Incidence of diabetes mellitus type 2 complications among Saudi adult patients at primary health care center

The Association Between Vitamin B12 Deficiency and Diabetic Foot Ulcer in Type 2 Diabetic Patients in Qassim Province, Saudi Arabia: A Case-Control Study

Background Diabetic foot ulcer (DFU) is a major complication of diabetes with many identified risk factors. These include poor control of diabetes, cardiovascular disease, smoking, and end-stage kidney disease. This study aims to shed light on the micronutrient status of diabetic patients and its effect on DFU, particularly, the association between vitamin B12 deficiency and DFU. Methodology This retrospective case-control study included adults in Buraydah who were at least 18 years old and had type 2 diabetes mellitus. Data were obtained from the electronic files of the patients who visited the diabetes center from January 2018 to August 2023 and were analyzed using SPSS version 27.0.1 (IBM Corp., Armonk, NY, USA). Results The research involved 221 participants, with 114 controls (individuals with diabetes but no DFU), and 107 cases (individuals with diabetes affected by DFU). Vitamin B12 levels varied, with 79.2% falling within the normal range of 187-883 pg/mL. The average age of cases (58.5 years, SD = 11.3) was notably higher than that of controls (54.1 years, SD = 14.1). Glycated hemoglobin levels were significantly higher in cases (8.7, SD = 2.0) compared to controls (7.6, SD = 2.2) (p < 0.001). Regarding physical activity, cases showed a significantly higher percentage of inactivity (62.1%) compared to controls (39.1%) (p = 0.046). Neuropathy exhibited a significant association with ulcer development, with 59.1% of cases having neuropathy compared to 23.5% of controls (p < 0.001). Furthermore, complications such as dry foot and fissures (60.0% vs. 6.3%), Charcot joint (36.8% vs. 12.2%), and foot trauma (40.9% vs. 3.9%) were significantly more prevalent in cases compared to controls (p < 0.001 for all). Conclusions The significant associations observed with advanced age, uncontrolled diabetes, longer diabetes duration, neuropathy, and specific foot complications underscore the multifactorial nature of ulcer development. The normal levels of vitamin B12 in most patients reflect no positive impact of normalized vitamin B12 levels on DFU. However, further observational studies with multiple vitamin B12 readings over a longer period are needed to establish its association with DFU development.

Levels and predictors of nurses' knowledge about diabetes care and management: disparity between perceived and actual knowledge

BACKGROUND

Nurses have a crucial role in managing, educating, and caring for diabetic patients. However, their knowledge should be regularly assessed to avoid preventable complications and reduce costs. Therefore, the present study assessed the perceived and actual knowledge about diabetes among nurses in Hail province of Saudi Arabia and investigated predictors of such knowledge.

METHODS

A cross-sectional study was conducted among 325 conveniently sampled nurses from all public hospitals and primary healthcare centres in Hail province from September to December 2022. A pre-designed questionnaire was used to collect demographic and practice-related characteristics of the nurses. In addition, data on nurses' perceived and actual knowledge about diabetes were collected using the Diabetes Self-Report Tool (DSRT) and Diabetes Basic Knowledge Tool (DBKT) self-report questionnaires, respectively. The mean knowledge scores for demographic and practice-related variables were compared using the independent-samples t-test and one-way analysis of variance. Multiple linear regression was used to identify significant predictors of perceived and actual knowledge. The correlation between perceived and actual knowledge was investigated using Pearson's correlation coefficient. A P-value ˂0.05 was considered statistically significant.

RESULTS

Based on a highest maximum score of 60 using the DSRT, the mean score of perceived knowledge was 38.4 ± 12.0, corresponding to a percentage mean score of 64%. On the other hand, based on a highest maximum score of 49 using the DBKT, the mean score of actual knowledge was 23.2 ± 9.6, corresponding to a percentage mean score of 47.3% of correct responses. Being Indian, having a diploma or a bachelor's degree, and having a poor or fair self-perception of competence in diabetes care were predictors of lower perceived knowledge scores, whereas having no access to diabetes guidelines was a predictor of higher scores. However, being non-Saudi and having experience of at least 16 years were predictors of higher actual knowledge scores. The correlation between actual and perceived knowledge about diabetes was negligible and statistically non-significant (r = 0.011, P = 0.055).

CONCLUSION

Nurses affiliated with public health facilities in Hail province lack adequate knowledge about diabetes, with no correlation between what is perceived to be known and what is actually known. Indian citizenship, having a diploma or bachelor's degree, not having access to diabetes guidelines, not attending courses/workshops, and having a poor or fair self-perception of competence in diabetes care can significantly predict nurses' perceived knowledge. However, being non-Saudi (Filipino or Indian) and having at least 16 years of experience can significantly predict their actual knowledge of diabetes.

Knowledge, attitude, and practice of primary care physicians for pretravel counseling for type 2 diabetes patients in Jazan Region, Kingdom of Saudi Arabia

Background and Objective

Pretravel advice given by the primary healthcare (PHC) physicians is of vital importance to diabetic patients to maintain their glycemic status during their travel as many of them are not aware of the risks of travel on their health status. Our objective was to assess the status of pretravel counseling for type 2 diabetic patients (knowledge, attitude, and practice) in Jazan Region, Kingdom of Saudi Arabia (KSA) among the PHC physicians.

Materials and Methods

A cross-sectional study was carried out among a sample of PHC physicians working at the PHC centers in Jazan Region, KSA. The data were collected using a validated self-administered questionnaire.

Results

The study included 250 PHC physicians. The age of 45.2% of them ranged between 30 and 39 years, and males represented 56.2% of them. Overall, the knowledge score ranged between 0 and 10 with a median (interquartile range [IQR]) of 6 (5-7). Physicians aged 40-49 years (P < 0.001), non-Saudis (P = 0.005), and more experienced physicians (>15 years) (P < 0.001) were more knowledgeable than their counterparts. The attitude score ranged between 6 and 30 with a median (IQR) of 25 (22-27). Saudi physicians were more likely than non-Saudis to have more positive attitude toward pretravel counseling for diabetic patients (P = 0.007). The practice score ranged between 1 and 13 with a median (IQR) of 6 (5-8).

Conclusion

The PHC physicians in Jazan Region, KSA, had a moderate level of knowledge and practice as well as encouraging attitude concerning pretravel counseling for type 2 diabetic patients. However, their knowledge and attitude from one side were not associated with their practice from the other side.

A case series of autologous platelet-rich plasma injection in treating chronic ulcers conducted in Saudi Arabia

Objective

This is a case series study of 14 cases of chronic unhealed ulcers involving patients of 19-85 years, aimed to demonstrate the positive therapeutic outcomes of using autologous platelet rich plasma (PRP) in diabetic foot ulcer (DFU) and other chronic wound healing.

Methods

This is a formal consecutive clinical case series. Patients with chronic unhealed ulcers were enrolled from the amputation prevention clinic by an interdisciplinary team includes podiatrist, general surgeon, orthopedic, vascular surgeon, and wound care nurses at Kahel Specialized Centre, a specialized center for managing foot and ankle diseases, located in Riyadh, Saudi Arabia. Those patients who presented with chronic wounds and showed no significant wound reduction despite following the standard wound care protocol were included in the study. There were no specific predetermined exclusion criteria when considering patients for treatment with this modality.

Results

In this case series, majority (80%) of the patients were above 50 years of age, and 10 (66.7%) patients were male and 5 (33.3%) were female. Of all the cases presented to the amputation prevention clinic, majority (73.3%) reported suffering from type 2 diabetes mellitus (DM) and also, one reported type 1 DM [6.7%]). All the cases of DFU received a combination of hydrogel and autologous PRP treatment and were put of suitable offloading devices, except one case received a combination of Cadexomer iodine, hydrogel and PRP treatment. In the present case series involving 3-14 weeks of the treatment duration, only 2-3 doses of autologous PRP provided complete healing and or maximum wound closure.

Conclusion

Autologous PRP therapy is efficacious in facilitating, enhancing wound healing and aids in complete wound closure. This case series was limited in term of the sample size which is the number patients enrolled for the study, hence, the study finding remain inconclusive to some extent and hence, further study is required with greater number of sample size. The strength of this study is that it is the first study in Saudi Arabia and gulf region, to report the beneficial effect of PRP in chronic unhealed ulcers including diabetic ulcers.

The contribution of gastrointestinal microbiota in the existence of type 2 diabetes in Saudi Arabia: Current information and perspectives

Diabetes mellitus (DM) is a genuine international health issue, with Saudi Arabia ranking among the top nations with the largest diabetes prevalence. Following the International Diabetes Federation (IDF), 3.8 million Saudi Arabian people had diabetes in 2014. The occurrence of diabetes in Saudi Arabia is likely to elevate due to the current trend in the general rise of socio-economic status, which positively correlates with diabetes prevalence. The incidence of Type 2 diabetes (T2D) is highest within the age group ≥ 45 years, especially in Riyadh and Jeddah, the metro cities of Saudi Arabia. Previous studies have shown that the incidence of T2D is larger in urban regions (25.5%) than in rural regions (19.5%). Both Riyadh and Jeddah are urban areas with different food habits and locations in Saudi Arabia. Recent studies have indicated the correlation between altered alimentary tract microbiota with type 2 diabetes. Gut microbiota plays a critical role in degrading undigested dietary compounds and releasing a vast array of metabolites that directly and indirectly affects host health. In the current review, we shed light on the state of information on the realization of the types and functions of the alimentary tract microbiome and how it plays a causative agent in the up growth of T2D.

A systematic review of factors associated with uncontrolled diabetes and meta-analysis of its prevalence in Saudi Arabia since 2006

The study aims to systematically review the literature for risk factors associated with poor glycaemic control among type 2 diabetes mellitus (T2DM) patients in Saudi Arabia (SA) and conducts a meta-analysis of its prevalence. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, we searched the Scopus, PubMed, PsycINFO, Web of Science, and CINAHL Plus databases from May to November 2018. The search terms were T2DM, glycaemic control, and SA. The inclusion criteria include the following: observational studies which were conducted in T2DM patients in SA reporting prevalence or/and personal, psychological or behavioural predictors in papers published after 2006. Articles were assessed using a modified Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) tool. Studies included in the meta-analysis defined uncontrolled T2DM as glycated haemoglobin ≥7% (53 mmol/mol), and reported results were based on a random-effects model. Eighteen of the following articles (3 retrospective cohort studies, 1 case-control study, and 14 cross-sectional studies) were included. The quality of the studies (high: 2; moderate: 7, and low: 9) varied. The pooled prevalence of uncontrolled T2DM in SA was 77.7% (95% CI, 71.2-84.2). In the included studies, the most consistent predictors of poor glycaemic control were longer diabetes duration, lack of self-efficacy, and low knowledge of diabetes. However, significant variations in research designs were observed across the studies. A national diabetes prevention and treatment program is needed to lessen the burden of diabetes in SA. Future studies should address the personal, psychological, and behavioural factors of poor glycaemic control in SA at national level.

Selenoprotein W deficiency does not affect oxidative stress and insulin sensitivity in the skeletal muscle of high-fat diet-fed obese mice

Selenoprotein W (SelW) is a selenium-containing protein with a redox motif found abundantly in the skeletal muscle of rodents. Previous in vitro studies suggest that SelW plays an antioxidant role; however, relatively few in vivo studies have addressed the antioxidant role of SelW. Since oxidative stress is a causative factor for the development of insulin resistance in obese subjects, we hypothesized that if SelW plays a role as an antioxidant, SelW deficiency could aggravate the oxidative stress and insulin resistance caused by a high-fat diet. SelW deficiency did not affect insulin sensitivity and H₂O₂ levels in the skeletal muscle of control diet-fed mice. SelW levels in the skeletal muscle were decreased by high-fat diet feeding for 12 wk. High-fat diet induced obesity and insulin resistance and increased the levels of H₂O₂ and oxidative stress makers, which were not affected by SelW deficiency. High-fat diet feeding increased the expression of antioxidant enzymes; however, SelW deficiency did not affect the expression levels of antioxidants. These results suggest that SelW does not play a protective role against oxidative stress and insulin resistance in the skeletal muscle of high-fat diet-fed obese mice.

Lifestyle factors and macro- and micro-vascular complications among people with type 2 diabetes in Saudi Arabia

AIMS

The aim of this study is to identify lifestyle factors that place people with type 2 diabetes in Saudi Arabia at a greater risk of macro- and microvascular complications.

METHODS

A survey was conducted among adults with type 2 diabetes who attended diabetes centres in three major cities in Saudi Arabia. Participants were interviewed and their medical files were reviewed for lab test results and documented comorbidities. Associations between complication and lifestyle factors were assessed using multiple logistic regression analysis.

RESULTS

A total of 1121 participants were recruited. Mean age was 57.6 (±11.1) years. The prevalence of coronary artery disease, diabetic foot, and stroke was 17.0%, 13.1% and 3.7%, and that of neuropathy, renal impairment, and retinopathy was 20.3%, 14.5%, and 42.8% respectively. Lifestyle factors associated with one or more of the complications were inadequate physical activity, longer sitting time, obesity, current or past smoking, passive smoking, hypertension, poor glycaemic control, low HDL and high triglycerides.

CONCLUSIONS

Diabetes complications are common among people with type 2 diabetes in Saudi Arabia. Life style factors such as inadequate physical activity, longer sitting time, obesity, smoking, hypertension, and poor control of blood glucose and lipids should be assimilated into complications prevention program.

Incidence and prevalence rates of diabetes mellitus in Saudi Arabia: An overview

Objective: This study aimed to report on the trends in incidence and prevalence rates of diabetes mellitus in Saudi Arabia over the last 25 years (1990–2015).

Design: A descriptive review.

Methods: A systematic search was conducted for English-language, peer reviewed publications of any research design via Medline, EBSCO, PubMed and Scopus from 1990 to 2015. Of 106 articles retrieved, after removal of duplicates and quality appraisal, 8 studies were included in the review and synthesised based on study characteristics, design and findings.

Findings: Studies originated from Saudi Arabia and applied a variety of research designs and tools to diagnosis diabetes. Of the 8 included studies; three reported type 1 diabetes and five on type 2 diabetes. Overall, findings indicated that the incidence and prevalence rate of diabetes is rising particularly among females, older children/adolescent and in urban areas.

Conclusion: Further development are required to assess the health intervention, polices, guidelines, self-management programs in Saudi Arabia.

Association between the physical activity level and the quality of life of patients with type 2 diabetes mellitus

[Purpose] Physical activity and regular exercise play an important role in glycemic control, which is considered an important part of the treatment of type 2 diabetes mellitus. This study evaluated physical activity level and its relationship with quality of life in patients with type 2 diabetes mellitus. [Subjects and Methods] We evaluated 129 subjects with type 2 diabetes mellitus through a face-to-face interview using the short version of the International Physical Activity Questionnaire and Diabetes-39. Demographic data, diabetes symptoms, time of initial diagnosis, and treatment procedure/approaches were recorded. [Results] Of the study subjects, 51 (39.5%) had low, 67 had moderate (51.9%), and 11 (8.5%) had high activity levels. The mean weekly sitting duration was 302 minutes. The mean weekly walking time was 231.7 minutes. Except for the "diabetes control" domain, scores for all the subgroups and the total score in the quality-of-life assessment had a statistically significant negative correlation with physical activity level. [Discussion] Physical inactivity negatively affects the quality of life of diabetic patients. A planned exercise education program and incorporation of exercise into the lifestyle can improve the quality of life of patients with type 2 diabetes mellitus.

Effects of exercise on glycemic control in type 2 diabetes mellitus in Koreans: the fifth Korea National Health and Nutrition Examination Survey (KNHANES V)

[Purpose] The aim of this study was to investigate the effect of exercise on glycemic control using data from fifth Korea National Health and Nutrition Examination Survey and to provide appropriate exercise guidelines for patients with type 2 diabetes mellitus in Korea. [Subjects and Methods] We selected 1,328 patients from the fifth Korea National Health and Nutrition Examination Survey database who had type 2 diabetes and ranged in age from 30 to 90 years. Statistical analyses included χ(2) tests, multiple linear regression, and logistic regression. [Results] Factors found to be significantly related to glycemic control included income level, physical activity based on intensity of aerobic exercise, use of diabetes medicine, presence of hypertension, duration of diabetes, and waist circumference. In addition, engaging in combined low- and moderate-intensity aerobic exercise when adjusted for resistance exercise was found to lower the risk of glycemic control failure. [Conclusion] Patients with type 2 diabetes mellitus in Korea should engage in combined low- and moderate-intensity aerobic exercise such as walking for 30 minutes or more five times a week. Physical activity is likely to improve glycemic control and thus prevent the acute and chronic complications of diabetes mellitus.