Prevalence of Type 2 Diabetes Mellitus in the General Population of Saudi Arabia, 2000-2020: A Systematic Review and Meta-Analysis of Observational Studies

Protective Effects of Isolated Curcumin From Curcuma longa on Key Enzymes Involved in the Insulin Signaling Pathway and Digestive and Metabolic Enzymes Associated With Obesity, Type 2 Diabetes, and Hypertension

This study explores the potential of curcumin (CUR), extracted from Curcuma longa, in combating obesity and Type 2 diabetes. Obesity and Type 2 diabetes were induced in rats through a high-fat and high-fructose diet (HFFD), and CUR, after purification and characterization by Fourier transform infrared spectroscopy (FTIR) and ultraviolet (UV) spectroscopy, was administered for 3 months via gastric gavage. The results show that CUR supplementation activates the insulin signaling pathway in a dose-dependent manner, leading to improved insulin sensitivity. Specifically, administering CUR at a daily dose of 100 mg/kg significantly reduces the activities of protein tyrosine phosphatase (PTP1B) and dipeptidyl peptidase-4 (DPP-4) by 43% and 45%, respectively, in obese and Type 2 diabetic rats compared to untreated obese rats. Furthermore, CUR effectively inhibits lipase and α-amylase activities at both the serum and intestinal levels. In obese rats, CUR administration reduces glycogen phosphorylase (GP) activity by 35% and enhances glycogen synthase (GS) activity by 78%, leading to a substantial increase in hepatic glycogen content. Additionally, CUR also led to a 21% reduction in food intake and a 12% decrease in water consumption. These changes contributed to significant reductions in the blood sugar and glycosylated hemoglobin (HbA1c) levels, with decreases of 59% and 53%, respectively. Additionally, administering CUR at a dose of 100 mg/kg body weight reduced thiobarbituric acid reactive substances (TBARSs), hydrogen peroxide (H2O2), and total oxidant status (TOS) in obese and diabetic rats, with reductions of 49%, 59%, and 58%, respectively. Furthermore, CUR demonstrates a strong regulatory effect on the levels of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and total cholesterol (TC). Overall, these results underscore the CUR potential for treating and preventing diabetes and obesity.

Patient-centered care and satisfaction of patients with diabetes: insights from a survey among patients at primary healthcare centers in Saudi Arabia

BACKGROUND AND OBJECTIVE

Patient-centered care (PCC) and patient satisfaction are pivotal in healthcare provision for patients with diabetes. This study investigates the link between perceived PCC and satisfaction with care among patients with diabetes in Saudi Arabia.

METHODS

A cross-sectional study was conducted at 47 primary healthcare centers affiliated with general hospitals, including King Abdullah Medical Complex, King Abdulaziz Hospital, East Jeddah Hospital, King Fahd General Hospital, and Al Thagr General Hospital, operated by the Ministry of Health in Jeddah City, Saudi Arabia, between July and August 2023. Over 800 patients with diabetes were approached through a random sampling technique at the reception areas of these centers. These patients were directed to designated private rooms for further engagement, where they completed a face-to-face questionnaire administered by an interviewer. Data analysis was conducted using the software package SPSS version 28 and AMOS version 28.

RESULTS

Of the 594 patients who participated in the study (response rate 73.4%), the results indicated that the perceived level of PCC, including physical comfort (β = 0.200, p = 0.000), continuity in care transition (β = 0.114, p = 0.031), access to care (β = 0.203, p = 0.000), information and education (β = 0.169, p = 0.001), and family and friends involvement (β = 0.082, p = 0.023), were significantly related to patient satisfaction. However, other perceived PCC components, like patient preferences (β = 0.052, p = 0.233), care coordination (β = 0.078, p = 0.123), and emotional support (β=-0.080, p = 0.066), did not appear to have a significant relationship with patient satisfaction. Income and level of education substantially impacted the perception of PCC and satisfaction with care. One notable finding was that the perceived level of PCC had a strong positive relationship with patient satisfaction (β = 0.762, p = 0.002).

CONCLUSION

This study highlights the significant positive relationship between PCC and patient satisfaction in diabetes care in Saudi Arabia. It emphasizes the need for healthcare tailored to individual needs and demographic factors. This provide advocates the broader integration of PCC principles in health systems, particularly in Saudi Arabia, to improve patient experience and satisfaction. Policymakers should integrate patient-centered care into healthcare policies to improve service quality and health outcomes.

Molecular Pharmacology of Glucagon-Like Peptide 1-Based Therapies in the Management of Type Two Diabetes Mellitus and Obesity

Background

The global increase in type 2 diabetes mellitus (DM2) and obesity presents a significant public health challenge, as these interconnected conditions contribute to severe complications, including cardiovascular disease, stroke, and certain cancers. The incretin system, particularly glucagon-like peptide-1 (GLP-1), has emerged as a promising therapeutic target due to its role in glycemic control and weight management.

Objective

This review explores the molecular pharmacology of GLP-1 and its receptor agonists, evaluating their therapeutic efficacy in managing DM2 and obesity.

Methods

A comprehensive literature review was conducted, analyzing recent advancements in GLP-1-based therapies, their mechanisms of action, and their clinical applications. The review also highlights the pharmacokinetic modifications developed to enhance the stability and efficacy of GLP-1 receptor agonists.

Results

GLP-1 receptor agonists have demonstrated significant benefits in improving glycemic control, reducing body weight, and addressing metabolic complications. Novel therapeutic approaches, including dual and triple incretin receptor agonists, are showing enhanced efficacy in both diabetes and obesity management. However, challenges remain in optimizing treatment outcomes, addressing patient variability, and improving long-term adherence.

Conclusion

GLP-1-based therapies have revolutionized the management of DM2 and obesity. Continued research is essential to refine these treatments, overcome existing limitations, and develop personalized approaches to maximize patient outcomes.

Assessment of oral health status and practice among diabetic and nondiabetic participants

Introduction

Patients with diabetes are diagnosed and managed through family practice. They are more likely to have more severe periodontal disease. Good oral hygiene can prevent oral health problems. This study explored and identified the status, practice, and prevalence of oral hygiene among patients with diabetes compared with nondiabetic patients.

Methods

A cross-sectional study of dental health care clinic patients was conducted using questionnaires and a validated oral examination tool, the Simplified Oral Hygiene Index (OHI-S). Data were analyzed using SPSS software.

Results

A total of 238 participants enrolled in the study (46.6%) had diabetes mellitus. The mean age of the participants was 40.01 ± 13.03 years. Diabetics' Oral Hygiene Index (OHI) mean was 2.72 ± 1.19, compared with 2.02 ± 1.08 in nondiabetics (P < 0.001). There was no statistically significant difference in OHI scores between males and females (P > 0.05). Simplified OHI score >3 was higher among diabetics than nondiabetics, with an age-adjusted rate of 32.41 per 1000 compared to 13.63 per 1000 and an odd ratio of 3.66, 95% CI (3.5 to 3.8) P < 0.0001. Oral disease symptoms, gum bleeding, swelling, and tooth mobility were reported among patients with diabetes (37.8%, 36%, and 30.6%, respectively). Oral hygiene practices were suboptimal in patients with diabetes compared to nondiabetics.

Conclusion

There is a high prevalence of poor oral hygiene among patients with diabetes compared to nondiabetics which calls for multidisciplinary diabetic care in family practice to ensure the optimal quality of care.

Barriers to Access and Utilization of Diabetes Care Among Patients with Severe Mental Illness in Saudi Arabia: A Qualitative Interpretive Study

Background/Objectives: The prevalence of Diabetes Mellitus (DM) is a major concern in Saudi Arabia, making it a challenge for health delivery for those with severe mental illness (SMI). This study aims to explore the barriers to access and utilization of diabetes care among patients with diabetes and serious mental illnesses, their relatives, and healthcare providers to provide evidence-based recommendations for health policy improvement. Methods: A qualitative interpretive research design was used via Braun and Clarke's framework to analyze the data thematically. Semi-structured interviews were conducted with 35 participants, including patients, relatives, and healthcare providers between September and October 2023, in Jeddah city, Saudi Arabia. Results: The following four themes emerged from the qualitative data: (1) The status of integrated care, (2) Barriers to access to diabetes care at different levels, (3) Navigating obstacles to providing comprehensive diabetes care, and (4) Evidence-based recommendations for health policy improvement. Conclusions: This study underscores the necessity for a comprehensive and integrated approach to care, educational programs, specialized clinics, and improved healthcare logistics. Integrating mental health and diabetes management is needed to ensure better utilization.

Developing and standardizing a tool to assess the health education needs of diabetic patients at Jazan Armed Forces Hospital

BACKGROUND

Determining the health educational needs of people living with diabetes is essential in developing patient-centered, structured health education programs that aim to improve the outcome of diabetes care.

OBJECTIVES

To develop a tool for the identification of the health education needs of individuals living with diabetes in the Jazan Armed Forces Hospital (JAFH) and to standardize the questionnaire through the assessment of its reliability and validity.

METHODS

A cross-sectional design was used in the present work, which included 303 participants living with diabetes. The researchers and an expert panel in family medicine and endocrinology created a comprehensive and mutually exhaustive questionnaire covering every potential area of health education needs. It included a 15-item section with questions on a 5-point Likert scale for determining the participants' needs for health education. Cronbach's alpha was used to determine the Likert scale's reliability. Exploratory factor analysis was used to determine the Likert scale's construct validity.

RESULTS

The total number of males was 123 (40.6%) and that of females was 180 (59.4%). Their mean ages were 55.9 ± 12.9, ranging from 18 to 94 years. The reliability of the 15-item Likert scale was 83%, and it increased to 90% when the redundant items (n = 5) were eliminated. The test had an 86% test-retest reliability when repeated. Also, the final 10-item Likert scale has significant face, content, and construct validity. Two components with eigenvalues over 1 (generic knowledge about diabetes, and diabetes and travel) could be extracted out of the 10-item Likert scale.

CONCLUSION

The final 10-item Likert scale offers a good degree of validity and reliability for determining the health education needs of individuals living with diabetes. The two Likert scale components (general information on diabetes, and diabetes and travel) and their contributing items were identified from the questionnaire, which is standardized and helpful in both practice and research, in order to ascertain patients' needs and develop structured health education programs. The component "General information about diabetes" exhibited significant associations with the following items: diabetes risk factors and prevention; common oral agents for treating hypoglycemia; HbA1c (glycosylated hemoglobin) and normal blood glucose levels; and acute problems related to diabetes, such as hypoglycemia and diabetic ketoacidosis. On the other hand, diabetes and fasting; chronic complications of diabetes; and the significance of the yearly eye screening were the Likert scale items that contributed more to Component 2 (diabetes and travel).

Biochemical markers to detect protein malnutrition in type 2 diabetes and liver cirrhosis patients

The study aimed to evaluate blood biochemical markers in individuals with type 2 diabetes (T2D) and liver cirrhosis (LC) to discover if they may be utilized to assess their nutritional status, specifically protein malnutrition (PM). A retrospective examination of 500 T2D patients referred to the hospital from January 2022 to December 2023 was performed. After that, participants were split into 2 groups: LC and non-LC. The research comprised T2D individuals with LC. We used their medical data and referring physician reports. Two hundred thirty-five (47%) individuals diagnosed with both T2D and LC were included in the study out of a total of 500 patients referred to Madinah Hospital. The LC group had greater average age, body mass index (BMI), fasting blood glucose, hemoglobin A1c, insulin resistance, and triglycerides as compared to other T2D patient groups without LC. Two hundred thirty-five people with LC were evaluated nutritionally using biomarkers including total protein, albumin, urea, creatinine, and transferrin, which can be a useful evaluation method. A 53.2% of individuals with LC and T2D had PM. A 47% of 500 individuals with T2D and LC. LC had elevated levels of BMI, lipids, liver enzymes, and total bilirubin. A 53.2% had PM as shown by biochemical markers, which might be useful in evaluating patients' nutritional status. PM correlated with older age, decreased hemoglobin levels, reduced total protein, albumin, and transferrin but high ALP with high BMI index (obese). These findings can assist T2D with LC specialists develop better nutritional management and quality of life methods.

Assessment of Diabetes-Related Knowledge and Dietary Patterns Among Type 2 Diabetes Mellitus Patients in Central Saudi Arabia: Insights for Tailored Health Education Strategies

Background and Objectives: Understanding the knowledge and dietary patterns of type 2 diabetes mellitus (T2DM) patients is essential to identify gaps and design tailored health education strategies to improve self-management and clinical outcomes. We assessed the diabetes-related dietary patterns, knowledge, and associated factors of T2DM patients. Methods: The study utilized a cross-sectional design, surveying 363 T2DM patients using a validated and pretested questionnaire. Knowledge levels were categorized as low (<50%), medium (50-75%), and high (>75%), and dietary patterns were classified as unhealthy (<34%), moderately healthy (34-67%), and healthy (>67%). We analyzed the data using the Statistical Package for the Social Sciences (SPSS, version 23.0). The authors tested the relationship between diabetes-related dietary patterns and knowledge with Spearman's analysis. The multivariate regression approach established the factors associated with these two components. Results: The findings revealed that 36.4% of participants had low knowledge, 34.4% had medium knowledge, and only 29.2% demonstrated high knowledge. Regarding dietary patterns, 34.4% were categorized as unhealthy, 33.3% as moderately healthy, and 32.3% as healthy. The authors found that these two domains were positively correlated (rho = 0.649, p = 0.001). Diabetes-related knowledge was significantly associated with gender (p = 0.018), duration of diabetes (p = 0.001), and patients with a family history of T2DM (p = 0.007). The dietary pattern was significantly associated with age (p = 0.001), duration of diabetes (p = 0.032), and presence of other chronic diseases (p = 0.028). Conclusions: The findings underscore the need for targeted health education strategies that address gaps in dietary knowledge and promote healthier eating behaviors among T2DM patients in Central Saudi Arabia.

Impact of Order Restrictions on Hemoglobin A1c Requests at Primary Health Care Centers in Riyadh, Saudi Arabia

Purpose

The aim of the study was to assess the effect of policy intervention on the physician ordering of HbA1c for the patients seen at the primary health care center in Riyadh, Saudi Arabia.

Methods

The study included patients over the age of 18 for whom HbA1c tests were ordered before and after the policy restrictions were implemented at the three main Primary Health Care Centers under the Ministry of National Guard Health Affairs (MNGHA) in Riyadh, between October 2020 and August 2023. Several data management steps and restrictions were carried out to identify the patients seen before and after the intervention and controlled for the confounders. The outcome variable was inappropriate testing, and early testing was defined based on standard cutoffs of HbA1c, diabetic control, and patient history. The logistic regression analysis was used to identify predictors for early testing.

Results

Among 16,290 participants, the mean age was 50 ± 16 years, with a predominance of females (66.5%). Approximately 22.3% of participants were diabetic, and the mean HbA1c level was 6.2 ± 1.55%. About 89.6% of tests were deemed inappropriate based on criteria for glycemic control, diabetic status, and duration of testing. Policy restrictions led to a 70.3% reduction in the odds of early testing (OR = 0.297, 95% CI: 0.246-0.358, p < 0.001). Each unit increase in HbA1c decreased the odds of early testing by 1.517 (OR = 0.219, 95% CI: 0.193-0.249, p < 0.001). Additionally, younger participants were more likely to undergo early testing, with odds decreasing by 3% for each additional year of age (OR = 0.970, 95% CI: 0.966-0.974, p < 0.001).

Conclusion

We conclude that policy restriction alone might not be effective in reducing the burden of early testing. The early testing tendency was less in the post-intervention period. However, early testing was a common practice in both pre- and post-intervention phases. As physicians are the ones ordering the tests, deeper insight is needed from the physician's perspective.

Assessing intention to use mobile phone-based self-management support among adults with type 2 diabetes in Saudi Arabia: A cross-sectional study

Introduction

The use of mobile phone technology for chronic illness self-management is growing, and it may help people with type 2 diabetes mellitus (T2DM). Innovative methods are needed to improve patient involvement and disease management in the Kingdom of Saudi Arabia due to the high incidence of T2DM.

Objective

The purpose of this study was to explore how the T2DM patients in KSA utilizes their mobile phones for self-management.

Methods

A cross-sectional study was conducted between April and June 2025 among T2DM patients who were attending endocrinologists for their diabetes management in the Northern Border region (Rafha and Arar) and the Central region (Riyadh) in KSA using a validated questionnaire.

Results

This study included a total of 267 participants with T2DM. Nearly all participants (99.3%) possess a cellphone, with 94.8% having daily internet access. The majority of the patients reported to have an intention to use mobile phones and the internet for managing diabetes, with 78.3% for dietary planning, 79.4% for physical activity planning, and 78.7% for text messages as reminders. Factors such as female (p = 0.008), younger age (p = 0.001), and duration of diabetes (p = <0.001) were significantly associated with the intention to use mobile apps for managing their diabetes.

Conclusions

This study demonstrates a significantly higher inclination of participants toward mobile phone technology for diabetes self-management vs. face-to-face consultations. These findings highlight the promising role of mobile phone technology for enhancing diabetes self-management among T2DM patients, thus highlighting the need for targeted interventions.

Discovery of Non-Peptide GLP-1 Positive Allosteric Modulators from Natural Products: Virtual Screening, Molecular Dynamics, ADMET Profiling, Repurposing, and Chemical Scaffolds Identification

Background/Objectives: Glucagon-like peptide-1 (GLP-1) receptor is currently one of the most explored targets exploited for the management of diabetes and obesity, with many aspects of its mechanisms behind cardiovascular protection yet to be fully elucidated. Research dedicated towards the development of oral GLP-1 therapy and non-peptide ligands with broader clinical applications is crucial towards unveiling the full therapeutic capacity of this potent class of medicines. Methods: This study describes the virtual screening of a natural product database consisting of 695,133 compounds for positive GLP-1 allosteric modulation. The database, obtained from the Coconut website, was filtered according to a set of physicochemical descriptors, then was shape screened against the crystal ligand conformation. This filtered database consisting of 26,325 compounds was used for virtual screening against the GLP-1 allosteric site. Results: The results identified ten best hits with the XP score ranging from -9.6 to -7.6 and MM-GBSA scores ranging from -50.8 to -32.4 and another 58 hits from docked pose filter and a second round of XP docking and MM-GBSA calculation followed by molecular dynamics. The analysis of results identified hits from various natural products (NPs) classes, to whom attributed antidiabetic and anti-obesity effects have been previously reported. The results also pointed to β-lactam antibiotics that may be evaluated in drug repurposing studies for off-target effects. The calculated ADMET properties for those hits revealed suitable profiles for further development in terms of bioavailability and toxicity. Conclusions: The current study identified several NPs as potential GLP-1 positive allosteric modulators and revealed common structural scaffolds including peptidomimetics, lactams, coumarins, and sulfonamides with peptidomimetics being the most prominent especially in indole and coumarin cores.

In Vivo and Computational Studies on Sitagliptin's Neuroprotective Role in Type 2 Diabetes Mellitus: Implications for Alzheimer's Disease

BACKGROUND/OBJECTIVES

Diabetes mellitus (DM), a widespread endocrine disorder characterized by chronic hyperglycemia, can cause nerve damage and increase the risk of neurodegenerative diseases such as Alzheimer's disease (AD). Effective blood glucose management is essential, and sitagliptin (SITG), a dipeptidyl peptidase-4 (DPP-4) inhibitor, may offer neuroprotective benefits in type 2 diabetes mellitus (T2DM).

METHODS

T2DM was induced in rats using nicotinamide (NICO) and streptozotocin (STZ), and biomarkers of AD and DM-linked enzymes, inflammation, oxidative stress, and apoptosis were evaluated in the brain. Computational studies supported the in vivo findings.

RESULTS

SITG significantly reduced the brain enzyme levels of acetylcholinesterase (AChE), beta-secretase-1 (BACE-1), DPP-4, and glycogen synthase kinase-3β (GSK-3β) in T2DM-induced rats. It also reduced inflammation by lowering cyclooxygenase-2 (COX-2), prostaglandin E2 (PGE2), tumor necrosis factor-α (TNF-α), and nuclear factor-κB (NF-κB). Additionally, SITG improved oxidative stress markers by reducing malondialdehyde (MDA) and enhancing glutathione (GSH). It increased anti-apoptotic B-cell lymphoma protein-2 (Bcl-2) while reducing pro-apoptotic markers such as Bcl-2-associated X (BAX) and Caspace-3. SITG also lowered blood glucose levels and improved plasma insulin levels. To explore potential molecular level mechanisms, docking was performed on AChE, COX-2, GSK-3β, BACE-1, and Caspace-3. The potential binding affinity of SITG for the above-mentioned target enzymes were 10.8, 8.0, 9.7, 7.7, and 7.9 kcal/mol, respectively, comparable to co-crystallized ligands. Further binding mode analysis of the lowest energy conformation revealed interactions with the critical residues.

CONCLUSIONS

These findings highlight SITG's neuroprotective molecular targets in T2DM-associated neurodegeneration and its potential as a therapeutic approach for AD, warranting further clinical investigations.

Modeling the Clinical and Economic Burden of Therapeutic Inertia in People with Type 2 Diabetes in Saudi Arabia

INTRODUCTION

Therapeutic inertia in type 2 diabetes, defined as a failure to intensify treatment despite poor glycemic control, can arise due to a variety of factors, despite evidence linking improved glycemic control with reductions in diabetes-related complications. The present study aimed to evaluate the health and economic burden of therapeutic inertia in people with type 2 diabetes in Saudi Arabia.

METHODS

The IQVIA Core Diabetes Model (v.9.0) was used to evaluate outcomes. Baseline cohort characteristics were sourced from Saudi-specific data, with baseline glycated hemoglobin (HbA1c) tested at 8.0%, 9.0%, and 10.0%. Modeled subjects were brought to an HbA1c target of 7.0% immediately or after delays of 1-5 years across time horizons of 3-50 years. Outcomes were discounted annually at 3.0%. Costs were accounted from a societal perspective and expressed in 2023 Saudi Arabian Riyals (SAR).

RESULTS

Immediate glycemic control was associated with improved or equal life expectancy and quality-adjusted life expectancy and cost savings in all scenarios compared with delays in achieving target HbA1c. Combined cost savings ranged from SAR 411 (EUR 102) per person with a baseline HbA1c of 8.0% versus a 1-year delay over a 3-year time horizon, to SAR 21,422 (EUR 5291) per person with a baseline HbA1c of 10.0% versus a 5-year delay over a 50-year time horizon. Discounted life expectancy and quality-adjusted life expectancy were projected to improve by up to 0.4 years and 0.5 quality-adjusted life years (QALYs), respectively, with immediate glycemic control.

CONCLUSION

Therapeutic inertia was associated with a substantial health and economic burden in Saudi Arabia. Interventions and initiatives that can help to reduce therapeutic inertia are likely to improve health outcomes and reduce healthcare expenditure.

Anxiety and Depression Among Patients with Diabetes in Saudi Arabia and Egypt

BACKGROUND

Mental stress plagued type II diabetes (T2DM) patients. The psychological and emotional issues related to diabetes and its effects include depression, anxiety, poor diet, and hypoglycemia fear.

AIM

Compare the impact of diabetes on depression and anxiety in Egyptian and Saudi diabetics.

METHODS

The diabetes, gastroenterology, and hepatology sections of University of Ha'il Clinic, KSA, and the Theodor Bilharz Research Institute, Egypt, conducted this retrospective study. Everyone gave informed consent before participating. Interviews with male and female outpatients and inpatients were conducted from June 2021 to December 2022. The self-administered validated Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9) scale measured sociodemographic characteristics and symptoms of depression and anxiety.

RESULTS

In patients with diabetes, the prevalence of depression was higher in KSA [34.8%] than in Egypt [18%], while anxiety was higher in Egypt [40%] than in KSA [29.1%]. Most depressed patients were 31-55 years old (61.2%) from KSA and 97.8% (41-55 years old) from Egypt. Female anxiety was 70.7% in KSA and 51.0% in Egypt, with no significant difference. The duration of diabetes in depressed patients was 5-10 years ([46.9%, Saudis] vs. [57.8%, Egyptians]), while anxious patients (5-10 years [39.0%, Saudis] vs. >20 years [65.0%, Egyptians]) were mainly type-2. Most depressive patients had an HbA1c (59.2%) from 7-10% (Saudis) and 77.8% [>10% Egyptians] compared to anxiety patients (46.3%) and 48.0% [>10% Egyptians]. Depressed and anxious patients from both nations had higher glucose, triglycerides, and cholesterol levels. Saudis and Egyptians with obesity had higher rates of sadness (75.5% vs. 68.9%) and anxiety (82.9% vs. 69.0%). Treatment adherence and serum glucose monitoring were not significantly different from depression in diabetes individuals in both ethnicities.

CONCLUSIONS

Anxiety was more common among Egyptian patients because of overcrowding, working whole days to fulfill life requirements, and the unavailability of health insurance to all citizens. Meanwhile, in KSA, obesity, unhealthy food, and less exercise reflect the high percentage of depression among patients with diabetes. The detection of depression and anxiety in the context of DM should be critical for the physical health and quality of life of Saudi and Egyptian diabetics. Further investigation is warranted to encompass anxiety and depression within the scope of future research.

Metabolomics Revealed the Effects of Momordica charantia L. Saponins on Diabetic Hyperglycemia and Wound Healing in Mice

Momordica charantia L. saponins (MCS) may promote wound-healing properties but the underlying mechanisms are unclear. This study aimed to examine the effects and mechanisms of MCS on diabetic wounds. The results have shown that higher MCS intake lowered fasting blood glucose levels, serum lipids, and lipopolysaccharides in diabetic mice. MCS-treated diabetic mice exhibited faster wound healing than the diabetic control groups. After three days, the diabetic control groups exhibited a wound area reduction of only 19.3%, while a 39.75% reduction was observed following high-dose MCS treatment. Five potential biomarkers were screened in the metabolomics study. The results revealed that MCS mainly regulated glycerophospholipid metabolism, fructose and mannose metabolism, steroid hormone biosynthesis, pyrimidine metabolism, and the Krebs cycle, thus affecting wound healing. Overall, MCS could not only exert a hypoglycemic effect but also promote diabetic wound healing, making it a potential treatment option for diabetes-related wounds.

Predictors of medication regimen complexity and its impact on hemoglobin a1c in type 2 diabetes patients: a retrospective analysis in ambulatory care in Makkah City

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a widespread chronic disease that poses a significant management challenge due to the complexity of the associated medication regimens, which can have a considerable impact on patient outcomes.

OBJECTIVES

Explore the complexity level of diabetes medications among patients with T2DM and to identify the predictors of medication regimen complexity (MRC) and its correlation with hemoglobin A1C (HbA1c) levels.

DESIGN

Retrospective, cross-sectional study.

SETTING

An ambulatory care setting of a tertiary hospital in Makkah City, Saudi Arabia.

PATIENTS AND METHODS

Patients with T2DM referred to the diabetic clinic were identified and assessed for eligibility. The data were collected from patient electronic medical records between October 2022 and September 2023. The MRC Index was used to evaluate the complexity of the patients' medication regimens.

MAIN OUTCOMES MEASURES

MRC index scores and HbA1c levels.

SAMPLE SIZE

353 records of patients with T2DM.

RESULTS

The analysis revealed that 61.8% (n=218) of patients had high MRC, with the dosing frequency contributing significantly to their MRC (mean=3.9, SD=1.9). Having polypharmacy and longstanding T2DM were predictors of high MRC (odds ratios=4.9 and 2.6, respectively; P≤.01). Additionally, there was an inverse association between the patients' diabetes-specific MRC index scores and their glycemic control (odds ratios=0.2, P<.001).

CONCLUSION

The study findings highlight the importance of considering MRC in managing T2DM. Simplifying medication regimens and optimizing medication management strategies can improve patient outcomes. Further research is needed to explore interventions to reduce MRC and enhance diabetes management in this population.

LIMITATIONS

Retrospective study design measuring the MRC at a diabetes-specific level.

The Pattern of Practice in the Management of Early Diabetic Kidney Disease

Background and objectives Diabetes is a leading cause of kidney failure in various regions worldwide. To detect renal disease in individuals with diabetes, screening typically involves evaluating the glomerular filtration rate and measuring albuminuria. Although there are established guidelines for these screenings, adherence to them varies. This study aims to examine the prevalence of albuminuria screening among adults with diabetes mellitus (DM) and to assess the different practices in managing these patients across primary and tertiary care settings. Methods This cross-sectional observational study involved adult patients with DM attending outpatient clinics in both primary and tertiary care settings. Patient data were gathered using a standardized form, excluding those with established chronic kidney disease (CKD) who were under nephrology care. Results The study included 1,010 patients, with 303 (30%) from primary care clinics and 707 (70%) from tertiary care clinics. The cohort comprised 582 (58%) females, with a median age of 62 years (IQR: 55-70), and approximately 990 (98%) had type 2 DM (T2DM). Annual albumin-to-creatinine ratio (ACR) screening was conducted for 498 out of 1,010 patients (49%) (95% confidence interval {CI}: 46%-52%). Screening compliance was notably higher in primary care settings compared to tertiary care clinics. Older patients (over 60 years) and those with hypertension or cardiac conditions were less likely to undergo screening. Among those screened, 185 of 498 patients (37%) (95% CI: 33%-41%) had abnormal albuminuria (ACR > 3). Conclusion Albuminuria is a significant indicator of progressing renal disease and cardiovascular risk. The annual screening rate for albuminuria in diabetic patients is inadequate. Primary care physicians show better adherence to screening guidelines compared to their tertiary care counterparts. Increasing physician awareness about the importance of screening could improve guideline compliance and mitigate the adverse effects of albuminuria.

The effectiveness of 0.5 mg and 1mg of semaglutide in patients with type two diabetes and predictors of response: a retrospective cohort study

Background

Semaglutide is a glucagon-like peptide-1 receptor agonists (GLP-1-RAs) approved for the treatment of type 2 diabetes mellitus (T2DM) at doses up to 1 mg. The results from randomized control trials and real-world studies revealed that weekly semaglutide was associated with significant improvements in HbA1c and body weight. To our knowledge, no study assessed the effectiveness of using semaglutide for patients with T2DM in the Saudi population. We aim to assess the effectiveness of once weekly SC 0.5 and 1 mg of semaglutide on HbA1c and weight reduction in patients with T2DM in the Saudi population within 12 months of use, evaluate the predictors of response, and compare the effect of the two doses.

Method

This is a retrospective cohort study conducted at Security Force Hospital in Riyadh, Saudi Arabia. Using electronic medical records of patients with type two diabetes who received semaglutide 0.5 or 1 mg for a total duration of at least 12 months of use.

Results

Within the study period of semaglutide use, HbA1c significantly decreased from baseline by -2.1% (-2.3 to -1.91, 95% CI) (P <0.001). While the mean change in weight was -6.19 kg (-6.66 to -5.72, 95% CI) (P<0.001). Moreover, BMI, FBG, total cholesterol, LDL, and TG all decreased significantly from baseline (p<0.001). When comparing the sub-groups of 0.5 and 1 mg doses, although results were numerically favorable of 1 mg, there were no statistically significant differences in HbA1c % (-2.1 ± 1.8 vs. -2.1 ± 1.9, p-value= 0.934, respectively), and weight (-6.1 ± 5 vs. -6.2 ± 4.4 kg, p-value=0.837, respectively). Significant predictors of HbA1c reduction were the duration of DM, baseline HbA1c, and insulin therapy. While the significant predictor for weight reduction was insulin therapy.

Conclusion

This study is document the effectiveness of once-weekly SC semaglutide on glycemic control and weight loss in real-world practice. We recommend a starting goal dose of 0.5 mg and gradual increase of dose based individual patient response. further studies are needed to assess the effectiveness and tolerability of various semagltude doses.

Exploring university students' nutrition literacy in Saudi Arabia: a cross-sectional survey

Introduction

Improving individuals' nutrition literacy can be one way to promote healthy dietary behaviors, which lowers the incidence of non-communicable diseases. In Saudi Arabia, there is a limited information regarding nutrition literacy among students. Therefore, the purposes of this study was to investigate university students' nutrition literacy and identify its predictors in Saudi Arabia. Another objective was to assess how nutrition literacy is associated with eating habits among this sample.

Methods

This cross-sectional study was carried out among students attending the University of Jeddah and King Abdulaziz University (Jeddah City) in Saudi Arabia from June 2023 to September 2023. Using a convenience sampling approach, 570 students were enrolled in this study. An online-based structured survey tool including demographic details, a food frequency questionnaire, and a nutrition literacy scale was used to collect the data. Descriptive and multiple binary logistic regression analysis were performed.

Results

Approximately 40.4% of the participants exhibited poor nutrition literacy. Female students were less likely than male students to have poor nutrition literacy (adjusted odds ratio, AOR = 0.62; 95% confidence interval, CI = 0.42, 0.92). Underweight (AOR = 1.73; 95%CI = 1.22, 4.56) and overweight participants (AOR = 3.1; 95%CI = 2.77, 7.23) were at higher risk of having poor level of nutrition literacy as compared to those who had normal weight. Students who did not take any nutrition-related courses had a 1.3 times higher probability of having a poor level of nutrition literacy compared to their counterparts (AOR = 1.3; 95%CI = 1.05, 3.74). Moreover, poor nutrition literacy was associated with higher weekly consumption frequencies of red meat, processed foods, funk foods and sugar-sweetened beverages.

Conclusion

A higher percentage of university students had poor nutrition literacy, which was associated with gender, self-reported BMI status, nutrition-related courses and unhealthy eating habits. These findings can assist university administrators and policymakers in implementing effective measures to enhance students' nutrition literacy rates in Saudi Arabia.

Knowledge, Attitudes, and Determinants of Nonalcoholic Fatty Liver Disease Among Adults in Jazan Province: A Cross-Sectional Study

Background Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease globally, with its prevalence rising worldwide. This study aimed to evaluate the knowledge, attitudes, and determinants related to NAFLD among adults in Jazan, Saudi Arabia. Methods  A cross-sectional study was conducted using a validated online questionnaire distributed to 540 participants in Jazan Province. Data analysis involved descriptive and comparative statistics to assess knowledge, attitudes, and influencing factors related to NAFLD. Results The majority of participants (244, 45.2%) demonstrated poor knowledge about NAFLD, while 226 (41.9%) had fair knowledge. Notably, individuals aged 40-49, males, healthcare workers, those with obesity and diabetes mellitus, and those with a family history of NAFLD showed significantly higher levels of knowledge (p < 0.05). Regarding attitudes, most participants (64.4%) exhibited a positive attitude toward NAFLD, 28.3% had a satisfactory attitude, and only 7% demonstrated a poor attitude. Conclusion The findings highlight the need for targeted educational interventions and public awareness campaigns to enhance the general public's understanding of NAFLD. Providing accurate and up-to-date information about the disease, its consequences, and preventive measures is crucial for improving awareness and knowledge.

Abdominal Obesity-Metabolic Syndrome 3 Misclassified as Type 1 Diabetes Mellitus

Age is no longer the most important differentiating feature between type 1 and type 2 diabetes, as obesity and metabolic syndrome are on the rise in the pediatric population. Here we present a case of a 30-year-old male individual initially diagnosed with uncontrolled type 1 diabetes mellitus (T1DM) since the age of 15, and treatment with high insulin doses has been unsuccessful. He was later identified as having abdominal obesity-metabolic syndrome 3 (AOMS3) based on strong family history and the presence of insulin resistance features. AOMS3 is characterized by early-onset coronary artery disease, central obesity, hypertension, and diabetes. Early detection of this condition is crucial to implement timely interventions and preventing the onset of complications.

Treatment modification patterns of glucose-lowering agents in Saudi Arabia: A retrospective real-world data analysis

AIM

The growing number of antidiabetics has broadened therapeutic options, leading to heterogeneity in prescribing patterns. Studies identifying antidiabetics modification patterns are lacking in Saudi Arabia. Therefore, the aim of this study is to describe modification patterns in Saudi patients.

METHODS

Patients ≥ 18 years old with at least one antidiabetic between 2016 and 2022 were included. Follow-up started from the earliest to the last prescription.Two modification types were evaluated: "add-on," prescribing new antidiabetics within a treatment episode, and "switching", starting a new treatment episode after the preceding ends. Descriptive statistics were used to characterize patients and estimate events proportions.

RESULTS

Of 122,291 patients, 47.2 % had treatment interruption or modification, totaling 303,781 events. Interruptions accounted for 54 %, add-on for 11 %, and switching for 35 %. The median time to first event was 159 days. The most add-on included dipeptidyl peptidase-4 inhibitor (DPP-4) inhibitors to biguanide and sulfonylurea (8 %), and sulfonylurea to biguanide (8 %). Among 106,405 switching events, 23 % shifted from dual to monotherapy and 17 % from monotherapy to dual therapy.

CONCLUSION

Nearly half of patients experienced modifications or interruptions, with notable shifts between monotherapies and dual therapies. These findings highlight the evolving landscape of treatment patterns in Saudi Arabia and guide future research and decision-making.

Retinopathy risk factors in patients with type 2 diabetes on liraglutide

Liraglutide, a glucagon-like peptide 1 receptor agonist, effectively treats type 2 diabetes(T2D) by lowering glucose levels, suppressing glucagon release, and promoting insulin secretion. Liraglutide has been shown to reduce body weight and glycated hemoglobin (HbA1c) levels and improve cardiovascular outcomes. However, evidence regarding the association between liraglutide and diabetic retinopathy in the Middle East is insufficient. Therefore, this study aimed to investigate the characteristics and risk factors of diabetic retinopathy in patients with T2D treated with liraglutide in Saudi Arabia. This retrospective cohort study was conducted on patients (≥14 years) with T2D treated with liraglutide between 2015 and 2021, who had a documented retinopathy assessment at baseline before liraglutide initiation and during follow-up, at King Abdulaziz Medical City (KAMC), Riyadh. Data collection included demographic information, retinopathy status, body mass index (BMI), and HbA1c level at baseline and follow-up after liraglutide use. The study included 181 patients with a mean age of 58.2 (9.8) years. Of these, 72.9% were females. At baseline, the median weight (interquartile range) was 88 (77-100) kg, diabetes duration was 19 (13-23.5) years, and HbA1c level was 9% (8-10%). Total of 69.6% were on insulin, 22.7% were on oral hypoglycemic agents, and 7.7% were on no other medications in addition to liraglutide. After a median of 2 years follow-up, both HbA1c level and weight decreased significantly (P < .001). Seventy-one of the 87 patients (81.6%) without retinopathy at baseline continued to show no retinopathy. Among patients with retinopathy at baseline, 25.5% showed improvement and 44.7% showed no change. In the multivariate binary mixed effect analysis, factors significantly associated with retinopathy were: use of insulin (odds ratio [OR]:2.68; 95% confidence interval [CI]: 1.18-6.09, P = .019), older age (OR:1.03; 95% CI: 1.00-1.06; P = .022), higher HbA1c level (OR:1.17; 95% CI: 1.02-1.34; P = .024), Hypertension (OR:2.56; 95% CI: 1.13-5.76; P=<.0001) and longer diabetes duration (OR:1.04; 95% CI: 1.00-1.08; P = .024). In conclusion, liraglutide use caused significant reductions in the HbA1c level and weight of patients with T2D. Most patients showed no change in retinopathy status after liraglutide use.

Evaluation of Sleep Quality Among People Living With Type 2 Diabetes Mellitus in Taif, Saudi Arabia: A Cross-Sectional Study

BACKGROUND

 Type 2 diabetes mellitus (T2DM) is characterized by high blood glucose levels, which are highly associated with poor sleep quality, cardiovascular disease, and pathological changes. This research examines the relationship between sleep quality and T2DM and compares it with nondiabetics within the Taif community. The findings of this study will provide valuable insights and recommendations to enhance the overall health quality in Taif, Saudi Arabia.

METHODOLOGY

 A cross-sectional study was conducted on 547 patients with T2DM between December 1, 2023, and April 1, 2024, in Taif. The sleep quality was assessed using the Sleep Quality Questionnaire (SQQ). Data were collected using an online questionnaire with two parts: primary demographic data and an assessment of sleep quality using the SQQ.

RESULTS

 Our study enrolled 814 participants, including 547 with T2DM and 267 nondiabetics. Participants with T2DM had poorer sleep quality, with a median score of 21 vs. 25 (P < 0.001). Significant factors affecting sleep quality included gender (P = 0.002), marital status (P = 0.023), and job status (P = 0.023). Nondiabetics had better sleep quality (76%) than participants with T2DM (61.1%). Males, married, and employed individuals reported higher sleep quality scores.

CONCLUSIONS

 Research indicates that individuals with T2DM experience lower sleep quality than the general population, particularly among female, unmarried, and unemployed individuals. To enhance sleep quality in patients with T2DM, it is essential to increase awareness, provide education on proper sleep habits, and highlight the importance of effective diabetes management, screening for sleep disorders, and consistent monitoring.

The single point insulin sensitivity estimator (SPISE) is associated with bone health in Arab adults

BACKGROUND

The Single Point Insulin Sensitivity Estimator (SPISE) index is a surrogate marker for insulin sensitivity. Given the emerging role of bone as an active endocrine organ, its associations with non-invasive measures of extra-skeletal functions such as insulin sensitivity warrant investigation.

AIMS

This study aimed to explore the relationship between the SPISE index and Bone Mineral Density (BMD) in an adult population.

METHODS

Data from a total of 1270 Arab adults (84% females, mean age 56.7 ± 8.1 years) from the Osteoporosis Registry Database of the Chair for Biomarkers of Chronic Diseases in King Saud University, Riyadh, Saudi Arabia was used in this study. T-scores and SPISE were calculated. Regression models were used to determine associations between SPISE and bone health indices.

RESULTS

The low BMD group (N = 853; T-score <-1.0) had significantly higher SPISE values than those with normal BMD (N = 417; T-score - 1.0 and above) (4.6 ± 1.3 vs. 4.3 ± 1.2, p < 0.001). Multivariate linear regression, adjusted for covariates, confirmed a significant inverse association between SPISE and BMD for all participants (β=-0.22, p < 0.001), as well as both groups [normal BMD (β = -0.10, p = 0.02) and low BMD groups (β = -0.15, p < 0.001)]. SPISE, family history of T2DM, and history of fractures collectively account for 17% of the variances perceived in T-score for all participants (p < 0.001).

CONCLUSIONS

A significant inverse association between the SPISE index and BMD was observed in adults, suggesting a link between BMD and extra-skeletal health. Underlying mechanisms need to be investigated prospectively using BMD as secondary outcomes in lifestyle modification programs.

Prevalence of Anemia in Type 2 Diabetic Patients and ‎correlation with Body Mass Index and Kidney ‎function in Palestine

Background

The objective of this study was to determine the prevalence of anemia in patients with type 2 diabetes mellitus and ‎to identify the set of anthropometric and biochemical factors that jointly influence ‎the diabetic and anemic patients including ‎body mass index and kidney function.‎‎.

Methods

A retrospective cross-sectional design study that was carried out in a private medical center ‎in Palestine. The study included a total of 453 patients with type 2 diabetes. Inclusion criteria ‎included all patients (18 years or older) suffering from type 2 Diabetes mellitus attended the ‎diabetic clinic from the 1st of January 2018, till 30th of December 2018.‎.

Results

A total number of 453 diabetic patients were recruited in the study. Male constituted 48.5% ‎‎(n=220) of the study sample and 51.4% (n=233) were female. Of total 453 diabetic patients, ‎‎38.4% (95% CI, 34%-43%) had anemia. The results of statistical modeling showed that female ‎gender (AOR 18.5; 95% CI 9.35-21.97), presence of hypertension (AOR 2.11; 95% CI 1.98- ‎‎4.25), high BMI (AOR 1.101; 95% CI 1.045-1.159), high Serum Creatinine (AOR 1.72; 95% ‎CI 1.22-2.13), high BUN level (AOR 1.22; 95% CI 1.145-1.301) and low e-GFR (AOR ‎‎0.571; 95% CI 0.271-0.872) are strong determents of anemia in type 2 diabetic patients.‎.

Conclusion

The results of the current study revealed a high prevalence of Anemia among type 2 diabetes ‎Mellitus patients. A significant association was reported between Anemia, kidney functions and ‎body mass index.‎.

Diabetes-related lower limb wounds: Antibiotic susceptibility pattern and biofilm formation

The expeditious incidence of diabetes mellitus in Riyadh, Saudi Arabia, there is a significant increase in the total number of people with diabetic foot ulcers. For diabetic lower limb wound infections (DLWs) to be effectively treated, information on the prevalence of bacteria that cause in this region as well as their patterns of antibiotic resistance is significant. Growing evidence indicates that biofilm formers are present in chronic DFU and that these biofilm formers promote the emergence of multi-drug antibiotic resistant (MDR) strains and therapeutic rejection. The current study targeted to isolate bacteria from wounds caused by diabetes specifically at hospitals in Riyadh and assess the bacterium's resistance to antibiotics and propensity to develop biofilms. Totally 63 pathogenic microbes were identified from 70 patients suffering from DFU. Sixteen (25.4%) of the 63 bacterial strains were gram-positive, and 47 (74.6%) were gram-negative. Most of the gram-negative bacteria were resistant to tigecycline, nitrofurantoin, ampicillin, amoxicillin, cefalotin, and cefoxitin. Several gram-negative bacteria are susceptible to piperacillin, meropenem, amikacin, gentamicin, imipenem, ciprofloxacin, and trimethoprim. The most significant antibiotic that demonstrated 100% susceptibility to all pathogens was meropenem. Serratia marcescens and Staphylococcus aureus were shown to have significant biofilm formers. MDR bacterial strains comprised about 87.5% of the biofilm former strains. To the best of our knowledge, Riyadh, Saudi Arabia is the first region where Serratia marcescens was the most common bacteria from DFU infections. Our research findings would deliver information on evidence-based alternative strategies to develop effective treatment approaches for DFU treatment.

Oral administration of proniosomal glibenclamide formulation protects testicular tissue from hyperglycemia fluctuations and ROS via Nrf2/HO-1 pathway

Type 2 diabetes causes high blood sugar due to insulin malfunction and is linked to male infertility. Using proniosomes can enhance the effectiveness of Glibenclamide, a medication that stimulates insulin secretion. In our study, male rats with diabetes were treated with GLB with or without proniosomal for 14 days. Proniosomal formulations maintained glucose levels prevented weight loss and showed normal testicular tissue. GLB-proniosomal reduces ROS caused by T2DM through Nrf2, HO-1 pathway and increases CAT, SOD, and GSH production in response to insulin and glucose uptake. The reference and proniosomal treatments showed CAT and SOD significant enzymatic elevation compared to the positive and negative control. CAT significantly correlated with Gpx4 expression with P = 0.0169 and r = 0.98; similarly, the enzymatic activity of SOD also showed a positive correlation between the average glucose levels (r = 0.99 and P = 0.0037). Intestinally, GSH analysis revealed that only proniosomal-GLB samples are significantly elevated from the positive control, with a P value of 0.0210. The data showed proniosomal-GLB was more effective than pure GLB, confirmed by higher Nrf2 (2.050 folds), HO-1 (2.148 folds), and GPx4 (1.9 folds) transcript levels relative to the control with less sample diversity compared to the reference samples, indicating proniosomal stabilized GLB in the blood. Administering GLB and proniosomes formulation has effectively restored testicular function and sperm production in diabetic rats by regulating ROS levels and upregulating anti-ROS in response to glucose uptake. These findings may lead to better treatments for diabetic patients who have infertility issues.

Prevalence and Determinants of Obesity and Overweight Among Children and Adolescents in the Middle East and North African Countries: An Updated Systematic Review

In recent years, the countries of the Middle East and North Africa (MENA) region have experienced alarming increases in the prevalence of childhood overweight and obesity. This updated systematic review sought to measure the prevalence and determinants of obesity and overweight among children and adolescents in MENA countries. A literature search for relevant observational studies published in English was conducted using PubMed, Web of Science, Google Scholar, and Saudi Digital Library. The risk of bias was evaluated using the Newcastle-Ottawa Scale. Twenty-one published articles during the past five years were included in the systematic review. Varied approaches were used to diagnose childhood overweight and obesity, including the International Obesity Taskforce (IOTF), Centre for Disease Control (CDC), World Health Organization (WHO), and Saudi Growth Pattern Curves. We found that the combined prevalence of childhood overweight and obesity in the Middle East is up to 49.4%, depending on the methods applied in their studies. Risk factors identified were age, male gender, lack of sufficient physical activity, consumption of fried food, perceived stress level, number of family members, family size, mother's occupation, education level, family history of obesity, high energy consumption from carbohydrates, ≥2 hours spent on watching television on weekend days with overweight, and always eating breakfast while watching television with obesity. The results of this review indicate that the issue of childhood and adolescent overweight and obesity in the Middle East is substantial and concerning. Most of the risk factors identified are modifiable and, if given appropriate attention, could significantly reduce the burden of associated chronic complications.

Characteristics, Outcomes, and Associations of Venous Thromboembolism in Diabetic Patients Infected With COVID-19 in Riyadh, Saudi Arabia

Background The associations and risk factors for venous thromboembolism (VTE) among hospitalized COVID-19 patients remain ambiguous in the literature, with some conflicting findings, especially in Saudi Arabia. In this study, we aim to elaborate on these data by examining regional patient populations and exploring the incidence, lab findings, and outcomes of VTE among hospitalized COVID-19 patients known to have diabetes mellitus (DM). Methodology This cross-sectional study was conducted at King Abdulaziz Medical City in Riyadh. The BestCare system was used to collect patients' data between September 2020 and February 2022. JMP15 was used for data analysis. Frequencies and percentages were used for categorical data, and median and interquartile ranges were used for quantitative data. The chi-square and Kruskal-Wallis rank-sum tests were used to assess the difference between categorical and quantitative variables, respectively. Nominal logistical regression was used to assess diabetes as a risk factor for developing VTE among COVID-19 patients. Results Data from 153 admitted patients were collected after they satisfied the inclusion criteria. Of these patients, 39 (25.49%) developed VTE. The demographic data included age group, gender, and DM status presented as frequencies and percentages. Through bivariate analysis, patients with longer hospital stays had at least one episode of VTE (p = 0.0072). Using nominal logistic regression analysis, diabetes as a risk factor (odds ratio = 4.11, confidence interval = 0.955-5.05, p = 0.0287) was significantly associated with the development of VTE in COVID-19 patients. Conclusions Based on our study, diabetes proved significant when evaluating the possible factors regarding VTE development in COVID-19 patients. In addition, the length of stay also played a critical role in the severity of VTE in COVID-19 patients. Similar studies should be conducted on a national scale in Saudi Arabia to accomplish two goals: first, to gain further understanding of the impact of the variables investigated in our population, and second, to publish data that are more generalizable to the larger population of Saudi Arabia.

An updated systematic review and Meta-analysis of the prevalence of type 2 diabetes in Iran, 1996-2023

Background

Diabetes mellitus (DM) poses a significant threat to public health, and the anticipated surge of over 100% in the age-standardized prevalence of type 2 diabetes in Iran between 2021 and 2050 underscores the pressing need for focused attention. The rationale for estimating the prevalence of type 2 diabetes in Iran becomes even more compelling when considering the potential cascading effects on the healthcare system, quality of life, and economic burden. The aim of this study was to estimate the prevalence and trends of DM from 1996 to 2023 in the Islamic Republic of Iran.

Methods

Up to July 2023, without deadlines, the search for appropriate articles in Persian and English. Iranian sources including SID, Magiran, and Element were included in the databases, along with foreign ones like PubMed/MEDLINE, Web of Science, Science Direct, Embase, Scopus, ProQuest, and Google Scholar. Using the JBI quality checklist, the study's level of quality was evaluated. Version 14 of STATA was used to carry out the statistical analysis. The Dersimonian and Liard random-effects models were used because of heterogeneity. To investigate the causes of heterogeneity, subgroup analysis and univariate meta-regression were utilized. Sensitivity analysis was then carried out to see how each study's findings affected the final findings. The prevalence pattern over time was also followed using cumulative meta-analysis.

Results

There were 53 studies in all, with a combined sample size of 1,244,896 people. Men were predicted to have a type 2 diabetes prevalence of 10.80% (95% CI: 9.1-12.4), while women were assessed to have a prevalence of 13.4% (95% CI: 11.6-15.3). Additionally, the prevalence of diabetes was much higher in the 55-64 age group, coming in at 21.7% (95% CI: 17.5-25.0). The anticipated prevalence of diabetes was 7.08% for 1988 to 2002, 9.05% for 2003 to 2007, 9.14% for 2008 to 2012, 15.0% for 2013 to 2017, and 13.40% for 2018 to 2023, among other time periods. Geographically, type 2 diabetes was most prevalent in Khuzestan (15.3%), followed by Razavi Khorasan (14.4%), Qazvin (14.3%), and Yazd (12.6%).

Conclusion

The prevalence of type 2 diabetes was estimated at 10.8%, highlighting variations across gender, age groups, and geographic regions that underscore the necessity for specific interventions. These findings advocate for proactive measures, including tailored screening and lifestyle modification programs. The notable temporal increase from 2013 to 2017 signals the need for policymakers and healthcare practitioners to develop effective strategies, anticipating and addressing the potential future burden on the healthcare system.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023437506, identifier: CRD42023437506.

Establishment of reference interval for hemoglobin A1C and other hemoglobin subfractions for healthy Saudi adults

BACKGROUND

The establishment of Reference Intervals (RIs) for Hemoglobin A1C and other hemoglobin subfractions (A1A, A1B, F, LA1C, A0) is of utmost importance in screening, diagnosing, and monitoring diabetes and other hemoglobin abnormalities through the application of high-pressure liquid chromatography (HPLC) technique. Because there are no locally established RIs for these parameters, it is essential to establish RIs specific to the Saudi population to accurately diagnose and monitor diabetic individuals and identify abnormal levels in hemoglobin subfractions.

METHODS

As part of the IFCC global multicenter study of laboratory reference values, a cross-sectional study was conducted in Saudi Arabia. The study involved recruiting a total of 381 healthy adult subjects (>18 years, BMI 28.3 ± 6 kg/m2). Blood samples were analyzed for A1C, biochemical and other immunoassay parameters. The need for RIs based on sex, age, and BMI was determined using the standard deviation ratio (SDR) through a 3-level nested ANOVA.

RESULTS

Based on the threshold of SDR≥0.4, RIs for A1C and other Hb subfractions were not partitioned by sex or BMI, but partitioned by age (<45 & ≥45 years) for A1C, LA1C, A0 and F. Spearman's correlation between glucose, insulin, and C-peptide showed a positive association with different hemoglobin subtractions of A1B, F, A1C, and LA1C. The RIs were obtained by using the parametric method and the latent abnormal values exclusion (LAVE) principle was applied on A1C.

CONCLUSION

This study established RIs for A1C and other Hb subfractions for healthy adult Saudis. Age was found to be an important source of variation for most of the parameters including A1C. These findings will enhance the understanding and clinical decision-making concerning A1C and other hemoglobin subfractions. The elevated upper limit of RIs for A1C reflects the high prevalence of diabetes in the Saudi population specially in those with increased age.

Association of Anxiety and Depressive Symptoms and Treatment Adherence Among Patients With Type 2 Diabetes Mellitus in Jazan, Saudi Arabia: A Cross-Sectional Study

BACKGROUND

Diabetes mellitus is a serious public health concern. It is associated with many psychological problems, such as depression, anxiety, and eating disorders. These co-morbidities are associated with improper adherence to treatment, self-care, poor glycemic control, more complications, and worse outcomes.

METHODS

This study aimed to measure the level of medication adherence among type 2 diabetics in Jazan, Saudi Arabia, and to find its association with their psychological status (specifically, depression and anxiety). A cross-sectional descriptive design was used among adults with type 2 diabetes at the Diabetes and Endocrinology Center in Jazan, Saudi Arabia. The estimated sample size was 480 patients. The General Medication Adherence Scale and Patient Health Questionnaire-4 (PHQ-4) were used as tools to achieve the study objectives.

RESULTS

A total of 449 diabetic patients completed the survey (93.5% response rate). Patients with poor, low, and partial adherence account for 337 (75%) of patients and only 112 (25%) have good and high medication adherence. Employment and duration of illness were highly significant with a positive relationship to treatment adherence (p = 0.010 and 0.000, respectively). On the other hand, age and disease duration had a significant relationship with psychological disorders (p = 0.029 and 0.002, respectively). Of the patients, 64 (14.3%) had high scores on the PHQ-4, with depressive symptoms in 46 (10.24%) and anxiety symptoms in 75 (16.7%). Correlation analysis reveals that there is a highly significant negative correlation between psychological disorders and adherence to medications (r = -0.288, p = 0.000).

CONCLUSION

A negative correlation between psychological disorders and adherence to medications was found. The findings indicate the importance of psychological support for diabetic patients for better treatment adherence.

Global prevalence of cardiovascular risk factors based on the Life's Essential 8 score: an overview of systematic reviews and meta-analysis

Cardiovascular health (CVH) is a critical issue for global health. However, no previous study has determined the prevalence of cardiovascular risk factors based on the American Heart Association's (AHA) Life's Essential 8 (LE8). Therefore, we aimed to estimate the global prevalence of the eight cardiovascular risk factors identified in the LE8. A systematic search of systematic reviews with meta-analysis on cardiovascular risk factors covering data reported between 2000 and 2019 was conducted on PubMed, Epistemonikos, and the Cochrane Library until 1 May 2023. After applying exclusion criteria, 79 studies remained in the final selection for the narrative synthesis in the systematic review, of which 33 of them were used in the meta-analysis which included 2 555 639 participants from 104 countries. The overall pooled prevalence of cardiovascular risk factors was as follows: insufficient physical activity, 26.3% (95% CI 2.3%-63.4%), no adherence to a healthy diet, 34.1% (95% CI 5.8%-71.2%), nicotine exposure, 15.4% (95% CI 10.4%-21.2%), insufficient sleep quality, 38.5% (95% CI 14.0%-66.7%), obesity, 17.3% (95% CI 6.1%-32.6%), dyslipidemia, 34.1% (95% CI 33.8%-34.4%), diabetes, 12.0% (95% CI 7.0%-18.2%), and hypertension, 29.4% (95% CI 23.3%-35.8%). These results warrant prevention strategies aimed at reducing insufficient sleep quality, and no adherence to a healthy diet as leading cardiovascular risk factors worldwide. The high prevalence of hypertension among children and adults is concerning and should also be adequately addressed through global policies.

Artificial intelligence approaches for early detection of neurocognitive disorders among older adults

Introduction

Dementia is one of the major global health issues among the aging population, characterized clinically by a progressive decline in higher cognitive functions. This paper aims to apply various artificial intelligence (AI) approaches to detect patients with mild cognitive impairment (MCI) or dementia accurately.

Methods

Quantitative research was conducted to address the objective of this study using randomly selected 343 Saudi patients. The Chi-square test was conducted to determine the association of the patient's cognitive function with various features, including demographical and medical history. Two widely used AI algorithms, logistic regression and support vector machine (SVM), were used for detecting cognitive decline. This study also assessed patients' cognitive function based on gender and developed the predicting models for males and females separately.

Results

Fifty four percent of patients have normal cognitive function, 34% have MCI, and 12% have dementia. The prediction accuracies for all the developed models are greater than 71%, indicating good prediction capability. However, the developed SVM models performed the best, with an accuracy of 93.3% for all patients, 94.4% for males only, and 95.5% for females only. The top 10 significant predictors based on the developed SVM model are education, bedtime, taking pills for chronic pain, diabetes, stroke, gender, chronic pains, coronary artery diseases, and wake-up time.

Conclusion

The results of this study emphasize the higher accuracy and reliability of the proposed methods in cognitive decline prediction that health practitioners can use for the early detection of dementia. This research can also stipulate substantial direction and supportive intuitions for scholars to enhance their understanding of crucial research, emerging trends, and new developments in future cognitive decline studies.

The Influence of Social Support on Self-Care Behavior among T2DM Patients

Introduction

T2DM is a chronic health condition that requires routine self-care. Despite T2DM patients being able to manage self-care behaviors, psychosocial factors, including social support, have been considered effective in improving diabetic self-care behaviors.

Objective

This study aimed at examining the influence of social support on self-care behavior among T2DM patients in Dr. Soliaman Fakeeh Hospital.

Methods

This was a cross-sectional study. The study was carried out at Dr. Soliaman Fakeeh Hospital using a sample size of 192 T2DM patients. Data were collected using a self-administered questionnaire comprised of a demographic section, the Scale of Perceived Social Support (MSPSS) section, and the Diabetes Self-Care Activities Questionnaire (DSCAQ) section. The data were analyzed using descriptive statistics and inferential statistics.

Results

The study analyzed data from 192 complete responses (91.86%) out of 209 respondents. Regarding gender, most of the respondents were female T2DM patients (n  =  103, 53.6%), while males (n  =  89, 46.4%) The highest level of social support was from the family (mean of 5.49). The highest performing self-care activity performed by the respondents was blood glucose monitoring (mean of 6.01). Analysis of the correlation between the Scale of Perceived Social Support (MSPSS) and the DSCAQ revealed positive and significant correlations (r  =  0.370, p  =  0.001).

Conclusions

This study showed that social support influenced self-care behaviors in patients with T2DM. Therefore, interventions should be developed focused on enhancing the levels of social support and self-care behaviors.

Evaluation of Self-Management Behaviors and Its Correlation with the Metabolic Syndrome among the Type 2 Diabetes Mellitus Patients of Northern Saudi Arabia

Self-management behavior among diabetes patients is essential to monitor blood sugar levels, make necessary lifestyle changes, and help patients reduce their risk of complications from diabetes. We assessed the prevalence of metabolic syndrome (MS) and its association with self-management behavior and sociodemographic characteristics among 310 patients with type 2 diabetes mellitus (T2DM) attending different diabetes care centers in northern Saudi Arabia. We evaluated the self-management behaviors of patients with T2DM using a validated Arabic version of the Summary of Diabetes Self-Care Activities Scale. Regarding MS, we applied the National Cholesterol Education Program (NCEP) Adult Treatment Plan-3 (ATP-3) guidelines. A logistic regression analysis was used to identify the predictors of MS. We found that more than one-third (36.5%) of patients had MS according to the NCEP ATP-3 criteria. The prevalence of MS was significantly associated with unsatisfactory self-management behaviors. Regarding sociodemographic predictors for MS, we found a significant association between gender (ref: female: Adjusted OR (AOR) = 1.89, 95%CI = 1.17-2.95, p = 0.007) and body mass index (ref.: normal range: AOR = 2.98, 95%CI = 1.31-5.07, p = 0.003). Our findings suggest a tailor-made multifaceted intervention to improve the self-management behaviors of T2DM patients, which, in turn, can reduce MS.

Protective Effects of Sitagliptin on Streptozotocin-Induced Hepatic Injury in Diabetic Rats: A Possible Mechanisms

Diabetes is a ubiquitous disease that causes several complications. It is associated with insulin resistance, which affects the metabolism of proteins, carbohydrates, and fats and triggers liver diseases such as fatty liver disease, steatohepatitis, fibrosis, and cirrhosis. Despite the effectiveness of Sitagliptin (ST) as an antidiabetic drug, its role in diabetes-induced liver injury is yet to be fully investigated. Therefore, this study aims to investigate the effect of ST on hepatic oxidative injury, inflammation, apoptosis, and the mTOR/NF-κB/NLRP3 signaling pathway in streptozotocin (STZ)-induced liver injury. Rats were allocated into four groups: two nondiabetic groups, control rats and ST rats (100 mg/kg), and two diabetic groups induced by STZ, and they received either normal saline or ST for 90 days. Diabetic rats showed significant hyperglycemia, hyperlipidemia, and elevation in liver enzymes. After STZ induction, the results revealed remarkable increases in hepatic oxidative stress, inflammation, and hepatocyte degeneration. In addition, STZ upregulated the immunoreactivity of NF-κB/p65, NLRP3, and mTOR but downregulated IKB-α in liver tissue. The use of ST mitigated metabolic and hepatic changes induced by STZ; it also reduced oxidative stress, inflammation, and hepatocyte degeneration. The normal expression of NF-κB/p65, NLRP3, mTOR, and IKB-α were restored with ST treatment. Based on that, our study revealed for the first time the hepatoprotective effect of ST that is mediated by controlling inflammation, oxidative stress, and mTOR/NF-κB/NLRP3 signaling.

The Relationship of ABO and Rh Blood Group Types With Severe COVID-19 Disease Mortality in ICU Patients: Insights From a Single-Center Experience in Southern Saudi Arabia

Introduction The global COVID-19 pandemic has triggered an unprecedented public health crisis, emphasizing the need to understand factors influencing disease outcomes. This study explores the role of genetic variations in blood group antigens, particularly ABO and RhD, in shaping mortality rates among critically ill COVID-19 patients in the southern region of Saudi Arabia. Methods Utilizing a retrospective, noninterventional approach, we analyzed medical records of 594 COVID-19 patients admitted to the intensive care unit (ICU) at Aseer Central Hospital from August 2020 to April 2021. The cohort, with a mean age of 60.5 years, consisted of a predominantly male population. Results The study encompassed a diverse age range of 18 to 103 years, with a mean age of 60.5 ± 17.3 years. Of the 594 patients, 398 (67%) were male, and only 5 (0.8%) had a history of smoking. Blood group distribution revealed 275 (48.4%) with O-, 189 (33.3%) with A+, and 51 (9%) with AB- types. Predominant chronic conditions included diabetes mellitus (35.5%). Tragically, 320 patients (54.6%) experienced mortality, with a 100% mortality rate for the B+ blood group and 92.9% for O- blood group. Conclusion This analysis establishes significant statistical links, underscoring the pivotal role of blood type, particularly the Rh factor, in influencing mortality risk among critically ill COVID-19 patients. These findings contribute valuable insights into risk stratification and personalized care for severe cases, emphasizing the importance of genetic considerations in understanding disease outcomes.

Adoption of Wearable Insulin Biosensors for Diabetes Management: A Cross-Sectional Study

BACKGROUND

Wearable insulin biosensors represent a novel approach that combines the benefits of real-time glucose monitoring and automated insulin delivery, potentially revolutionizing how individuals with diabetes manage their condition.

STUDY PURPOSE

To analyze the behavioral intentions of wearable insulin biosensors among diabetes patients, the factors that drive or hinder their usage, and the implications for diabetes management and healthcare outcomes.

METHODS

A cross-sectional survey design was adopted in this study. The validated questionnaire included 10 factors (Performance expectancy, effort expectancy, social influence, facilitating conditions, behavioral intention, trust, perceived privacy risk, and personal innovativeness) affecting the acceptance of wearable insulin sensors. A total of 248 diabetic patients who had used wearable sensors participated in the study.

RESULTS

Performance expectancy was rated the highest (Mean = 3.84 out of 5), followed by effort expectancy (Mean = 3.78 out of 5), and trust (Mean = 3.53 out of 5). Statistically significant differences (p < 0.05) were observed with respect to socio-demographic variables including age and gender on various influencing factors and adoption intentions. PE, EE, and trust were positively associated with adoption intentions.

CONCLUSION

While wearable insulin sensors are positively perceived with respect to diabetes management, issues like privacy and security may affect their adoption.

The risk of developing type 2 diabetes mellitus among the students of Hail University, Saudi Arabia

Background

Globally, it is estimated that approximately 537 million adults are living with diabetes. Of them, more than 90% have type 2 diabetes (T2DM). In 2023, a previous meta-analysis showed that the prevalence of T2DM among the general adult population in Saudi Arabia was 28%. This study was conducted to assess the risk of developing T2DM among the students at Hail University, Saudi Arabia.

Methods

This cross-sectional study was conducted in 2022/2023 among a census sample of 740 students (both genders, aged 17-26 years) studying at nine colleges of Hail University, Saudi Arabia. The diabetes risk score was assessed using the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK). Anthropometric measurements were measured and recorded using standard methods. Socio-demographic variables were also obtained with an interview-based questionnaire. Statistical analysis was performed using SPSS version 25.

Results

A total of 740 students were included in the final analysis. Of them, 274 (37.0%) were male students and 466 (63.0%) were female students. The mean age of the study participants is 19.9 ± 1.6 years. The findings showed that 61.9% of the study participants were at intermediate and high risk of diabetes (59.7 and 2.2%, respectively). The majority 85.7% of male students were at intermediate risk of diabetes, and 5.8% were at high risk of diabetes. In total, 44.4% of female students were at intermediate risk of diabetes, and none of them were at high risk of diabetes. For the following variables (age, gender, college name, area of the university, academic years, weight, height, and BMI), the differences were statistically significant between different categories of diabetes risk scores (P-values < 0.005).

Conclusion

More than half of the students at the Hail University of Saudi Arabia have an intermediate and high risk of T2DM. Male students are at a higher risk compared to female students. The high risk of T2DM among university students should be seriously considered.

Comprehensive Molecular Evaluation of HNF-1 Alpha, miR-27a, and miR-146 Gene Variants and Their Link with Predisposition and Progression in Type 2 Diabetes Patients

BACKGROUND

Type 2 diabetes (T2D) is a metabolic condition induced by insulin resistance and pancreatic beta cell dysfunction. MicroRNAs (miRNAs) have biological significance because they regulate processes such as the molecular signaling pathways involved in the pathophysiology of diabetes mellitus. The hepatocyte nuclear factor-1 alpha (HNF-1 alpha) is a transcription factor found in hepatocytes and the pancreas. Mutations in the HNF-1 alpha gene were reportedly associated with maturity-onset diabetes of the young (MODY). The objective of the present study was to examine the associations between MiR-27a, MiR-146, and HNF-1 alpha single-nucleotide variations (SNVs) with T2D risk in the Saudi population.

METHODOLOGY

We evaluated the association of SNVs of miR-27a rs895819 A>G, 146a-rs2910164 C>G, and HNF-1 alpha rs1169288 G>T (I27L) with the risk of T2D in Saudi patients with the Amplification Refractory Mutation System PCR (ARMS-PCR). For the miR-27a SNVs, we used 115 cases (82 males, 33 females) and 117 matched healthy controls (HCs); for the Mir-146 SNVs, we used 103 cases (70 males, 33 females) and 108 matched HCs; and for the HNF-1 alpha, we employed 110 patients (80 males, 30 females) and 110 HCs. The blood biochemistry of the participants was essayed using commercial kits, and the methods of statistical analysis used were the Chi-square test, the Fisher exact test, and a multivariate analysis based on logistic regression, like the odds ratio (OD) and risk ratio (RR), with 95% confidence intervals (CIs).

RESULTS

The MiR-27a rs895819 AG genotype was linked to increased T2D susceptibility, with OR = 2.01 and p-value = 0.011, and the miR-146 rs2910164 CG genotype and C allele were linked to an elevated risk of T2D, with OR = 2.75, p-value < 0.0016, OR = 1.77, and p-value = 0.004. The results also showed that the GT genotype and T allele of the HNF-1 alpha (rs1169288) G>T is linked to T2D, with OR = 2.18, p-value = 0.0061, and 1.77, p-value = 0.0059.

CONCLUSIONS

The SNVs in miR-27a, miR-146, and HNF-1 alpha can be potential loci for T2D risk. The limitations of this study include the relatively small sample size and the fact that it was a cross-sectional study. To our knowledge, this is the first study to highlight the association between miR-27a, miR-146, and HNF-1 alpha SNVs and the risk of T2D in the Saudi population. Future large-scale case-control studies, as well as studies on the functions of the proteins and protein interaction studies for HNF-1 alpha, are required to verify our findings. Furthermore, these findings can be used for the identification and stratification of at-risk populations via genetic testing for T2D-prevention strategies.

A Review of the Anti-Obesity Effects of Wild Edible Plants in the Mediterranean Diet and Their Active Compounds: From Traditional Uses to Action Mechanisms and Therapeutic Targets

Obesity is a long-term condition resulting from a continuous imbalance between the amount of energy consumed and expended. It is associated with premature mortality and contributes to a large portion of the global chronic disease burden, including diabesity, cardiovascular disease, hypertension, and some cancers. While lifestyle changes and dietary adjustments are the primary ways to manage obesity, they may not always be sufficient for long-term weight loss. In these cases, medication may be necessary. However, the options for drugs are limited due to their potential side effects. As a result, there is a need to identify safe and effective alternative treatments. Recently, dietary compounds, plants, and bioactive phytochemicals have been considered as promising sources for discovering new pharmacological agents to treat obesity and its related complications. These natural products can function independently or synergistically with other plants to augment their effects at various levels of the body. They can modulate appetite, lipase activity, thermogenesis and fat synthesis and degradation, satiation, adipogenesis, and adipocyte apoptosis. Additionally, targeting adipocyte growth and differentiation with diverse medicinal plants/diet is a significant strategy for devising new anti-obesity drugs that can intervene in preadipocytes, maturing preadipocytes, and mature adipocytes. Clinical trials have shown that the wild edible plants in the Mediterranean diet can reduce the risk of obesity and its related diseases. This review examines the effectiveness of the common components of the Mediterranean diet in managing obesity and its associated health issues. We conducted a comprehensive literature review using PubMed, Science Direct, Google Scholar, and Medline Plus to gather data on the therapeutic effects of the Mediterranean diet and phytochemicals in treating obesity and its associated diseases.

Association of Selenium Intake and Selenium Concentrations with Risk of Type 2 Diabetes in Adults: A Narrative Review

Several recent studies have suggested selenium (Se) as a potential risk factor for diabetes mellitus (DM); however, the relationship between high Se levels and type 2 diabetes mellitus (T2DM) risk remains unclear. This review article aimed to provide a comprehensive discussion to clarify the association between high dietary Se intake and blood Se concentrations and the risk of T2DM among adults. We conducted searches in the PubMed, Science Direct, and Google Scholar databases for the years 2016 to 2022 and evaluated 12 articles from systematic reviews, meta-analyses, cohort studies, and cross-sectional studies. This review found a controversial association between high blood Se concentrations and T2DM risk while demonstrating a positive correlation with DM risk. In contrast, there are conflicting results regarding the association between high dietary Se intake and T2DM risk. Thus, longitudinal studies and randomized controlled trials are needed to better elucidate the link.