic medical records. Information collected included patient age, sex, and HbA1c readings. Three HbA1c readings of interest that were defined and collected are pre-COVID reading, in-COVID reading, and post-COVID reading. RESULTS: The difference of female participants' readings was statistically non-significant (Z= -0.416, p = 0.678), with a pre- and post-COVID median of 10.70 (Q1= 9.00, Q3= 12.15), and 10.50 (Q1= 8.80, Q3= 12.35), respectively. In contrast, the difference was statistically significant among male participants (Z= -2.334, p = 0.02), with a pre- and post-COVID median of 10.20 (Q1= 8.70, Q3= 11.80), and 10.65 (Q1= 9.00, Q3= 12.70), respectively. There was a statistically significant increase in HbA1c of persons > 11 years old (Z= -2.471, p= 0.013), with a pre- and post-COVID median of 10.40 (Q1= 9.00, Q3= 12.10), and 10.90 (Q1= 9.00, Q3= 12.60), respectively. Conversely, persons ≤ 11 years old showed no statistically significant change in HbA1c (Z= -.457, p= 0.648), with a pre- and post-COVID median of 10.45 (Q1= 8.70, Q3= 11.85), and 10.20 (Q1= 8.40, Q3= 12.075), respectively. Disregarding any influence of time, the effect of sex showed no statistically significant difference in HbA1c between males and females [F (1,125) = 0.008, p = 0.930]. Meanwhile, the age effect on HbA1c, regardless of time influence, was statistically significant [F (1,125) = 4.993, p = 0.027]. There was no statistically significant interaction between time and sex on HbA1c levels [F (1.74, 217) = 0.096, p = 0.883] and between age and time [F (3.92,289.57) = 1.693, p = 0.190]. CONCLUSIONS: The number of visits to healthcare facilities dropped significantly during the COVID-19 pandemic, but the rate of newly diagnosed T1DM increased. There was a variable effect on HbA1c levels of those patients, which suggests that each demographic group in the population might have been affected differently by the pandemic. Future research should determine factors associated with better glycemic control and measures to sustain these changes the pandemic might have created.
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Affiliation(s)
- Mohammad Hussain Al-Qahtani
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia,,Address correspondence to: Mohammad Hussain Al-Qahtani, e-mail:
| | | | | | - Abdullah Abdulsalam Yousef
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Bassam Hassan Awary
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Waleed Hamad Albuali
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Haneen Abdulsalam Yousef
- Department of Family Medicine, College of Medicine, Imam Abdulrahman Bin Faisal university, Dammam, Saudi Arabia
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Albuali WH, Al-Qahtan MH. Diabetic Ketoacidosis and its Severity Predictors in Type 1 Diabetic Children; A 10-year Experience of A Teaching Hospital in Saudi Arabia. Rev Diabet Stud 2022; 18:146-151. [PMID: 36309773 PMCID: PMC9652709 DOI: 10.1900/rds.2022.18.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE: Our objective was to determine the trend and precipitating factors of the severity of diabetic ketoacidosis (DKA) in the population admitted to the Pediatric Intensive Care Unit (PICU) in a large teaching hospital in the Eastern region of Saudi Arabia. METHODS: We conducted a retrospective, analytical study at King Fahad Hospital, Imam Abdulrahman Bin Faisal University, Alkhobar, Saudi Arabia. We retrieved the complete medical records of 2234 children who were admitted to the PICU during the 10-year period of 2010 through 2019. The children included those with polydipsia, polyurea, abdominal pain, vomiting, dehydration, and weight loss, as well as breathing disturbances due to acidosis and CNS issues such as lethargy or coma and elevated blood glucose level, > 200 mg/dL [> 11.1 mmol/L], venous pH 7.3, serum total CO2 15 mmol/L, and blood- hydroxybutyrate concentration 3 mmol/L or moderate or severe ketonuria. RESULTS: Out of 2234 PICU admissions, 211 (9.4%) were diagnosed with DKA. A persistent increase in the rate of DKA ended up at 14.1% in 2019 (p = .005). The incidence of DKA was 88/2234 (3.93%). The severity of DKA was as follows: 130 (61.6%) had severe and 81 (38.4%) had moderate DKA. Excessive sweet intake without adding insulin in 83 (39.3%) patients and unhealthy lifestyles (35.1%) were the best predictors of severe DKA (p = .001). CONCLUSION: Over a 10-year period, the DKA pattern was persistently rising and slightly falling, which ended up at the significantly highest rate of 14.1% in 2019. URTI, pneumonia, unhealthy lifestyle, and excess sweet intake were significant precipitating factors associated with severe DKA.
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Bali IA, Al-Jelaify MR, AlRuthia Y, Mulla JZ, Amlih DF, Bin Omair AI, Al Khalifah RA. Estimated Cost-effectiveness of Subcutaneous Insulin Aspart in the Management of Mild Diabetic Ketoacidosis Among Children. JAMA Netw Open 2022; 5:e2230043. [PMID: 36066894 PMCID: PMC9449786 DOI: 10.1001/jamanetworkopen.2022.30043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Intravenous (IV) insulin infusion is the standard of care for treating diabetic ketoacidosis (DKA) worldwide. Subcutaneous (SC) insulin aspart could decrease the use of health care resources. OBJECTIVE To compare the cost-effectiveness of mild uncomplicated DKA management with SC insulin aspart vs IV insulin infusion among pediatric patients from the perspective of a public health care payer using clinical data. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation included children aged 2 to 14 years presenting to the emergency department of a single academic medical center with mild DKA between January 1, 2015, and March 15, 2020. The medical records for DKA treatment course and its associated hospitalization costs were reviewed. Data were analyzed from January 1, 2015, to March 15, 2020. EXPOSURES Subcutaneous insulin aspart vs IV regular insulin infusion. MAIN OUTCOMES AND MEASURES The incremental cost-effectiveness ratio (US dollars per hour), duration of DKA treatment, and length of hospital stay. RESULTS A total of 129 children with mild DKA episodes (mean [SD] age, 9.9 [3.1] years; 72 girls [55.8%]) were enrolled in the study. Seventy children received SC insulin aspart and 59 received IV regular insulin. Overall, the length of hospital stay in the SC insulin group was reduced (mean, 16.9 [95% CI, -31.0 to -2.9] hours) compared with the IV insulin group (P = .005). The mean (SD) cost of hospitalization in the SC insulin group (US $1071.99 [US $523.89]) was less than that in the IV insulin group (US $1648.90 [US $788.03]; P = .001). The incremental cost-effectiveness ratio was -34.08 (95% CI, -25.97 to -129.82) USD/h. The use of SC insulin aspart was associated with a lower likelihood of prolonged hospital stay (β = -17.22 [95% CI, -32.41 to -2.04]; P = .03) than IV regular insulin when controlling for age and sex. CONCLUSION AND RELEVANCE Findings of this economic evaluation suggest that SC insulin aspart is dominant vs IV regular insulin in the management of mild uncomplicated DKA in children.
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Affiliation(s)
- Ibrahim Abdulaziz Bali
- Division of Pediatric Endocrinology, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Jaazeel Zohair Mulla
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Dana Fawzi Amlih
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Reem Abdullah Al Khalifah
- Division of Pediatric Endocrinology, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Alrasheed AA. Dyslipidemia Among Patients With Type 1 Diabetes and Its Associated Factors in Saudi Arabia: An Analytical Cross-Sectional Study. Cureus 2022; 14:e21923. [PMID: 35265434 PMCID: PMC8899866 DOI: 10.7759/cureus.21923] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 12/18/2022] Open
Abstract
Objectives The present study was conducted to determine the prevalence of dyslipidemia among patients with type 1 diabetes mellitus (T1DM) and its associated factors in Saudi Arabia. Methods An analytical cross-sectional study was conducted to examine patients with T1DM at a tertiary care hospital in Riyadh, Saudi Arabia. The hospital’s electronic medical records (EMRs) and a telephone survey were used to collect data after obtaining institutional approval and informed consent from every patient. The inclusion criteria included age >18 years, T1DM, and follow-up at the tertiary care hospital. The data collected included age, gender, hypertension, glycosylated hemoglobin (HbA1c), body mass index (BMI), diabetes duration, total cholesterol, triglycerides (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL). Results A total of 234 patients with T1DM were included in the study, which comprised 44.4% men and 55.6% women with an average age of 30.9 ± 9.7 years. Total cholesterol, TG, LDL-C, and HDL-C were 4.6 ± 1.04 mmol/L, 1.1 ± 0.60 mmol/L, 2.6 ± 0.89 mmol/L, and 1.5 ± 0.43 mmol/L, respectively. About 18.4% were hypertensive, and about 51.9% and 50% men and women had dyslipidemia, respectively. Males and HbA1c ≥ 7% showed significant associations with dyslipidemia. Conclusion Dyslipidemia is prevalent in patients with T1DM in Saudi Arabia, which warrants the use of solid preventive strategies to limit the risk of cardiovascular disease.
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Fernandez-Luque L, Al Herbish A, Al Shammari R, Argente J, Bin-Abbas B, Deeb A, Dixon D, Zary N, Koledova E, Savage MO. Digital Health for Supporting Precision Medicine in Pediatric Endocrine Disorders: Opportunities for Improved Patient Care. Front Pediatr 2021; 9:715705. [PMID: 34395347 PMCID: PMC8358399 DOI: 10.3389/fped.2021.715705] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/17/2021] [Indexed: 12/16/2022] Open
Abstract
Digitalization of healthcare delivery is rapidly fostering development of precision medicine. Multiple digital technologies, known as telehealth or eHealth tools, are guiding individualized diagnosis and treatment for patients, and can contribute significantly to the objectives of precision medicine. From a basis of "one-size-fits-all" healthcare, precision medicine provides a paradigm shift to deliver a more nuanced and personalized approach. Genomic medicine utilizing new technologies can provide precision analysis of causative mutations, with personalized understanding of mechanisms and effective therapy. Education is fundamental to the telehealth process, with artificial intelligence (AI) enhancing learning for healthcare professionals and empowering patients to contribute to their care. The Gulf Cooperation Council (GCC) region is rapidly implementing telehealth strategies at all levels and a workshop was convened to discuss aspirations of precision medicine in the context of pediatric endocrinology, including diabetes and growth disorders, with this paper based on those discussions. GCC regional investment in AI, bioinformatics and genomic medicine, is rapidly providing healthcare benefits. However, embracing precision medicine is presenting some major new design, installation and skills challenges. Genomic medicine is enabling precision and personalization of diagnosis and therapy of endocrine conditions. Digital education and communication tools in the field of endocrinology include chatbots, interactive robots and augmented reality. Obesity and diabetes are a major challenge in the GCC region and eHealth tools are increasingly being used for management of care. With regard to growth failure, digital technologies for growth hormone (GH) administration are being shown to enhance adherence and response outcomes. While technical innovations become more affordable with increasing adoption, we should be aware of sustainability, design and implementation costs, training of HCPs and prediction of overall healthcare benefits, which are essential for precision medicine to develop and for its objectives to be achieved.
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Affiliation(s)
| | | | - Riyad Al Shammari
- National Center for Artificial Intelligence, Saudi Data and Artificial Intelligence Authority, Riyadh, Saudi Arabia
| | - Jesús Argente
- Department of Pediatrics & Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- IMDEA Food Institute, CEIUAM+CSIC, Madrid, Spain
| | - Bassam Bin-Abbas
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Asma Deeb
- Paediatric Endocrine Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - David Dixon
- Connected Health and Devices, Merck, Ares Trading SA, Aubonne, Switzerland
| | - Nabil Zary
- Institute for Excellence in Health Professions Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | | | - Martin O. Savage
- Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine & Dentistry, London, United Kingdom
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Alaqeel A, Aljuraibah F, Alsuhaibani M, Huneif M, Alsaheel A, Dubayee MA, Alsaedi A, Bakkar A, Alnahari A, Taha A, Alharbi K, Alanazi Y, Almadhi S, Khalifah RA. The Impact of COVID-19 Pandemic Lockdown on the Incidence of New-Onset Type 1 Diabetes and Ketoacidosis Among Saudi Children. Front Endocrinol (Lausanne) 2021; 12:669302. [PMID: 33868185 PMCID: PMC8049603 DOI: 10.3389/fendo.2021.669302] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/18/2021] [Indexed: 12/22/2022] Open
Abstract
Background Overburdened healthcare systems during the coronavirus disease (COVID-19) pandemic led to suboptimal chronic disease management, including that of pediatric type 1 diabetes mellitus (T1DM). The pandemic also caused delayed detection of new-onset diabetes in children; this increased the risk and severity of diabetic ketoacidosis (DKA). We therefore investigated the frequency of new-onset pediatric T1DM and DKA in Saudi Arabia during the COVID-19 pandemic and compared it to the same period in 2019. Methods We conducted a multicenter retrospective cohort study, including patients aged 1-14 years admitted with new-onset T1DM or DKA during the COVID-19 pandemic (March-June 2020) and the same period in 2019. We assessed factors including age, sex, anthropometric measures, nationality, duration of diabetes, diabetes management, HbA1c levels, glycemic control, cause of admission, blood gas levels, etiology of DKA, DKA complications, length of hospital stay, and COVID-19 test status. Result During the lockdown, 106 children, compared with 154 in 2019, were admitted to 6 pediatric diabetes centers. Among the admissions, DKA was higher in 2020 than in 2019 (83% vs. 73%; P=0.05; risk ratio=1.15; 95% confidence interval, 1.04-1.26), after adjusting for age and sex. DKA frequency among new-onset T1DM and HbA1c levels at diagnosis were higher in 2020 than in 2019 (26% vs. 13.4% [P=<0.001] and 12.1 ± 0.2 vs. 10.8 ± 0.25 [P<0.001], respectively). Females and older patients had a higher risk of DKA. Conclusion The lockdown implemented in Saudi Arabia has significantly impacted children with T1DM and led to an increased DKA frequency, including children with new-onset T1DM, potentially owing to delayed presentation.
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Affiliation(s)
- Aqeel Alaqeel
- Department of Pediatrics, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Fahad Aljuraibah
- Pediatric Department, King Abdullah Specialized Children’s Hospital, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard-Health Affairs (MNGHA), Riyadh, Saudi Arabia
| | - Mohammed Alsuhaibani
- Department of Pediatrics, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Mohammed Huneif
- Department of Pediatrics, College of Medicine, Najran University, Najran, Saudi Arabia
| | - Abdulhameed Alsaheel
- Pediatric Endocrine Department, Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammad Al Dubayee
- Pediatric Department, King Abdullah Specialized Children’s Hospital, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard-Health Affairs (MNGHA), Riyadh, Saudi Arabia
| | - Abdulaziz Alsaedi
- Al Hada Armed Forces Hospital, Pediatric Department, Pediatric Endocrine Division, Taif, Saudi Arabia
| | - Ayman Bakkar
- Al Hada Armed Forces Hospital, Pediatric Department, Pediatric Endocrine Division, Taif, Saudi Arabia
| | - Ahmed Alnahari
- Diabetes and Endocrinology Center, King Fahad Central Hospital in Jizan, Jizan, Saudi Arabia
| | - Areej Taha
- Pediatric Endocrinology Division, Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khulood Alharbi
- Pediatric Department, King Abdullah Specialized Children’s Hospital, Riyadh, Saudi Arabia
- Department of Pediatrics, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Yousef Alanazi
- Pediatric Department, King Abdullah Specialized Children’s Hospital, Riyadh, Saudi Arabia
- Department of Pediatrics, College of Medicine, Majmaah University, Majmaah, Saudi Arabia
| | - Samia Almadhi
- Pediatric Endocrine Department, Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Reem Al Khalifah
- Pediatric Endocrinology Division, Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Ahmed NFH, Alqahtani AS, Albalawi NMR, Alanazi FKM, Alharbi FM, Alsabah BA, Alatawi AM, Alghuraydh AI. Diabetes in Adolescents and Children in Saudi Arabia: A Systematic review. ARCHIVES OF PHARMACY PRACTICE 2021. [DOI: 10.51847/iwjj2omwja] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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