Ten-year Diabetes Risk Forecast in the Capital of Jordan: Arab Diabetes Risk Assessment Questionnaire Perspective-A Strobe-Complaint Article

Prevalence and associated factors of non-communicable chronic diseases among university academics in Jordan

The increasing prevalence of non-communicable chronic diseases on a global, regional, and local scale demonstrates the extensive impact of these diseases, which now account for 70% of all worldwide deaths and affect a diverse population outside affluent places. The purpose of this study was to assess the prevalence and associated factors of non-communicable chronic diseases among academics at Mutah University in Jordan, while also taking into account the global trend of non-communicable diseases impacting different demographics. In a cross-sectional study, the majority of faculty members completed a questionnaire that included demographic information and prevalence of chronic diseases. The most prevalent conditions detected were hypertension (19.6%), diabetes mellitus (17.5%), rheumatoid arthritis (14.2%), heart disease (12.6%), and respiratory disorders (11.3%). Specifically, smoking and being overweight are underlined as significant risk factors, particularly among male respondents. These findings highlight the need of implementing health promotion programs in educational academic institutions, with an emphasis on fostering healthy dietary habits and encouraging physical activity.

Ramadan fasting and weight change trajectories: Time-varying association of weight during and after Ramadan in low-income and refugee populations

Obesity is a significant driver of the global burden of non-communicable diseases. Fasting is one approach that has been shown to improve health outcomes. However, the effects of Ramadan fasting differ in that the type, frequency, quantity, and time of food consumption vary. This phenomenon requires in-depth evaluation considering that 90% of Muslims (~2 billion people) fast during Ramadan. To address this issue, we evaluated the pattern of weight change during and following Ramadan for a total of 52 weeks. The study was conducted in Amman, Jordan. Between 2012 and 2015, 913 participants were recruited as part of a trial investigating the efficacy of a weight loss intervention among those with or at risk for diabetes. Weight was measured weekly starting at the beginning of Ramadan, and changes were analyzed using discrete and spline models adjusted for age, sex, and trial group. Results show slight weight gain within the first two weeks and weight loss in the subsequent weeks. During the first week of Ramadan, the estimate for a weight reduction was 0·427 kg, (95% CI: -0·007, 0·861), increasing to 1·567 kg, (95% CI: 2·547, 3·527) at week 26. There was clear evidence of gradual weight gain from about 4 to 15 weeks and a drop towards the end of the investigation at week 28 (-0·12kg, 95% CI: -0·89, 0·56). Our results show that weight changes occurred during and after Ramadan. Weight fluctuations may affect health risks, and thus, findings from this study can inform interventions. Public health agencies could leverage this period of dietary change to sustain some of the benefits of fasting. The authors (DEZ, EFD) acknowledge the Mulago Foundation, the Horace W. Goldsmith Foundation, Robert Wood Johnson Foundation, and the World Diabetes Foundation. TRIAL REGISTRATION. Clinicaltrials.gov registry identifier: NCT01596244.

Role of community pharmacists in medication management during COVID-19 lockdown

Preventive and control measures implemented by many countries to mitigate the spread of COVID-19 may negatively impact medication and chronic disease management, which can interfere with achieving patients' therapeutic goals. This study aims to evaluate the effect of the COVID-19 lockdown on these aspects, while exploring the role of community pharmacists. A cross-sectional study was conducted via a web-based questionnaire that targeted individuals who suffer from chronic diseases in Jordan. Participants were recruited by convenience sampling and were asked to self-report their ability to access medication, and the perceived role of community pharmacists. Among the 431 participants, the mean age ± SD (years) was 53.8 ± 13.7 and 60.1% (n= 259) were females. Participants mainly reported difficulties in accessing medication (n=198, 45.9%), reduced supplies or unavailability of medications (n=213, 49.4%), nonadherence to medications due to lack of access (n=98, 22.7%) and high costs (n=85, 19.7%). Participants avoided follow-ups due to a fear of infection (n=367, 82.5%) or prolonged waiting time in clinics (n=322, 74.7%). An increased reliance on the community pharmacy for medical advice was reported by 39.9% (n=172) of the participants, with half of them (n=217, 50.3%) depending on the pharmacists for advice regarding over-the-counter medications and COVID-19-related information (n=119, 27.6%). There is an urgent need to involve community pharmacists in medication and chronic disease management with a focus on patient adherence to ensure the optimal management of such vulnerable patient groups. Future studies to assess the effect of pharmacists' contributions towards enhancing medication/disease management are warranted.

Treatment related problems in Jordanian hemodialysis patients

Background Treatment related problems are any event or circumstance involving patient treatment that actually or potentially interferes with an optimum outcome for a patient. Hemodialysis patients have on average 5-6 comorbid conditions and require 8-12 medications each day making them vulnerable to treatment related problems. Objective This study aimed to investigate treatment related problems affecting Jordanian hemodialysis patients, as well as assessing the factors associated with them. Setting Three hemodialysis centers in Jordan. Method A cross sectional multi-centered study was conducted. Direct interviews and patient files were used to collect patient information. A validated data collection form was used. Main outcome measure The average number of treatment related problems per patient. Results 160 patients from three different Jordanian dialysis centers were included. The cohort was 53 ± 15.2 years old, been on dialysis for 5.9 ± 5.3 years, had 3.9 ± 1.8 comorbid conditions and took 10.2 ± 2.8 different medications. There were a total of 1018 treatment related problems, a treatment related problem occurred once every 1.47 drug exposures. Adverse events were the most commonly occurring treatment related problems (27%), followed by indication related errors and dosing errors (24% and 21%, respectively). The number of treatment related problems is positively associated with age, the number of comorbid conditions, the number of hospital admissions in the previous year and the number of medications taken by the patient. Conclusion In the Jordanian hemodialysis population, treatment related problems affect virtually all patients. Most patients suffered adverse drug events and/or had drug indication problems. The number of treatment related problems correlated positively with age and the number of medications taken by the patient. Those with more treatment related problems also had higher hospital admissions and longer admission periods. Serious measures should be made in order to reduce the number of treatment related problems affecting this vulnerable population.

The Association Between Dietary Habits and Other Lifestyle Indicators and Dysglycemia in Saudi Adults Free of Previous Diagnosis of Diabetes

Objective:

Study the association of dietary habits and other indicators of lifestyle with dysglycemia in Saudi adults.

Methods:

In a cross-sectional design, data were obtained from 1403 Saudi adults (⩾20 years), not previously diagnosed with diabetes. Demographics, lifestyle variables and dietary habits were obtained using a predesigned questionnaire. Fasting plasma glucose, glycated hemoglobin and 1-hour oral glucose tolerance test were used to identify dysglycemia. Regression analysis was performed to determine the associations of dietary factors and other indicators of lifestyle with dysglycemia.

Results:

A total 1075 adults (596 men, and 479 women) had normoglycemia, and 328 (195 men, and 133 women) had dysglycemia. Following adjustment for age, BMI and waist circumference, in men the weekly intake of 5 portions or more of red meat and Turkish coffee were associated with decreased odds of having dysglycemia odds ratio (OR) 0.444 (95% CI: 0.223, 0.881; P = .02) and 0.387 (95% CI: 0.202, 0.74; P = .004), respectively. In women, the intake of fresh juice 1 to 4 portions per week and 5 portions or more were associated with OR 0.603 (95% CI: 0.369, 0.985; P = .043) and OR 0.511 (95% CI: 0.279, 0.935; P = .029) decreased odds of having dysglycemia, respectively compared with women who did not drink fresh juice. The intake of 5 times or more per week of hibiscus drink was associated with increased odds of having dysglycemia, OR 5.551 (95% CI: 1.576, 19.55, P = .008) compared with women not using such a drink. Other lifestyle factors were not associated with dysglycemia.

Conclusion:

Dietary practices by studied Saudis have some impact on risk of dysglycemia, with obvious sex differences.

Artificial Neural Networks Model for Predicting Type 2 Diabetes Mellitus Based on VDR Gene FokI Polymorphism, Lipid Profile and Demographic Data

Type 2 diabetes mellitus (T2DM) is a multifactorial disease associated with many genetic polymorphisms; among them is the FokI polymorphism in the vitamin D receptor (VDR) gene. In this case-control study, samples from 82 T2DM patients and 82 healthy controls were examined to investigate the association of the FokI polymorphism and lipid profile with T2DM in the Jordanian population. DNA was extracted from blood and genotyped for the FokI polymorphism by polymerase chain reaction (PCR) and DNA sequencing. Lipid profile and fasting blood sugar were also measured. There were significant differences in high-density lipoprotein (HDL) cholesterol and triglyceride levels between T2DM and control samples. Frequencies of the FokI polymorphism (CC, CT and TT) were determined in T2DM and control samples and were not significantly different. Furthermore, there was no significant association between the FokI polymorphism and T2DM or lipid profile. A feed-forward neural network (FNN) was used as a computational platform to predict the persons with diabetes based on the FokI polymorphism, lipid profile, gender and age. The accuracy of prediction reached 88% when all parameters were included, 81% when the FokI polymorphism was excluded, and 72% when lipids were only included. This is the first study investigating the association of the VDR gene FokI polymorphism with T2DM in the Jordanian population, and it showed negative association. Diabetes was predicted with high accuracy based on medical data using an FNN. This highlights the great value of incorporating neural network tools into large medical databases and the ability to predict patient susceptibility to diabetes.

Diabetes mellitus risk among Jordanians in a dental setting: a cross-sectional study

BACKGROUND

Dental offices can be useful to screen and identify patients at risk of developing diabetes mellitus (DM) using risk prediction tools. The Finnish Diabetes Risk Score (FINDRISC) is a validated, questionnaire-based tool used to predict the 10-year risk of developing type II DM.

OBJECTIVES

To determine the 10-year DM risk among Jordanians using the FINDRISC questionnaire in a dental setting.

MATERIALS AND METHODS

Participants attending two university dental teaching centres between March 2017 and February 2018 were interviewed using an Arabic translated version of the FINDRISC questionnaire. Anthropometrics including weight, height, waist circumference (WC) and body mass index (BMI) were recorded. Random capillary blood glucose level was measured for each participant. Statistical analysis was done using Chi-square and independent t-tests.

RESULTS

A total of 1,247 (436 males and 811 females) participants were included. As defined by BMI, 1,012 (81.2%) participants were either overweight or obese. Abdominal adiposity as determined by WC was seen in 738 (59.2%) participants. The mean (± SD) FINDRISC score for females (11.3 ± 4.3) was significantly higher (P = 0.001) than males (10.4 ± 4.9). After age adjustment, more females were in the high-risk categories (FINDRISC ≥ 15) compared with males. This trend was seen among all age groups, but was statistically significant in the older age groups; 55-64 years (P = 0.037) and ≥ 65 years (P = 0.004).

CONCLUSION

In a developing Middle Eastern country such as Jordan, almost half of Jordanians attending university dental clinics are at a moderate to high risk of developing type II DM in 10 years. The risk of DM should be considered in dental patients, particularly older females.

Epidemiology, Risk Factors, and Predictors of Disability in a Cohort of Jordanian Patients with the First Ischemic Stroke

OBJECTIVE

To identify the risk factors, etiologies, length of stay, severity, and predictors of disability among patients with the first ischemic stroke in Jordan.

METHODS

A retrospective cohort study of 142 patients who were admitted to the Neurology Department at King Abdullah University Hospital between July/2017 and March/2018 with a first ischemic stroke. Etiology was classified according to the TOAST criteria. Severity was represented by NIHSS score, disability by mRS score, and prolonged length of stay as hospitalizations more than 75th percentile of the cohort's median length of stay. Analysis of the sample demographics and descriptive statistics were done, including frequencies of prevalence of independent variables (risk factors) and frequencies of stroke and etiology work-up. Chi-square and univariate analysis of variance "ANOVA" were used to investigate the relationship between risk factors and type of stroke. Finally, logistic regression analysis was used to measure the contribution of each of the independent variables. IRB approval was obtained as necessary.

RESULTS

The mean age for the cohort was 66.5 years. The most common risk factors were hypertension (78.8%), diabetes mellitus (60.5%), and ischemic heart disease (29.4%). The most common stroke etiology was small-vessel occlusion (54.2%). Median length of stay was 4 days. Prolonged length of stay was observed in 23.23% of patients, which was associated with several factors, the most common of which were persistent dysphagia (57.5%), nosocomial infection (39.3%), and combined dysphagia and nosocomial infection (21.2%). The mean admission NIHSS score was 7.94, and on discharge was 5.76. In-hospital mortality was 2.81%, while 50% of patients had a favorable outcome on discharge (mRS score between 0-2). The mean discharge mRS score for the cohort was 2.47 (SD ± 1.79). Large artery atherosclerosis was associated with the highest residual disability with a mean score of 3.67 (SD ± 1.88), while the stroke of undetermined etiology was associated with the lowest residual disability with a mean score of 1.60 (SD ± 1.78). Significant predictors of mRS score were smoking (t 3.24, P < 0.001), age (t 1.98, P < 0.049), and NIHSS score (t 9.979, P 0.000).

CONCLUSION

Ischemic strokes have different etiologies that are associated with different levels of impact on the patient's clinical status and prognosis. Large artery atherosclerosis was associated with the highest residual disability. Regarding predictors of prognosis, current smoking status, age above 50, gender, and NIHSS on admission appear to be the strongest predictors of prognosis. Finally, higher NIHSS score on admission resulted in a longer hospital stay.

Challenges that face the establishment of diabetes biobank in Jordan: a qualitative analysis of an online discussion forum

Introduction: Diabetes is common in Jordan with a prevalence of about 13% of the population. Establishment of a diabetes biobank in Jordan could have an enormous impact on the management and prevention of the disease.

Methods: In the current study, ethical challenges that might face the establishment of a biobank were examined by 28 researchers from the Middle East and North Africa region using an online discussion forum.

Results: All participants agreed on the importance of the establishment of a diabetes biobank in Jordan. The possible challenges that were discussed included confidentiality and privacy, informed consent, specimen ownership and participants’ rights, data sharing, returning of research results and incidental findings, lack of legislations, and importance of social awareness and public engagements with biobanks.

Conclusion: In conclusion, participants support the establishment of a diabetes biobank in Jordan; however, some ethical issues should be considered to ensure the success of the biobank.

Metformin Pharmacogenetics: Effects of SLC22A1, SLC22A2, and SLC22A3 Polymorphisms on Glycemic Control and HbA1c Levels

Type 2 diabetes mellitus (T2DM) constitutes a major portion of Jordan’s disease burden, and incidence rates are rising at a rapid rate. Due to variability in the drug’s response between ethnic groups, it is imperative that the pharmacogenetics of metformin be investigated in the Jordanian population. The objective of this study was to investigate the relationship between twenty-one single nucleotide polymorphisms (SNPs) in the SLC22A1, SLC22A2, and SLC22A3 genes and their effects on metformin pharmacogenetics in Jordanian patients diagnosed with type 2 diabetes mellitus. Blood samples were collected from 212 Jordanian diabetics who fulfilled the inclusion criteria, which were then used in SNP genotyping and determination of HbA1c levels. The rs12194182 SNP in the SLC22A3 gene was found to have a significant association (p < 0.05) with lower mean HbA1c levels, and this association more pronounced in patients with the CC genotype (i.e., p-value was significant before correcting for multiple testing). Moreover, the multinomial logistic regression analysis showed that SNP genotypes within the SLC22A1, SLC22A2, and SLC22A3 genes, body mass index (BMI) and age of diagnosis were significantly associated with glycemic control (p < 0.05). The results of this study can be used to predict response to metformin and other classes of T2DM drugs, making treatment more individualized and resulting in better clinical outcomes.

Comparison of diabetes risk estimate in the cities of Riyadh and Amman

A significant rise in the prevalence of type 2 diabetes mellitus (T2DM) in the Middle-east and North Africa (MENA) region has seen over the last few decades. The present observational study aimed to evaluate and compare the risk of developing T2DM in the cities of Riyadh and Amman using the Arab Diabetes Risk Assessment Questionnaire (ARABRISK).The ARABRISK was administered in a total of 1116 healthy male and female individuals in the age group of 40 to 74 years with no prior history of diabetes in the city of Riyadh (Saudi Arabia) and Amman (Jordan). ARABRISK is an Arabic version of the Canadian Diabetes Risk Assessment Questionnaire (CANRISK), which was adapted and validated for the use in Arab-speaking individuals in Saudi Arabia and Jordan.The participants from Amman region had higher mean total ARABRISK score compared to the Riyadh region for all categories of ARABRISK. However, the difference was significant in both low- and high-risk categories (P = .02 and P = .01, respectively) but not significant for moderate category (P = .17). In the Riyadh population, female participants had significantly higher ARABRISK total scores compared to male in both moderate- and high-risk categories (P = .01). However, in the Amman population, male participants had significantly higher ARABRISK total scores compared to female in both low- and moderate-risk categories (P = .01).The present study suggested an increased risk of developing T2DM in the cities of Riyadh and Amman. However, the population of Amman had a higher risk of developing T2DM compared to the population of Riyadh.

Diabetes Risk Score in a Young Student Population in Jordan: A Cross-Sectional Study

Background. The Middle East is the home to the most obese population in the world, and type 2 diabetes mellitus is endemic in the region. However, little is known about risk factors for diabetes in the younger age groups. Methods. The Finnish Diabetes Risk Score (FINDRISC) is a simple, validated tool to identify persons at risk of diabetes. We investigated students at Hashemite University in Jordan with FINDRISC and measured fasting plasma glucose in those who were categorized in the high-risk group. Results. Overall, 1821 students (881 [48.4%] female) were included in the study. Risk factors for diabetes were common: 422 (23.2%) were overweight or obese and 497 (27.3%) had central obesity. Using the FINDRISC score, 94 (5.2%) students were at moderate risk and 32 (1.8%) at high risk of diabetes. The mean FINDRISC score was significantly higher in men than women (5.9 versus 5.4; p = 0.002). Twenty-eight students in the high-risk group had a subsequent plasma glucose measurement, and 8 (29%) of them fulfilled the diagnostic criteria for diabetes. Conclusions. Risk factors for diabetes were common in a young student population in Jordan, suggesting that preventive measures should be initiated early in adulthood to turn the diabetes epidemic in the region.