Prevalence of Prediabetes, Diabetes and Its Predictors among Females in Alkharj, Saudi Arabia: A Cross-Sectional Study

Factors Associated with the Incidence of Prediabetes in Bogor, Indonesia: A Cohort Study

BACKGROUND

Prediabetes is a golden period because the blood sugar levels can be lowered to normal levels, unlike diabetes mellitus. Studies on risk factors of prediabetes in Indonesia have never been conducted before, especially with cohort study design. The purpose of this study was to identify risk factors associated with prediabetes in Indonesia based on a cohort study conducted in Bogor, Indonesia. Study Design: A retrospective cohort study.

METHODS

This study was conducted using data from the Bogor Cohort Study done by the Ministry of Health of Indonesia, which included individuals aged more than 25 years. Individuals who had impaired fasting glucose (IFG) (100-125 mg/dL) and/or impaired glucose tolerance (IGT) (140-199 mg/dL) at baseline screening were excluded from the study. Demographic characteristics, risk factors, and clinical observations were extracted using a questionnaire. Cox regression was used for data analysis.

RESULTS

The cumulative incidence of prediabetes in Bogor was 50.3%. Factors associated with prediabetes were old age (RR: 1.33; 95% CI 1.19, 1.47), female gender (RR: 1.32; 95% CI 1.18, 1.48), overweight (RR: 1.17; 95% CI 1.01, 1.36), obesity (RR: 1.26; 95% CI 1.08, 1.46), central obesity (RR: 1.17; 95% CI 1.02, 1.34), high cholesterol levels (RR: 1.11; 95% CI 1.00, 1.22), and hypertension (RR: 1.27; 95% CI 1.14, 1.42).

CONCLUSION

Age is a dominant risk factor for prediabetes. Therefore, it is important to stick to a healthy lifestyle by doing more physical activities and maintaining a balanced diet since young age to prevent prediabetes.

Characteristics and risk factors associated with developing prediabetes in Saudi Arabia

OBJECTIVE

Prediabetes is prevalent in Saudi Arabia and globally. It is associated with adverse health outcomes and complications. Consequently, this study aimed to determine the risk factors associated with developing prediabetes in Saudi Arabia.

METHODS

This is a case-control study conducted at the Family and Community Medicine Department at Prince Sultan Military Medical City, Riyadh, Saudi Arabia. The cases included individuals with prediabetes (prediabetes group), and the control group included individuals with normal HbA1c levels who were not diagnosed with prediabetes or diabetes. The data collected included sociodemographic data, clinical parameters, laboratory tests, and medical conditions.

RESULTS

The study included 46,201 patients (16,029 patients with prediabetes and 30,173 in the control group). The age of the patients (mean ± SD) with prediabetes was significantly higher than that of the control group (47.22 ± 14.04 versus 36.12 ± 11.83, p < 0.0001). A higher proportion of men was noted in the prediabetes group compared to the control group (36.32% versus 26.54%, p < 0.0001). The body mass index (mean ± SD) was higher in the prediabetes group compared to the control group (33.76 ± 6.75 versus 30.16 ± 7.26, p < 0.0001). The multiple logistic regression analysis showed six independent risk factors associated with prediabetes. These included age (aOR [95% CI] = 1.067 [1.065-1.069]) and gender, with women at a lower risk compared to men (aOR [95% CI] = 0.695 [0.664-0.728]). Other independent risk factors included polycystic ovarian syndrome (aOR [95% CI] = 58.102 (35.731-94.479]), obesity (aOR [95% CI] = 1.265 [1.075-1.487]), cardiac conditions (aOR [95% CI] = 4.870 [1.024-23.154]), and hypertension (aOR [95% CI] = 1.133 [1.031-1.245]).

CONCLUSIONS

The study showed that several risk factors are associated with the development of prediabetes in the Saudi population. Addressing these factors can help prevent prediabetes, and consequently, its burden and further progression to diabetes.

Prevalence of Clinical Manifestations Known to Be Associated With Insulin Resistance Among Female Medical Students of a Private College in Saudi Arabia

Background Insulin resistance has a significant relationship with a lot of chronic diseases. This is an alarm for the future high prevalence of many chronic diseases. Due to the lack of sufficient data surrounding the clinical manifestations of insulin resistance among the Saudi population, the study aims to fill this gap by assessing the prevalence of dermatological, cognitive, daytime sleep, and craving changes in the Saudi population, which are markers of insulin resistance. Methods A cross-sectional study was carried out to study the prevalence of clinical manifestations known to be associated with insulin resistance with a convenient nonprobability sample among 272 female medical students at the Ibn Sina National College for Medical Studies, a private medical college in Jeddah, Saudi Arabia. Each participant underwent an in-person interview where height, weight, and waist circumference were measured and BMI calculated. The in-person interview was performed using a series of questionnaires that assessed demographic data and clinical manifestations related to insulin resistance. Data was collected and grouped using Microsoft Excel (Microsoft Corp., Redmond, WA, USA). Statistical analyses were performed using IBM SPSS Statistics for Windows, version 22 (IBM Corp., Armonk, NY, USA). For prevalence calculations, percentages were used. The Chi-square test was used to analyze qualitative variables. The level of significance adopted was p < 0.05. Results The research revealed that acanthosis nigricans, skin tags, and alopecia areata were statistically significant in relation to waist circumference as an indicator of insulin resistance. Conversely, of all the dermatological manifestations, acne, psoriasis, hidradenitis suppurativa, hirsutism, and vitiligo were not associated with waist circumference. Also, polycystic ovary syndrome (PCOS) was statistically significant. Regards cognitive changes, carbohydrate craving, and day sleep were all proportionally higher in the high waist circumference category but were not found to be significantly significant in relation to waist circumference. Conclusion  The findings of the study confirm the association of dermatological and endocrine features such as acanthosis nigricans, skin tags, alopecia areata, and PCOS with waist circumference as an indicator of insulin resistance. The high prevalence of increased waist circumference in the study population is also in line with international data concerning the increasing incidence of insulin resistance and, consequently, diabetes mellitus will be seen among younger age groups.

A systematic review of obesity burden in Saudi Arabia: Prevalence and associated co-morbidities

Introduction

Saudi Arabia has experienced an increasing trend in obesity prevalence in the last three decades; obesity is a significant risk factor for non-communicable diseases, which may cause healthcare and economic burdens. In this systematic review, we aim to explore the obesity prevalence, obesity-related complications (ORCs), and the economic burden of obesity in Saudi Arabia.

Methods

Literature searches for relevant local studies across Saudi Arabia spanning 2012 to 2022 were performed in PubMed and EMBASE, along with supplementary searches for relevant congress abstracts. Only studies that discussed obesity prevalence in Saudi Arabia in relation to any gender or age group, the prevalence of ORCs in Saudi Arabia for any gender or age group, and/or the economic burden of obesity and how it impacts the healthcare system in Saudi Arabia, and were published in the English language, were selected for inclusion. No age or gender restrictions were imposed.

Results

The prevalence of obesity in Saudi Arabia ranged from 20% to 39% and up to 19.4% among adults and adolescents, respectively. The most reported ORCs were hypertension (67.6%), type 2 diabetes (60.7%), and hypercholesterolaemia (51.3%), and an association between obesity and ORCs was established, showing an increased risk with increasing body mass index. The economic burden of obesity across Saudi Arabia was estimated to be 6.4 billion US dollars (USD) for treatment and management.

Conclusion

Obesity affects a substantial proportion of the Saudi general population and is a significant burden on individuals, as demonstrated by the prevalence of ORCs. Multifaceted, short- and long-term approaches involving interventions that operate at multiple levels and target both individuals and communities are urgently needed; there is a particular need for a national strategy and a specific, systems-based policy. Further research will help increase awareness of obesity and its management, which will be crucial for transforming the healthcare system under Vision 2030.

Relationship between Marriage and Prediabetes among Healthcare Workers: Mediating Effect of Triglycerides

Background and Objectives: In the literature, relationships between being married and having prediabetes or diabetes are inconsistent. We aimed to investigate whether marriage is a protective or risk factor for prediabetes and to uncover new insights into its impact on prediabetes. Materials and Methods: In this cross-sectional observational study, questionnaires were distributed by email to 1039 staff members who participated in an employee health check from a hospital affiliated with a medical university in Taiwan. Fasting blood glucose and triglyceride (TG) levels were checked and the questionnaires elicited basic demographic characteristics and included the Copenhagen Burnout Inventory and Nordic Musculoskeletal Questionnaire. The chi-square test or Fisher's exact test, logistic regression, and mediation analysis were conducted for statistical analysis. Results: Among the group aged 20-37 years, married (OR = 1.89, 95%CI: 1.08, 3.33), obesity (OR = 2.95, 95%CI: 1.49, 5.83), neck and shoulder pain (OR = 1.31, 95%CI: 1.01, 1.69), and elevated TG levels (OR = 1.01, 95%CI: 1.00, 1.01) were independent risk factors for prediabetes (impaired fasting glucose). For those >38 years old, overweight (OR = 2.08, 95%CI: 1.27, 3.43), obesity (OR = 4.30, 95%CI: 2.38, 7.79), and elevated triglyceride (TG) (OR = 1.003, 95%CI: 1.00, 1.01) were the independent risk factors for impaired fasting glucose. Increased TG levels serve as a mediating factor (Zm = 2.64, p < 0.01) linking marriage to an increased risk of prediabetes for the group aged 20-37 years. Conclusions: TGs play a significant role in the association between marriage and prediabetes among the group aged 20-37 years. Therefore, dietary habits, especially those of young adult couples should be considered. Our findings connect marital status to prediabetes, facilitating advances in diabetes prevention.

Prediction of Diabetes and Prediabetes among the Saudi Population Using a Non-Invasive Tool (AUSDRISK)

Background and Objectives: Screening for type 2 diabetes mellitus (DM2) aims to identify asymptomatic individuals who may be at a higher risk, allowing proactive interventions. The objective of this study was to predict the incidence of DM2 and prediabetes in the Saudi population over the next five years. Materials and Methods: The study was conducted in the Aseer region through August 2023 using a cross-sectional survey for data collection. A multistage stratified random sampling technique was adopted, and data were collected through face-to-face interviews using the validated Arabic version of the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK). Results: In total, 652 individuals were included in the study. Their mean age was 32.0 ± 12.0 years; 53.8% were male, 89.6% were from urban areas, and 55.8% were single. There were statistically significant differences between males and females in AUSDRISK items, including age, history of high blood glucose, use of medications for high blood pressure, smoking, physical activity, and measurements of waist circumference (p < 0.05). Based on AUSDRISK scores, 46.2% of the included participants were predicted to develop impaired glucose tolerance within the coming five years (65.8% among females vs. 23.6%), and 21.9% were predicted to develop DM2 (35.6% among males vs. 6.0% among females); this difference was statistically significant (p = 0.0001). Conclusions: Urgent public health action is required to prevent the increasing epidemic of DM2 in Saudi Arabia.

Evaluation of a Lipid Profile in Normoglycemic and Pre-diabetic Saudi Office Employees in Makka Region: A Case-Control Study

BACKGROUND

Diabetes mellitus (DM) poses a significant health challenge worldwide. The impact of a sedentary lifestyle in predicting and managing complications of diabetes represents an urgent need for health strategies. The objective of this study was to evaluate the lipid profile among normoglycemic and prediabetic Saudi office workers.

METHODS

The research was a case-control study carried out in Makkah al-Mukarramah (Kingdom of Saudi Arabia, KSA). Seventy-five office worker volunteers between the ages of 19 and 45 years were recruited for the study. The participants were divided into two groups: a control group of non-diabetic normal subjects (NGT) and prediabetic subjects with impaired fasting plasma glucose and/or impaired glucose tolerance (IGT), based on the American Diabetes Association recommendations. Measurements of glucose, hemoglobin A1C (HbA1C), total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were performed using standard procedures and commercial kits. Statistical analysis was performed to compare the lipid profile in the two groups, and a P-value of <0.05 was considered statistically significant.

RESULTS

A proportion (58.7%) of the office workers are prediabetics; prediabetic office workers had higher total cholesterol compared to the control group (p < 0.05). Triglyceride levels were higher in office workers with prediabetes compared to the normoglycemic group (p < 0.05). LDL levels were elevated in the prediabetic office workers compared to the control group (p < 0.05).

CONCLUSION

Office employees with prediabetes exhibit elevated levels of cholesterol, triglycerides, and LDL. The disturbance in lipid profile may be linked to impaired glucose tolerance in individuals with a sedentary lifestyle, such as office workers.

Family Involvement to Stop the Conversion of Prediabetes to Diabetes

Prediabetes is a condition associated with an increased risk of developing diabetes, in which blood glucose levels are high but not high enough to be diagnosed as diabetes. The rapid increase in the prevalence of prediabetes is a major global health challenge. The incidence of prediabetes has increased to pandemic levels and can lead to serious consequences. Unfortunately, nearly 90% of prediabetic individuals are unaware of their ailment. A quarter of prediabetic individuals develop type 2 diabetes mellitus (T2DM) within 3-5 years. Although prediabetes is a reversible condition, the prevention of diabetes has received little attention. It is essential for prediabetic individuals to implement new health-improvement techniques. Focusing on family systems is one strategy to promote health, which is determined by health patterns that are often taught, established, and adjusted within family contexts. For disease prevention, a family-based approach may be beneficial. Family support is essential for the metabolic control of the disease. This study aimed to show several strategies for involving the patient's family members in preventing the conversion of prediabetes to T2DM and to emphasize that the patient's family members are a valuable resource to reduce the incidence of diabetes.

Association Between Risk for Prediabetes and Type 2 Diabetes Mellitus Prevention Among Faculty Members and Administrative Staff of a Saudi University

BACKGROUND

Diabetes mellitus prevalence continues to rise globally, causing disability and decreased productivity among patients, a significant strain on healthcare systems, and a burden on national economies. In 2021, diabetes will affect approximately 537 million adults. The rising prevalence of prediabetes worldwide also poses a significant public health threat, as it is estimated that by 2030, more than 470 million individuals will be prediabetic.

OBJECTIVE

This study aimed to determine the association between the risk of prediabetes and the level of Type 2 Diabetes Mellitus (T2DM) prevention among faculty members and administrative staff of a Saudi university.

METHODS

An analytic cross-sectional study design was utilized. The prediabetes risk of respondents was assessed using a risk test developed by the CDC, while the participants' diabetes prevention practices were determined using a researcher-developed questionnaire. Data were collected from 360 selected faculty members and administrative staff of three randomly selected health colleges and three non-health colleges at King Faisal University, Hofuf, Al-Ahsa, Saudi Arabia, between September 25 and October 13, 2022. The collected data were subjected to estimation of proportion and logistic regression analyses using Epi InfoTM version 7.

RESULTS

Nearly 40% of respondents (39.72%, 95% CI: 34.80, 44.86) were found to be at high risk for prediabetes. The majority of university faculty and administrative staff consistently practiced T2DM preventive measures related to the limitation of processed food consumption, smoking cessation, and regular checking of weight and the nutritional value of food. However, there was poor T2DM prevention practice in terms of exercise, consumption of sweetened beverages, and stress reduction. Those who had a high prediabetes risk were 1.17 times more likely to engage in T2DM prevention practices. However, they were found to be 19% less likely to perform T2DM prevention practices when sociodemographic variables were held constant.

CONCLUSION

Prediabetes risk was prevalent among Saudi university faculty and administrative staff. T2DM prevention was not consistently practiced by those who had a high risk for prediabetes. High prediabetes risk was negatively associated with the level of T2DM prevention.

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

Background

The prevalence of type 2 diabetes mellitus (T2DM) has increased worldwide, including in Saudi Arabia.

Objective

To systematically review the available literature and assess the pooled prevalence of T2DM in Saudi Arabia between 2000 and 2020.

Methods

Observational studies that reported quantitative estimates of the prevalence of T2DM as their main outcome, included the general population of Saudi Arabia, and were published between 2000-2020 and in English were retrieved using three electronic databases (namely, CINAHL, Medline via PubMed, and Web of Science). Retrieved studies were screened, and relevant data were extracted. The Joanna Briggs Institute Critical Appraisal guideline was used to assess the methodological quality of included studies. A random-effects model was used to estimate the prevalence of T2DM.

Results

Twenty-three studies were included in the systematic review, of which 19 were included in the meta-analysis (total pooled population: 258,283). The overall pooled prevalence of T2DM in Saudi Arabia was 16.4% (95% CI: 11.6-17.5). However, there was heterogeneity in the results of the studies [I2 = 99.31%, P < 0.0001] and the summary values varied from 3.18% (95% CI: 1.46-5.95) to 94.34% (95% CI: 89.53-97.38). Although the prevalence of T2DM by age varied across studies, in most studies, it was higher among the older age groups. In addition, the prevalence of diabetes widely varied across the different geographical regions of Saudi Arabia.

Conclusions

This is the first meta-analysis that determined the pooled prevalence of T2DM in Saudi Arabia, and it revealed a high prevalence over the past two decades. However, owing to data collection inconsistencies in the identified studies, neither the modifiable (such as obesity, educational status, emotional support, etc.) nor the non-modifiable (such as gender and age) risk factors of T2DM could be determined, thereby indicating the need for a nationally collective effort in determining these factors.

Knowledge, Awareness, and Practice Related to Diabetic Foot Ulcer Among Healthcare Workers and Diabetic Patients and Their Relatives in Saudi Arabia: A Cross-Sectional Study

Background Diabetes mellitus is a chronic progressive metabolic disorder characterized by high blood sugar affecting the whole body resulting in a significant impact on the quality of life for the patients and their families. Diabetes mellitus complications lead to morbidity, disability, and mortality and represent a serious global health issue threatening the health system worldwide and resulting in a critical economic impact for all countries, especially epidemic ones. Objective The objective of this study was to assess the level of knowledge and awareness regarding diabetic foot and related behaviour among diabetic patients and their relatives, as well as healthcare workers in Saudi Arabia. Methods A cross-sectional analytic study was conducted in 2022 on healthcare workers, diabetic patients, and their relatives above the age of 18 in Saudi Arabia by using a valid, pretested structured questionnaire. The collected data were analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). Results In this study, there was no correlation between the healthcare workers' attitude and knowledge. A total of 131 healthcare workers were involved, and a majority of them had good knowledge regarding the predisposing factors of diabetic foot ulcers, and 63 (48.1%) had good knowledge regarding diabetes foot care. On the other hand, there was poor knowledge regarding the characteristics and complications of diabetes ulcers. This study showed various attitudes among healthcare workers regarding diabetic ulcer care. For example, they prioritized the prevention of ulcers over treatment (N=67, 51.1%), the majority of healthcare workers were very keen to wound care (N=77, 58.8%), and they believed that it was their responsibility to educate their patients about reducing re-ulceration (N=86; 65.7%). However, 52 participants (39.7%) considered management of diabetic foot ulcer time-consuming, 54 (41.2%) mentioned that if they had the opportunity, they would like to avoid taking care of the diabetic wound, and 51 (38.9%) reported non-satisfaction with diabetic wound care.  One hundred diabetic patients and 117 relatives also were involved, and only 41.3% of participants (patients and relatives) had good knowledge regarding diabetes mellitus. However, our findings also revealed that 91.65% of the participants had good knowledge and a favourable attitude towards diabetes mellitus and diabetic foot care. Nevertheless, even though the participants had good knowledge regarding foot care, they had poor practice, with 56.55% scoring poor on the assessment questionnaire.  Conclusion Our study shows that most of the participants had good knowledge and attitudes but poor practices. This highlights the need for more efforts to educate the Saudi population about diabetes and its complications.

Vascular complications in prediabetes and type 2 diabetes: a continuous process arising from a common pathology

The term, "prediabetes", describes a state of hyperglycaemia that is intermediate between true normoglycaemia and the diagnostic cut-offs for indices of glycaemia that are used to diagnose type 2 diabetes. The presence of prediabetes markedly increases the risk of developing type 2 diabetes. Numerous randomized, controlled evaluations of various agents have demonstrated significant prevention or delay of the onset of type 2 diabetes in subjects with prediabetes. Intensive lifestyle interventions and metformin have been studied most widely, with the lifestyle intervention being more effective in the majority of subjects. The application of therapeutic interventions at the time of prediabetes to preserve long-term outcomes has been controversial, however, due to a lack of evidence relating to the pathogenic effects of prediabetes and the effectiveness of interventions to produce a long-term clinical benefit. Recent studies have confirmed that prediabetes, however defined, is associated with a significantly increased risk of macrovascular and microvascular complications essentially identical to those of diabetes, and also with subclinical derangements of the function of microvasculature and neurons that likely signify increased risk of compilations in future. Normoglycaemia, prediabetes and type 2 diabetes appear to be part of a continuum of increased risk of adverse outcomes. Long-term (25-30 years) post-trial follow up of two major diabetes prevention trials have shown that short-term interventions to prevent diabetes lead to long-term reductions in the risk of complications. These findings support the concept of therapeutic intervention to preserve long-term health in people with prediabetes before type 2 diabetes becomes established.

Cardiovascular Risk Among Saudi Adults with Prediabetes: A Sub-Cohort Analysis from the Heart Health Promotion (HHP) Study

Background

This study aimed to estimate the prevalence of prediabetes among Saudi adults and to evaluate their risk of developing cardiovascular diseases.

Methods

This is a cohort of 2470 Saudi adults attending employee clinics in the university hospital. WHO-STEPs approach was used to collect sociodemographic (age, gender, and education), clinical (body mass index and blood pressure) and laboratory data (HbA1c, lipid profile and vitamin D concentration). Prediabetes was defined according to HbA1c level of 5.7–6.4%. Cardiovascular risk (CVR) scores were evaluated using the Framingham Risk Score. SPSS was used for data analysis to investigate the relation between different CVR and prediabetes.

Results

Prediabetes affected 25.1% of the study population. Males had higher rates of prediabetes than females (27.5% versus 23.5%). The prevalence of prediabetes increased from 11.6% among young individuals (18–29 years) to 56.0% among participants 60 years and older. Prediabetes patients exhibited considerably higher levels of all cardiovascular risk factors and nearly half of them (49.3%) had at least two risk factors. The prevalence of intermediate CVR among prediabetics was 13.2% compared to just 2.9% among the normal group, and high CVR was defined in 3.7% among prediabetics compared to only 1.7% in the normal group. Having prediabetes increased the odds to develop higher CVR of 2.64 times compared to those without prediabetes (OR = 2.64, 95% CI = 1.51–4.64) and the level of vitamin D did not affect the odds of CVR.

Conclusion

Prediabetes is quite prevalent among Saudi adults, and they are at a higher risk of cardiovascular diseases. Patients with prediabetes have higher cardiac risk scores when compared to normal participants across the whole spectrum of (25(OH)D) concentrations. Additionally, no significant correlation was observed between HbA1c and (25(OH)D) levels in prediabetics or normoglycemic subjects.

Psychological Wellbeing of Diabetic Individuals, Prediabetics, and Non-diabetics: A Population-Based Study in Saudi Arabia

Background

The increased burden of diabetes affects the quality of life, including psychosocial problems. The study aims to compare the psychological well-being of individuals who are prediabetic, diabetic, or non-diabetic.

Methods

A cross-sectional exploratory study was conducted from January to June 2016 (n = 1,019) in Al Kharj, Saudi Arabia. After consent and questionnaires were filled out, trained staff took blood samples followed by anthropometry. Chi-squared tests, one-way ANOVA, and multiple linear regression analyses were conducted to examine the association between diabetes classes defined by HbA1c cut-off levels set by the American Diabetes Association (three categories), individual items, and total score in general health questionnaire (GHQ). An ROC curve was plotted for the total GHQ-12 score against HbA1c.

Findings

The mean GHQ score for psychological distress was significantly higher (F = 6.569, P = 0.038) in the diabetics (mean = 14.7) and the prediabetics (12.4) than in the non-diabetics (10.71). Four out of six positive GHQ items and three out of six negative GHQ items significantly differed among the three classes of diabetes. The adjusted multivariate analysis revealed that people with diabetes were most likely to report psychological distress compared to non-diabetics (unstandardized beta = 2.414; P = 0.037). The AUC examining the relationship between HBA1c and GHQ scores showed a moderate but statistically insignificant sensitivity/specificity of 0.643 (P = 0.23).

Conclusion

This study demonstrates that psychological wellbeing is substantially poorer among diabetic or prediabetic individuals than non-diabetic individuals. Future longitudinal studies are required to examine a plausible causal relationship between diabetes/prediabetes and psychological distress.

Improving Current Glycated Hemoglobin Prediction in Adults: Use of Machine Learning Algorithms With Electronic Health Records

Background

Predicting the risk of glycated hemoglobin (HbA_1c) elevation can help identify patients with the potential for developing serious chronic health problems, such as diabetes. Early preventive interventions based upon advanced predictive models using electronic health records data for identifying such patients can ultimately help provide better health outcomes.

Objective

Our study investigated the performance of predictive models to forecast HbA_1c elevation levels by employing several machine learning models. We also examined the use of patient electronic health record longitudinal data in the performance of the predictive models. Explainable methods were employed to interpret the decisions made by the black box models.

Methods

This study employed multiple logistic regression, random forest, support vector machine, and logistic regression models, as well as a deep learning model (multilayer perceptron) to classify patients with normal (<5.7%) and elevated (≥5.7%) levels of HbA_1c. We also integrated current visit data with historical (longitudinal) data from previous visits. Explainable machine learning methods were used to interrogate the models and provide an understanding of the reasons behind the decisions made by the models. All models were trained and tested using a large data set from Saudi Arabia with 18,844 unique patient records.

Results

The machine learning models achieved promising results for predicting current HbA_1c elevation risk. When coupled with longitudinal data, the machine learning models outperformed the multiple logistic regression model used in the comparative study. The multilayer perceptron model achieved an accuracy of 83.22% for the area under receiver operating characteristic curve when used with historical data. All models showed a close level of agreement on the contribution of random blood sugar and age variables with and without longitudinal data.

Conclusions

This study shows that machine learning models can provide promising results for the task of predicting current HbA_1c levels (≥5.7% or less). Using patients’ longitudinal data improved the performance and affected the relative importance for the predictors used. The models showed results that are consistent with comparable studies.

Knowledge, attitude, and practice regarding diabetic foot care among Saudi and non-Saudi diabetic patients in Alkharj

Context

There is a high prevalence of diabetes mellitus in Saudi Arabia. Also, the diabetic foot complication rate is alarmingly high with many patients ending in amputation.

Aims

To assess the knowledge, attitude, and practices regarding diabetic foot care among Saudi and non-Saudi diabetic patients in Alkharj.

Settings and Design

It is a cross-sectional study conducted from May 22^nd, 2019 to April 1^st, 2020 at Diabetic clinic, Military Hospital in Alkharj.

Methods and Materials

Non-randomized, non-probability convenience sampling technique was used to collect data from 224 patients by using a validated and confidential questionnaire in either face-to-face interviews or as an electronic survey. All adult patients over 18 years of age of both sexes having type 1 and 2 diabetes mellitus were included. The patients who were unable to provide the requested information were excluded.

Statistical Analysis

The data were analyzed using SPSS version 24.

Results

The mean age of patients was 49.37 years with 58.5% male and 41.5% female patients. About 58% of patients had diabetes for more than 10 years. More than half of the patients reported some foot problems, while 9.4% have had active or healed ulcerations. The mean scores for knowledge, attitude, and practice were 8.576, 4, and 13, respectively, all statistically significant.

Conclusions

Our study population has sufficient knowledge about diabetes and its foot complication, and they also had a positive attitude towards its management. However, they were lagging in the practices required for diabetic foot management.

Family History, Consanguinity and Other Risk Factors Affecting the Prevalence of Prediabetes and Undiagnosed Diabetes Mellitus in Overweight and Obese Yemeni Adults

OBJECTIVE

Overweight and obese adults are at high risk for developing prediabetes and diabetes. The aim of this study was to measure the prevalence of prediabetes (pre-DM) and diabetes (DM) among Yemeni adults who were overweight or obese and had first-degree relatives with DM, consanguinity and other risk factors.

PATIENTS AND METHODS

This cross-sectional study included 612 adults, all with a BMI≥25 kg/m². BMI, blood pressure (BP) and waist circumference (WC) were measured in the clinic. Fasting blood glucose (FBG) was collected for all subjects. The patients either had first-degree relatives with diabetes or not, and the subjects answered a questionnaire regarding the consanguinity of their parents, exercise, khat chewing, smoking, and eating vegetables and fruits daily.

RESULTS

Of the 612 study participants (32% males and 68% females) aged 20-70 years old, 429 (70.1%) had a family history (FM) of DM ± consanguinity of parents, and 183 (29.9%) had no FM of diabetes. Multivariate analysis showed significant risk in those with class III obesity for pre-DM (AOR 3.10 95% CI 1.56-6.18 p value 0.001) and DM (AOR 3.35 95% CI 1.47-7.65 p value 0.004) and those who had siblings with DM had a risk for pre-DM (AOR 1.72 95% CI 1.09-2.71 p value 0.02) and DM (AOR 2.24 95% CI 1.25-4.0 p value 0.007). Khat chewing increased the risk for pre-DM (AOR 1.61 95% CI 1.04-2.48 p value 0.032) and for DM (AOR 2.09 95% CI 1.14-3.82 p value 0.017). Having consanguineous parents plus siblings with DM were associated with a higher risk of DM (p value 0.031).

CONCLUSION

There is a high prevalence of pre-DM and undiagnosed DM among overweight and obese Yemeni individuals. Class III obesity, having siblings with DM, chewing khat, and having consanguineous parents plus siblings with DM all increased the risk. This group should be screened at an early age for early detection of pre-DM and DM.

Prevalence of Diabetes Mellitus and Its Associated Factors in Bangladesh: Application of Two-level Logistic Regression Model

This study intends to explore the prevalence of diabetes mellitus (DM) and its associated factors in Bangladesh. The necessary information was extracted from Bangladesh Demographic and Health Survey (BDHS) 2011. In bivariate analysis, Chi-square test was performed to assess the association between selected covariates and diabetes status. A two-level logistic regression model with a random intercept at each of the individual and regional level was considered to identify the risk factors of DM. A total of 7,535 individuals were included in this study. From the univariate analysis, the prevalence of DM was found to be 33.3% in 50-54 age group for instance. In bivariate setup, all the selected covariates except sex of the participants were found significant for DM (p < 0.05). According to the two-level logistic regression model, the chance of occurring DM increases as age of the participants' increases. It was observed that female participants were more likely to have DM. The occurrence of DM was 62% higher for higher educated participants, 42% higher for the individuals who came from rich family and 63% higher for the individuals having hypertension. The chance of developing diabetes among overweighed people was almost double. However, the individuals engaged in physical work had less chance to have DM. This study calls for greater attention of government and other concerned entities to come up with appropriate policy interventions to lower the risk of DM.

Frequency and Awareness of Risk Factors of Non-Communicable Diseases among University Students in Saudi Arabia

BACKGROUND AND OBJECTIVE

Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality in developed countries. This study has evaluated the frequency of the risk factors of NCDs and its awareness among students in a University in Saudi Arabia.

METHODS

This cross-sectional study was conducted among 374 female students of Prince Sattam bin Abdulaziz University in Wadi Al Dawaser, Saudi Arabia. The study was carried out for a duration of six months, from August 2019 to January 2020. Standard self-administered questionnaire, anthropometric and biochemical parameters were used for data collection, analysed through SPSS version 20.0.

RESULTS

The mean age of the students was 20.6 years. The results showed that 64.7% of students were physically inactive, 52.4% spend more than two hours watching TV. The intake of adequate amount of fruits (14%) and vegetables (6.8%) was very little.. Junk food was consumed >11 times per week by 37.1%. The prevalence of overweight and severe obesity was 25.9% and 5.1% respectively. Blood sugar analysis showed 1.1% had pre-diabetes and 0.8% had diabetes. About 56.2% of students had no knowledge about NCDs and their risk factors.

CONCLUSION

A high prevalence of risk factors for NCDs was found among students. Awareness programs about healthy lifestyle practices; periodic screening of school and college students at regular intervals with appropriate advice are warranted to control the rising epidemic of NCDs.

Association of vitamin d with glycemic control in Saudi patients with type 2 diabetes: A retrospective chart review study in an emerging university hospital

Background

Vitamin D (mainly 25‐hydroxyvitamin D, 25[OH]D) has stimulated increasing interest in Saudi Arabia over the current years due to its association with several different chronic diseases such as diabetes. This study aims to ascertain whether the vitamin D level has any influence on glycemic control in Saudi patients with type 2 diabetes (T2DM).

Method

This retrospective study included 200 patients with T2DM who visited Prince Sattam Bin Abdulaziz University Hospital between January 2015 and December 2015. Venous blood was collected and examined for “serum/plasma levels of 25(OH)D” and related variables using kit methods. HbA1C levels <7% and ≥7% were taken as indicators of good and poor glycemic control, respectively. An association between vitamin D deficiency and poor glycemic control was determined using multinomial logistic regression analysis.

Results

Among the total of 200 patients with type 2 diabetes, 118 (59%) were female and 82 (41%) were males with the mean age 42.4 ± 14.8 years. Good glycemic control (HbA1c < 7) was observed in 127 (63.5%), and poor glycemic control (HbA1c > 7) was found in 73(36.5%). The mean serum 25(OH)vit D was 20.27 ± 8.66 ng/mL, with (52% vs 82%; P ≤ .001) of subjects identified to have vitamin D deficiency in good and poor glycemic control groups, respectively.

Conclusion

Taken together, our results demonstrated an association of vitamin D level with poor glycemic control in patients with type 2 diabetes. However, additional studies with larger sample size from local population are warranted in future to confirm and extend the findings of the present study.