Bachar Afandi

Assessment of dietary practice among diabetic patients in the United arab emirates.

OBJECTIVES The aim of this study was to assess dietary practices and risk profile (hypertension, obesity, lipid profile and glycemic control) among people with diabetes in Al-Ain District, United Arab Emirates (UAE). METHODS During 2006, we performed a cross-sectional study of diabetic patients attending diabetic outpatient clinics at Tawam Hospital and primary health care centers in Al-Ain District. Subjects completed an interviewer-administered questionnaire, blood pressure, body mass index, percentage body fat and abdominal circumference were measured and recorded and the most recent HbA1c levels and fasting lipid profile were identified. RESULTS A sample of 409 diabetic patients was recruited, 50% of whom were illiterate. Only 24% read food labeling. 76% reported being unable to distinguish clearly between low and high carbohydrate index food items and no one reported counting calorie intake. 46% reported that they had never been seen by dietician since their diagnosis. Their overall risk profile, notably body weight, lipid profile and blood pressure, was very unfavorable; more than half of the study sample had uncontrolled hypertension and uncontrolled lipid profile and the majority was overweight (36%) or obese (45%). Abdominal obesity was particularly common (59%). Only 31% had an HbA1c of less than 7%. CONCLUSIONS The dietary practices of diabetic patients in the UAE are inadequate and need improvement.

Physical Activity and Reported Barriers to Activity Among Type 2 Diabetic Patients in the United Arab Emirates

OBJECTIVES This study was designed to assess the physical activity practice among type 2 diabetic patients in the United Arab Emirates (UAE). METHODS This is a cross-sectional study of type 2 diabetic patients who participated in the outpatient clinics in Al-Ain District, during 2006. The patients completed an interviewer-administered questionnaire, and measurements of blood pressure, body mass index, body fat, abdominal circumference, glycemic control (HbA1c), and fasting lipid profile. RESULTS Of the 390 patients recruited, only 25% reported an increase in their physical activity levels following the diagnosis of diabetes, and only 3% reported physical activity levels that meet the recommended guidelines. More than half of the study subjects had uncontrolled hypertension (53%) and unacceptable lipid profiles; 71% had a high low-density lipoprotein (LDL), 73% had low high-density lipoprotein (HDL), and 59% had hypertriglyceridemia. Forty-four percent were obese and a further 34% were overweight. Abdominal obesity was also common (59%). Only 32% had an acceptable glycemic control. CONCLUSIONS The physical activity practice of type 2 diabetic patients in the UAE is largely inadequate to meet the recommended level necessary to prevent or ameliorate diabetic complications. Interventions aiming at overcoming the barriers to physical activity are urgently needed.

Cushing's syndrome caused by unsupervised use of ocular glucocorticoids.

OBJECTIVE To report a case of Cushings syndrome in an adult patient caused by prolonged and unsupervised use of glucocorticoid ocular drops. METHODS We present the clinical and laboratory findings and describe the clinical course of our patient. RESULTS A 33-year-old man with extensive ophthalmologic complaints and procedures, who had used glucocorticoid ocular drops for an extended period, was referred to the endocrinologist for new onset of type 2 diabetes mellitus. Clinically, the patient appeared cushingoid with a buffalo hump, thin skin, bruises, and purple striae, and his blood pressure was 130/90 mm Hg. Laboratory evaluation revealed a very low serum cortisol level with a concomitantly low-normal level of adrenocorticotropic hormone (corticotropin). In addition, the response to a corticotropin stimulation test was abnormal, an indication of suppression of the adrenal glands. After the patient discontinued the use of the glucocorticoid eyedrops, his cushingoid features gradually faded, and his blood pressure and serum glucose levels normalized. CONCLUSION Prolonged unsupervised use of glucocorticoid ocular drops may result in Cushings syndrome and its numerous associated complications. Physicians and pharmacists should be aware of this possibility and must educate patients about the potentially serious adverse effects of such use.

Screening strategy for type 2 diabetes in the United Arab Emirates.

The prevalence of type 2 diabetes mellitus (DM) among Emirati nationals is one of the highest in the world. The recently released United Arab Emirates National DM guidelines call for screening all adults aged 30 years and more. The authors explored the need for such a modification of current American Diabetes Association (ADA) guidelines. They also considered the prevalence rates for undiagnosed DM based on oral glucose tolerance test (OGTT) versus glycohemoglobin (HbA 1c) ≥ 6.5% in a population-based sample of 296 adult Emirati participants. In the low-risk ADA category, defined by age <45 years and BMI <25, only 1 of 68 (1.5%) participants was diagnosed with DM. The overall rate of DM based on HbA1c was lower than that based on OGTT (10.1% versus 14.2%; P < .05). The authors conclude that the ADA guidelines are adequate for screening in this high-risk population. They also find high discordance between HbA1c and OGTT.

Prevalence and Determinants of Peripheral Neuropathy in Patients with Type 2 Diabetes Attending a Tertiary Care Center in the United Arab Emirates

Objective: This study was designed to estimate prevalence and identify relevant determinants of peripheral neuropathy in patients >18 years old with type 2 diabetes mellitus of at least 12 months. Methods: Adults with type 2 diabetes mellitus (394 patients, age = 57 ± 12 yr, 67% females, duration of diabetes = 10.9 ± 7.9 yr) were randomly selected from the Diabetes Center at Tawam Hospital (Al Ain City, United Arab Emirates). The Michigan Neuropathy Screening Instrument (MNSI) history and sign scores were used to assess neuropathy. Stepwise logistic regression analysis was used to assess independent predictors of peripheral neuropathy on the Michigan score. Results: Prevalence of peripheral neuropathy was 10.4% based on the MNSI-history score of ≥7 and 25.6% based on the MNSI-sign score of ≥ 3. Logistic regression analysis revealed that HbA1c [OR=3.41, 95% CI; 1.15– 10.16] and physical activity [OR=4.99, 95% CI; 2.21–11.29] were significant predictors of the MNSI-history score. Age [OR=1.06, 95% CI; 1.03–1.09], height [OR=1.06, 95% CI; 1.02–1.10], systolic blood pressure [OR=1.03, 95% CI; 1.01–1.06] and duration of diabetes [OR=1.08, 95% CI; 1.04–1.13] were significant predictors of the MNSI-sign score. Conclusion: Peripheral neuropathy was common in the studied diabetic patients and was associated with modifiable risk factors, such as glycemic control, blood pressure control and physical activity.

Peripheral Artery Disease in Type 2 Diabetic Patients from the United Arab Emirates

Objectives: Peripheral Artery Disease (PAD) is common in patients with diabetes. Frequently, this complication is only recognized when the symptoms and signs are advanced. This study assessed its prevalence and associated risk factors in patients with type 2 diabetes mellitus who reside in the United Arab Emirates. The main purpose of the study was to identify potential disease modifiers that could be included in diabetic education programs. Methods: This prospective, cross-sectional study assessed PAD in 394 patients with type 2 diabetes mellitus. Each patient was investigated by history, physical examination and measurements of the ankle-brachial index (ABI) by bidirectional doppler. Results: Patients’ mean (±SD) age was 54 (±12) years and duration of diabetes 10 (±8) years. There were 264 females (67%). HbA1c was ≥7% in 247 (65%) patients, claudication present in 166 (42%) patients, reduced capillary refill time in 69 (17%) patients, retinopathy in 50 (13%) patients, and absent pulse in 20 (5%) patients. ABI was ≤1.0 in 149 (39%) patients (probable PAD) and <0.9 in 33 (9%) patients (significant PAD). Current smoking [odds ratio (OR)=3.9; confidence intervals (CI)=1.5-10.3; p-value=0.007], percent HbA1c (OR=3.4; CI=1.2-10.2; p-value=0.028) and hypertension on examination (OR=1.6; CI=1.0-2.6; p-value=0.041) were significant predictors of ABI ≤1.0. Current smoking (OR=3.7; CI=1.2-10.8; p-value=0.019) was significant predictor of ABI <0.9. Conclusions: These results confirm the deleterious effects of smoking on diabetes-association PAD. Thus, diabetic patients should be engaged in effective smoking prevention programs. Other modifiable interventions are controlling hyperglycemia and hypertension. Patients with abnormal ABI (especially <0.9) should have stringent risk assessments and be started on an individualized risk-reduction program.

Comparison of continuous glucose monitoring in adolescents with type 1 diabetes: Ramadan versus non-Ramadan

AIM To assess the impact of fasting on interstitial glucose (IG) in adolescents with type 1 DM (T1DM) by using continuous glucose monitoring (CGM). METHOD A minimum of 2.5 days CGM was done on adolescents with T1DM during fasting in Ramadan and in the month before or after Ramadan to compare the differences in mean IG, and in the durations of hypoglycemia (<70 mg/dL), hyperglycemia (200-299 mg/dL), and severe hyperglycemia (≥300 mg/dL). RESULTS Fourteen adolescents were studied, age 15 ± 4 years, duration of diabetes 6 ± 4 years, and HbA1C 8.6 ± 1.1% (70.3 mmol/mol). There was no difference in the mean IG (190 ± 39 and 180 ± 37, p= 0.4), or in the durations of hypoglycemia (5.14 ± 5% and 7.03 ± 4.9%, p=0.3), hyperglycemia (25.35 ± 11.3% and 24.24 ± 10.1% (P=0.7)), and severe hyperglycemia (13.21 ± 13.4% and 10.96 ± 10.6%, P=0.6), between Ramadan and, non-Ramadan, respectively. CONCLUSION Adolescents with T1DM have the same wide fluctuation in IG during fasting in Ramadan as they do outside Ramadan. Insulin regimen adjustment should be targeting both extremes of glucose abnormality.

Diabesity in the Arabian Gulf: Challenges and Opportunities

Diabesity (diabetes associated with obesity) is a major global and local public health concern, which has almost reached an epidemic order of magnitude in the countries of the Arabian Gulf and worldwide. We sought to review the lifestyle trends in this region and to highlight the challenges and opportunities that health care professionals face and attempt to address and correct them. In this regard, we aimed to review the regional data and widely held expert opinions in the Arabian Gulf and provide a thematic review of the size of the problem of diabesity and its risk factors, challenges, and opportunities. We also wished to delineate the barriers to health promotion, disease prevention, and identify social customs contributing to these challenges. Lastly, we wished to address specific problems with particular relevance to the region such as minimal exercise and unhealthy nutrition, concerns during pregnancy, the subject of childhood obesity, the impact of Ramadan fasting, and the expanding role of bariatric surgery. Finally, general recommendations for prevention, evidence-based, and culturally competent management strategies are presented to be considered at the levels of the individual, community, and policymakers.

Rate, Timing, and Severity of hypoglycemia in adolescents with Type 1 diabetes during ramadan fasting: A study with freestyle libre flash glucose monitoring system

Objectives: The objective of this study is to assess the frequency, timing, and severity of hypoglycemia in adolescents with type 1 diabetes mellitus (T1DM) during fasting the month of Ramadan. Patients and Methods: Twenty-five adolescents with T1DM who fasted Ramadan were monitored using the FreeStyle Libre® flash glucose monitoring (FGM) system. Percentage and total duration of hypoglycemia were extracted from the FGM downloads, and the differences were compared between different times of the day and night according to the eating pattern in Ramadan. Results: Mean age was 16 ± 3 years and mean glycated hemoglobin was 8.6 ± 1.2%, mean glucose level was 200 ± 84 mg/dl (11.1 ± 4.7 mmol/L), and the overall time spent in hypoglycemia was 5.7% ±3.0%. The average daily time spent in hypoglycemia was 1.39 h per patient. The incidence of hypoglycemia was 0% from 19:00 to 23:00 pm and 69% from 11:00 to 19:00. Analysis of hypoglycemia revealed that 65% were between 61 and 70 mg/dl and 8% lower than 50 mg/dl. Conclusions: Hypoglycemia is typically encountered during the hours preceding Iftar time indicating an over-effect of basal insulin. Basal insulin reduction is necessary to minimize the risk of hypoglycemia

Challenges in the management of Type 2 Diabetes among native women in the United Arab Emirates

AIM To investigate Type 2 Diabetes mellitus (T2DM) management in native female patients in the United Arab Emirates (UAE). METHODS Ninety women from the outpatient diabetes clinic at Tawam Hospital, UAE, were interviewed face-to-face about how they manage their disease, using a structured questionnaire. Clinical values of the patients were extracted from medical records. RESULTS The mean age of the women was 57.5 (SD: 12.7) years and half of them were illiterates. Two-third of the participants had hypertension and/or high cholesterol. A majority reported to have received information about lifestyle modification but admitted low physical activity and unhealthy diet. Mean weight and BMI were 80.0 (SD: 17.2) kg and 33.5 (SD: 6.3) kg/m2, respectively. Although the majority were taught how to measure blood glucose, 46% considered self-measurement difficult. Oral antihyperglycemic drugs were used by 96% of participants, and 31% were also taking injections. Forty-nine percent had HbA1c values below 7% and the average was 7.7% (range: 4.9-14.1). Two-third had systolic blood pressure (SBP) and low-density lipoprotein (LDL) values within the target range. CONCLUSION Despite major challenges in T2DM management among native female patients in UAE, this study shows that one in two patients had an overall glycemic control that was acceptable.