Behavioral trials in the Arab Gulf States: A scoping review

Systematic review and pooled analysis of randomized controlled trials in countries of the Gulf Cooperation Council (GCC): Methods and quality assessment

OBJECTIVES

To describe variations in characteristics of randomized controlled trials conducted in the Gulf Cooperation Council (GCC) countries, and critically appraising the quality of design, conduct and analysis of the trials.

METHODS

We carried out a systematically comprehensive electronic search of articles published between 1990 and 2018 and indexed in several databases: i) MEDLINE/PubMed, ii) EMBASE, iii) Cochrane Central Register of Controlled Trials (CENTRAL), iv) ClinicalTrials.gov, and v) World Health Organization International Clinical Trials Registry Platform. We summarized the overall risk of bias present in all analyzed studies using the Cochrane Collaboration risk of bias tool (CCRBT).

RESULTS

A remarkable shift in numbers of publications from 2006 onwards was found. The largest number of publications were from Saudi Arabia and consisted of hospitals/clinics based studies. Lack of randomization was found in the majority of reports, and nearly three-fourth of the studies involved the use of intention-to-treat (ITT) principle. However, the proportion of adequately generated random sequence methods has increased yearly, and this increase accounted for a relatively large proportion over the latter half of the studied period (p<0.001), in contrast to the proportion of allocation concealment and blinding. Journal impact factor was significantly correlated with the quality of random sequence generation (r=0.145; p=0.014).

CONCLUSION

The randomization methods have gained more attention over the last 3 decades. Secondly, Journal impact factor can serve as an indicator of randomization quality. To mitigate the large rate of overall high risk of bias in GCC studies, high-quality trials must be considered by ensuring adequate allocation concealment and blinding methods. PROSPERO No. ID: CRD42022310331.

The Transcultural Diabetes Nutrition Algorithm: A Middle Eastern Version

Diabetes prevalence is on the rise in the Middle East. In countries of the Gulf region-Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates-prevalence rates are among the highest in the world. Further, Egypt now ranks as one of the top 10 countries in the world for high number of people with diabetes. Medical nutrition therapy is key to optimal management of diabetes. Patient adherence to nutritional guidance depends on advice that is tailored to regional foods and cultural practices. In 2012, international experts created a transcultural Diabetes Nutrition Algorithm (tDNA) for broad applicability. The objective of this current project was to adapt the algorithm and supportive materials to the Middle East region. A Task Force of regional and global experts in the fields of diabetes, obesity, and metabolic disorders met to achieve consensus on Middle East-specific adaptations to the tDNA. Recommendations, position statements, figures, and tables are presented here, representing conclusions of the tDNA-Middle Eastern (tDNA-ME) Task Force. Educational materials can be used to help healthcare professionals optimize nutritional care for patients with type 2 diabetes. The tDNA-ME version provides evidence-based guidance on how to meet patients' nutritional needs while following customs of people living in the Middle Eastern region.