Riad A. Sulimani

Diabetes complications in 1952 type 2 diabetes mellitus patients managed in a single institution

BACKGROUND AND OBJECTIVES Because there is no recent update on the state of diabetes and its concomitant complications in Saudi Arabia, we undertook a study of the prevalence of health complications in patients with type 2 diabetes mellitus admitted to our institution. METHODS We conducted a retrospective review of medical records of adult Saudi patients with type 2 diabetes who were seen in clinics or admitted to the Security Forces Hospital, Riyadh, Saudi Arabia, between January 1989 and January 2004. RESULTS Of 1952 patients, 943 (48.3%) were males. For the whole study population the mean age at enrollment was 58.4±14.2 years, the mean age at onset of diabetes was 48.1±12.8 years, the mean duration of diabetes was 10.4±7.5 years, and the mean duration of follow-up was 7.9±4.6 years. Nephropathy was the most prevalent complication, occurring in 626 patients (32.1%). Acute coronary syndrome occurred in 451 (23.1%), cataracts in 447 (22.9%), retinopathy in 326 (16.7%), and myocardial infarction in 279 (14.3%), Doubling of serum creatinine was seen in 250 (12.8%) and 79 (4.0%) went into dialysis. Hypertension was present in 1524 (78.1%) and dyslipidemia in 764 (39.1%). Overall mortality was 8.2%. Multiple complications were frequent. Males had higher prevalence of complications than females (P<.05). Mortality was significantly higher in males 92 (9.8%) than females 69 (6.8%) (P=.024). The prevalence of complications significantly increased with duration of diabetes and age (P<.05). CONCLUSION Among Saudis, the prevalence of concomitant diabetic complications is high, with cardiovascular and renal complications the most frequent. Many patients had multiple complications. Early and frequent screenings in the patients with type 2 diabetes are desirable to identify patients at high risk for concomitant complications and to prevent disabilities.

Diabetes mellitus in Saudi Arabia: The clinical pattern and complications in 1,000 patients.

A retrospective and prospective study of 1,000 ambulatory and hospitalized diabetic patients was done in Riyadh, Saudi Arabia. Saudis completed 777 (77.7%) and non-Saudis 223 (22.3%). Sex distribution was equal among Saudis, males 389 (50.1%) and females 388 (49.9%), but non-Saudi males were predominant at 153 (68.6%), non-Saudi females 70 (31.4%) reflecting the preponderant male expatriate labor force. A proportion of different types of diabetes was: IDDM 115 (11.7%), non-obese non-insulin dependent diabetes mellitus (NIDDM) 405 (41.0%), obese NIDDM 412 (42.1%), and early onset non-insulin dependent diabetes (diagnosis under 30 years of age), 43 (4.4%). Regarding treatment, 388 (40.6%) received insulin followed by sulfonylurea, alone in 330 (33.5%), diet only 117 (12.0%), combination sulfonylurea and biguanide in 113 (11.6%), biguanide alone in 13 (1.3%) and insulin plus tablets in 7 (0.8%). Of 472 and 426 patients, 29.7% and 30.0% had elevated total cholesterol or triglycerides respectively, while 77.2% of 373 patients had elevated glycosylated hemoglobin (HbA1). At least once in 998 patients, diabetic ketoacidosis occurred in 7.6%.

The effect of ramadan fasting on diabetes control in type II diabetic patients

Abstract The effect of Ramadan fasting—defined as abstinence from eating or drinking from dawn till sunset during this lunar month—on the control of diabetes mellitus was studied in 47 type II diabetic patients and in a group of non-diabetic subjects. Body weight, glycosylated hemoglobin were determined before and immediately after Ramadan in both groups while glycosylated protein was also measured in 9 diabetic patients. In the diabetic patients, there was no significant change in their weights 75.2±12.8 vs 74.1±12.4 kgs., P=NS; glycosylated hemoglobin (10.9±3.1% vs 10.5±2.8%, P=NS; glycosylated protein (1.19±0.35 vs 1.17±0.39, P=NS) after the 30 day Ramadan fast. In the non-diabetic controls, there was a statistically significant loss in weight during the Ramadan fast 74.2 ±10.4 kgs. vs 72.5±10.2 kgs., p

The effects of Ramadan fasting on thyroid functions in healthy male subjects

Abstract The effects of Ramadan fasting on thyroid function tests in healthy male subjects were investigated. Plasma thyroxine (T4), Triiodothyronine (T3), thyroid stimulating hormone (TSH) and free T4 levels were determined in 28 healthy male subjects before and at the end of the 30 day Ramadan fast. The effect of short term food deprivation between dawn and sunset was also investigated. There were no significant differences between the morning and evening (after 14 hour fast) values in the thyroid function tests; the respective values (means ± SD) for a.m. and p.m. Plasma T4, T3, free T4 and TSH being 7.1±1.34 μg% and 7.2±1.33 μg%; 1.1±0.17 ng% and 1.1±0.11; 1.1±0.15 ng/dL and 1.1±0.20 ng/dL; 1.9±0.81 mu/ml and 1.4±0.51 mu/ml respectively; P>0.1 for all comparisons. In addition, there was no significant change in the results of the thyroid function tests done before and at the end of Ramadan. The values respectively for plasma T4, T3, free T4 and TSH before and after Ramadan were 7.0±1.08 μg% and 7.1±1.34 μg%; 1.1±0.17 ng/ml and 1.1±17 ng/ml; 1.1±0.21 ng/dL and 1.1±0.15 ng/dL; 1.7±0.62 mu/ml and 1.4±0.81 mu/ml; P>0.1 for all comparisons. It is concluded that Ramadan fasting by healthy adult males did not alter the standard indices of thyroid function.

Vitamin D status correction in Saudi Arabia: an experts’ consensus under the auspices of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases (ESCEO)

BackgroundVitamin D deficiency is common in the Middle East and in Saudi Arabia, in particular. While several international recommendations on the management of vitamin D deficiency have been documented and practiced globally, these recommendations should be adapted to the conditions of the Middle Eastern region. To address this challenge, the Prince Mutaib Chair for Biomarkers of Osteoporosis (PMCO) in King Saud University (KSU), Riyadh, KSA, together with local experts and in cooperation with the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO), organized a panel that formulated unified recommendations in the diagnosis and treatment of vitamin D deficiency in the region.MethodsThe selection of local and international experts commenced during the 2nd International Vitamin D Symposium conducted in Riyadh, Saudi Arabia, last January 20-–21, 2016. Reviews of the most recent literature were done, and face-to-face meetings were conducted for revisions and final recommendations.Results: Vitamin D sufficiency is defined as circulating serum 25(OH)D ≥50 nmol (≥20 ng/ml) for the general population and vitamin D adequacy as serum 25(OH)D >75 nmol/L l (>30 ng/ml) for the frail and osteoporotic elderly. Despite overwhelming prevalence of vitamin D deficiency, universal screening is not recommended. Recommendations for the general population, children, pregnant/lactating women, post-menopausal women, the elderly, and those with subsequent metabolic diseases were provided.ResultsVitamin D sufficiency is defined as circulating serum 25(OH)D ≥50 nmol (≥20 ng/ml) for the general population and vitamin D adequacy as serum 25(OH)D >75 nmol/L l (>30 ng/ml) for the frail and osteoporotic elderly. Despite overwhelming prevalence of vitamin D deficiency, universal screening is not recommended. Recommendations for the general population, children, pregnant/lactating women, post-menopausal women, the elderly, and those with subsequent metabolic diseases were provided.ConclusionVitamin D supplementation/correction is advised in all persons whose serum 25(OH)D falls below 50 nmol/l (20 ng/ml), and achieving a target of 75 nmol/l (30 ng/ml) is particularly suited for frail, osteoporotic, and older patients. Conducting well-designed clinical trials in the region that will address economic implications and investigations on the treatment persistence and compliance to vitamin D treatment in the region are encouraged.

Neonatal screening for congenital hypothyroidism: Incidence, imaging, feasability, and difficulties of a nationwide program.

A pilot project was carried out in Riyadh to study the incidence and pattern of congenital hypothyroidism (CH) among newborn delivered at the Ministry of Health (MOH) hospitals. Cord blood was assayed for thyroid stimulating hormone (TSH). For affected infants, Tc-99m pertechnetate thyroid scintigraphy and perchlorate discharge test (PDT) using I(123) were performed to determine the caused of congenital hypothyroidism. Fifteen affected newborns were diagnosed among 40,000 newborns screened giving an incidence of 1:2666. Tc-99m thyroid scan revealed athyreosis in five infants; the thyroid gland was ectopic in eight and thyroid in two infants. In eight infants thyroid tissue was visualized, PDT was performed and the test was positive in seven cases (two eutopic and five ectopic). We concluded that the incidence of CH was higher compared with other parts of the world. Thyroid scintigraphy has a primary role in the evaluation of infants with congenital hypothyroidism and should be part of the protocol for the screening program. As early initiation of thyroxine therapy will prevent neurological and physical handicaps of the disease, the decision was made to have a nationwide screening program established in Saudi Arabia. The organization and difficulties of the screening program are being discussed.

Pattern of diabetic foot lesions in Saudi Arabia: Experience from King Khalid University Hospital, Riyadh.

A retrospective study was carried out to estimate the magnitude and pattern of foot lesions seen in diabetics living in Saudi Arabia. A review of the records of 1010 diabetic patients seen at King Khalid University Hospital, Riyadh, revealed an overall prevalence of 10.4% for diabetic foot lesions. Of these, 88 patients were further characterized; 55 (62.5%) were males and 33 (37.5%) were females. Seventy-five patients (85.2%) were Saudis and 13 (14.8%) were non-Saudis. The average age was 58 years. Eighty-five patients had type 2 diabetes and three had type 1. The spectrum of foot lesions included: 10 cases of cellulitis, 33 cases of ulcers, 29 cases of gangrene, and 16 cases of abscess. Evidence of peripheral vascular disease was present in 48 patients (54.5%) while peripheral neuropathy was found in 43 (48.8%). Surgical debridement with prolonged dressing was done in 58 patients (66%) while amputation was performed in 30 (34.1%). The average hospitalization was 6.8 weeks. Diabetic foot lesions constitute a major complication of this disease in Saudi Arabia. The high amputation rate is a source of concern and improved techniques are urgently needed to reduce this serious outcome.

Vitamin D deficiency and biochemical variations among urban Saudi adolescent girls according to season

Objectives: To determine seasonal variations in the vitamin D status of Saudi adolescent girls in Riyadh, Kingdom of Saudi Arabia (KSA) and its effect in biochemical and clinical characteristics. Methods: In this prospective study, a total of 2000 Saudi females aged 12-18 years from different schools in Riyadh, KSA participated and submitted a generalized questionnaire with clinical information. Fasting blood samples were obtained in 1618 subjects for the winter season (December to February) and only 499 subjects returned to submit fasting blood samples for the summer season (June-August). Circulating serum 25(OH)D, parathyroid hormone (PTH), and other biomarkers of bone remodeling were measured during both seasons. Results: Vitamin D deficiency (serum 25(OH)D <25 nmol/L) was significantly higher during summer than winter (63.5% versus 40.8%; p<0.001). Mean serum PTH was also significantly higher during summer than winter (p<0.01). In all subjects, serum PTH showed a significant inverse association with 25(OH)D at levels below 40 nmol/L (r=-0.21; p<0.001). The prevalence of subjects having clinical and metabolic manifestations suggestive of osteomalacia was 2.1% (N=33 out of 1548). Conclusion: Seasonal variations in the vitamin D status of Saudi adolescent females significantly modifies biochemical parameters as response to vitamin D status change. In the meantime, heightened public health awareness should be given to populations at higher risk for vitamin D deficiency.

Ramadan fasting: Medical aspects in health and in disease.

Ramadan fasting is one of the Pillars of Islam. Its observance involves abstinence from eating and drinking from dawn until sunset during the entire holy month. The effects of Ramadan fasting on body physiology as well as on the different biochemical, hematological, and metabolic parameters are reviewed. Metabolic changes, when present, are mild and reversible. The effects of fasting on diabetes mellitus, treatment with nonsteroidal antiinflammatory agents, and anticoagulation therapy are discussed.

Thyrotoxicosis: Experience from the King Khalid University Hospital, Riyadh

ABSTRACT Ninety-one patients with thyrotoxicosis, 57 females and 34 males, 52 Saudis and 39 non-Saudis, were seen at King Khalid University Hospital, Riyadh. The mean age was 31.8 years. Seventy-ei...