Khalid Al-Rubeaan

Objectives The aim of the global DISCOVERing Treatment Reality of Type 2 Diabetes in Real World Settings (DISCOVER) Study was to provide a comprehensive real world assessment of the treatment pattern changes for patients with type 2 diabetes. The aim of this analysis was to assess the metabolic control and the annual incidence of hypoglycaemia, hospitalisation and complications among Saudi patients with type 2 diabetes initiating second-line therapy. Design This study is part of the observational, longitudinal, prospective multinational DISCOVER Study. Setting Governmental and private health sectors from different regions within Saudi Arabia. Participants The study recruited 519 patients with type 2 diabetes aged ≥18 years who were switching to second-line therapy. Patients who were already using insulin/injectable agents, patients with type 1 diabetes, pregnant women, and patients undergoing dialysis or with a history of renal transplantation were excluded. Primary and secondary outcome measures Metabolic control among patients with type 2 diabetes mellitus; fear of hypoglycaemia; quality of life; and the incidence of complications, hypoglycaemic events and/or hospitalisations. Data were analysed using descriptive statistics. Results A total of 519 patients were recruited with a mean age of 52.4±11 years. Of these participants, 54.7% were male and 45.3% were female. The incidence of hypoglycaemia was 56.72/1000 patient-years. The Hypoglycemia Fear Survey II showed a significant increase in patient worry related to hypoglycaemia from 6.4±11.9 at baseline to (p=0.0446) at the 36-month follow-up. The incidence of hospitalisation was 30.81/1000 patient-years. There was a moderate improvement in glycaemic control, represented as an HbA1c reduction from 8.8% at baseline to 8.2% at the 36-month follow-up. The incidence of macroangiopathy was 24.51/1000 patient-years and the incidence of microvascular complications such as retinopathy and albuminuria was 47.00/1000 patient-years and 221.71/1000 patient-years, respectively. The mean score of fear of hypoglycaemia showed an increase with 13.0±21.5 at baseline to 16.1±22.2 at the 36-month follow-up. When assessing the patients’ quality of life, there was an improvement in the mental component score from 47.4±9.1 at baseline to 53.0±6.7 at the 36-month follow-up. Conclusions Treatment intensification decisions should be made individually, weighing the benefit of good glycaemic control against the risk of hypoglycaemia. Trial registration number NCT02322762 and NCT02226822.

Objectives: Patients with type 2 diabetes nowadays have a wide range of new antidiabetic medications with better efficacy and safety. Physicians’ attitude toward selecting antidiabetic medications to reach targeted glycemic control and better quality-of-life (QOL) has not been studied prospectively. The global DISCOVER study aims to comprehensively provide a real-world assessment of the treatment pattern changes for patients with type 2 diabetes, in addition to QOL assessment. The Kingdom of Saudi Arabia was one of the countries participating in the DISCOVER study program. Methods: This study is a part of the prospective, longitudinal multinational DISCOVER study conducted in 38 countries including Saudi Arabia, a country facing an epidemic of type 2 diabetes, recruited 519 adult patients with type 2 diabetes with a mean age of 52.4 ± 11 years, where, they were followed up for three years period, where 477 patients completed the follow-up period. The clinical, biochemical, and patient lifestyle data were assessed periodically during the study period. DISCOVER study is registered with ClinicalTrials.gov identifiers: NCT02322762. Results: The most frequently used antidiabetic medications (ADMs) initially and during the follow-up were biguanides (metformin) and sulfonylureas (gliclazide, glibenclamide, glimepiride, glipizide, and glyclopyramide). Insulin (premix Insulin, basal insulin, and basal/bolus insulin) and dipeptidyl peptidase-4 (DPP-4) inhibitors (sitagliptin, vildagliptin, saxagliptin, and linagliptin) were the most frequent second and alternative of therapy. Other medications namely thiazolidinediones (TZds) (pioglitazone and rosiglitazone), incretins (exenatide and liraglutide), and Sodium-glucose co-transporter-2 (SGLT-2) inhibitors (canagliflozin) were used at a lesser rate. Drug availability, efficacy, and safety were the main determinants for choosing antidiabetic medications. The physical component score of the QOL had shown a significant decrease, while the mental component score has demonstrated an increase in QOL using SF36v2 Survey. Conclusions: There is an increasing trend of using of newly available ADMs, mainly DPP-4 inhibitors. The major limitation of ADMs use is related to efficacy, availability, and safety. This warrant taking all the measures to overcome these limitations through adopting a multidisciplinary team approach for close monitoring of the patients and any unfavorable side effects. Additionally, global insurance coverage for all patients with type 2 diabetes could be a solution for the drug availability factor.

The management of patients with type 2 diabetes is a complex process that must be individualized and be patient centered. The aim of this study was to assess the metabolic control, the annual incidence and crude prevalence of hypoglycemia, hospitalization, and complications among patients with type 2 diabetes initiating second-line therapy. This study is an observational, longitudinal, prospective study as a part of the multinational DISCOVERing Treatment Reality of Type 2 Diabetes in Real World Settings (DISCOVER) study, that recruited 519 patients with type 2 diabetes who were non-insulin users, aged ≥18 years, and switching to second-line therapy. The cohort was clinically evaluated over three years of follow up. Fear of hypoglycemia was assessed using the Hypoglycemia Fear Survey (HFS II), while the quality of life was assessed using SF36v2 questionnaire. Using second-line therapy improved metabolic control but the annual incidence of microangiopathies were at 61/1000 patient-years, 47/1000 patient-years, and 4/1000 patient-years for neuropathy, retinopathy, and nephropathy, respectively. The incidence of hypoglycemia was 57/1000 patient-years, where 50% were recurrent during the three-years period. The HFS II showed a significant increase in patients’ worries related to hypoglycemia. The incidence of hospitalization was 31/1000 patient-years, out of which 8/1000 patient-years were related to cardiovascular events, mainly myocardial infarction. Moderate metabolic control was associated with lower incidence of macro angiopathy and an increased incidence and fear of hypoglycemia, while it was associated with improved mental component score when assessing the patients’ quality of life. The treating physician’s decision of treatment intensification should be individualized with consideration of befits of good glycemic control versus the risk of hypoglycemia, especially in elderly patients.

BACKGROUND: Hearing loss is an underestimated comorbid condition in type 2 diabetes. OBJECTIVES: Investigate hearing loss as a comorbidity associated with type 2 diabetes mellitus and evaluate the factors associated with hearing loss. DESIGN: Cross-sectional. SETTING: Tertiary care center, diabetes clinic. PATIENTS AND METHODS: Patients with type 2 diabetes, aged 30 to 60 years, were randomly selected to participate. All patients underwent clinical ear examinations and were referred for full audiological evaluation. Otoacoustic emission was used to assess inner function, tympanometry to assess middle-ear function, and pure tone air/bone audiometry to assess hearing sensitivity. Risk factors for hearing loss were assessed by multivariate logistic regression. MAIN OUTCOME MEASURE: Frequency, severity and risk factors for hearing loss. SAMPLE SIZE: 157 RESULTS: Of the 157 patients, 77 had hearing loss in both ears (49.0%), 13 in the right ear only (8.3%), 14 in the left ear only (8.9%), and 53 (33.8%) had normal hearing. In the 181 ears with sensorineural hearing loss, 90 had mild loss (49.7%), 69 moderate loss (38.2%), 16 severe loss (8.8%) and 6 had profound loss (3.3%). Disabling hearing loss was observed in 46 (29%) patients. A higher frequency of hearing loss was present in patients with glycated hemoglobin levels ≥8%. In the multivariate logistic regression analysis, the most important factors associated with hearing loss were longer diabetes duration, poor glycemic control and the presence of hypertension. CONCLUSIONS: Hearing loss is an underestimated comorbid condition in type 2 diabetes that warrants frequent hearing assessments and management. Strict glycemic and hypertension control is essential for the minimization of the effects of diabetes on hearing sensitivity. LIMITATIONS: Small sample size, limited age window (30-60 years), which was chosen to eliminate the natural aging effect on hearing. Cross-sectional nature was not ideal for the assessment of causality. CONFLICT OF INTEREST: None.

Hormonal transition among middle-aged women with type 2 diabetes may exert an impact in the development of diabetic retinopathy (DR). In this cross-sectional study, we aimed to assess the levels of estradiol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) in the presence of DR and their relationship with risk factors for DR among pre- and post-menopausal women with type 2 diabetes. Serum levels of estradiol, FSH, and LH were measured using the immunoassay technique. All statistical analysis was performed using SPSS software. From the 255 participants, diabetes duration-matched, 35 premenopausal, and 57 postmenopausal women were selected for analysis. The levels of estradiol, LH, and FSH were found to be similar in participants with and without DR among pre- and post-menopausal women with diabetes. Estradiol level was not found to be related with the risk factors of DR among women with type 2 diabetes. In conclusion, female sex hormone, estradiol is not related to the presence of DR. Further prospective studies are necessary to reveal the mechanistic role of this hormone in the development of DR.

Objectives: The DISCOVER study is a global, prospective, three- year- observational (non-interventional) study that was conducted in 37 countries throughout the world including Saudi Arabia and aimed to assess variations in treatment patterns and therapeutic outcomes in type 2 diabetic patients. The current manuscript is reporting data of DISCOVER study across different health sectors of various provinces in the Kingdom of Saudi Arabia. Methods: In this study, 519 Saudi type 2 diabetics, non-insulin users, aged 18 years or older, initiating second line therapy, were selected from nine health institutes, in four out of five provinces in Saudi Arabia. Data was collected at baseline (initiation of 2^nd line therapy) by the treating physician using an electronic case report form (eCRF) via a web-based data capture system. Each selected subject was asked to complete four self-administered questionnaires. Results: The mean age of the studied population was mean age 52.4±11 years. Among the subjects selected from the nine medical centers, 55% were men, with almost 65% between the ages of 46 and 65 years. The oral agent used as 1^st line in the majority of patients was metformin, prescribed in 89.2% of the study cohort. In the second line, sitagliptin was the most frequently used, at 61.8%. gliclazide, glibenclamide, and glimepiride followed, at 35.6%, 13.1%, and 12.7%, respectively. Conclusion: Metformin, with or without sulfonylureas, is the most commonly prescribed first-line treatment for patients with type 2 diabetes, managed either in state institutions, or in the private sector. The most common second line drugs were DPP4 inhibitors, mainly sitagliptin, followed by the third and second generation of sulfonylureas. Drug affordability was not an issue, since the vast majority of the patients received free medication.

Background The importance of uric acid has been increasingly appreciated because of its association with the development of diabetes mellitus and related diseases. Objective This study was undertaken to evaluate the association of serum uric acid (SUA) level with different clinical and biochemical parameters in patients with type 2 diabetes from Saudi Arabia. Methods Clinical and biochemical data from the patients were obtained and assessed in a cross‐sectional design. Relationships between SUA level and various clinical and biochemical parameters were analyzed. Results SUA level was positively associated with increased incidence of cardiovascular diseases (CVD) in patients with abnormal eGFR (2). HbA1c was found to be inversely associated with hyperuricemia in patients with normal eGFR level (≥90 ml/min/1.73 m²). Incidence of metabolic syndrome did not show any relationship with SUA level. However, the incidence of hypertension, a component of metabolic syndrome, was significantly higher among patients with hyperuricemia. Waist circumference and serum triglycerides were increased, whereas serum high‐density lipoprotein level was decreased in patients with higher SUA level. Patients with hyperuricemia had higher incidence of CVDs than those of the normouricemic group. Conclusion SUA level was positively associated with incidence of cardiovascular diseases CVD in patients with abnormal eGFR. HbA1c correlated significantly with SUA level in patients with normal eGFR. Incidence of metabolic syndrome did not show any association with SUA level. Incidence of hypertension, waist circumference, and serum triglycerides were significantly higher and serum high‐density lipoprotein level was lower in patients with hyperuricemia.

Aim: To investigate the pathophysiological role of different biomarkers in diabetic kidney disease (DKD) among normoalbuminuric patients with a low-estimated glomerular filtration rate (eGFR). Meth...

OBJECTIVE: Hyperglycemia has an effect on all body tissues; one of them is the bone marrow. This effect is related to protein glycation and other chemical and physiological changes of red blood cells (RBCs). The aim of this study was to assess the effect of hyperglycemia on different RBCs indices along with evaluating these changes in the normal physiology and chronic diabetes complication pathology. PATIENTS AND METHODS: This is a cross-sectional hospital-based study of 1000 type 2 Saudi diabetic patients without any hematological diseases. Patients were fully evaluated clinically and biochemically with full blood hematological parameters assessment. The studied cohort matched the general characteristics of Saudi type 2 diabetic patients. RESULTS: This study shows that hyperglycemia increases the red blood cells count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC). Red blood cell distribution width (RDW) was negatively correlated with poor glycemic control. Concurrently, the presence of micro and macroangiopathies with hyperglycemia shortens the lifespan of RBCs. CONCLUSIONS: We conclude that hyperglycemia has an imposing effect on RBCs count and its physiological function, which can be normalized effectively with good glycemic control.