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      Diabetes Risk among Medical Students in Tabuk City, Saudi Arabia

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          Introduction: Diabetes risk estimation is essential for the implementation of preventive measures. Objectives: We aimed to assess the diabetes risk among medical students in Tabuk, Saudi Arabia. Methods: This cross-sectional study was conducted among 169 medical students in the Medical College, University of Tabuk, Saudi Arabia, from October 2017 to April 2018. Participants signed a written informed consent and then responded to a questionnaire modified from the Finnish and the ARABRISK diabetes score. The questionnaire consisted of eight components inquiring about age, BMI, central adiposity, fruit and vegetable consumption, physical activity if found to have high blood pressure or blood sugar, and family history of diabetes mellitus. The Statistical Package for Social Sciences (SPSS) was used for data analysis. Results: Out of 169 students (68% with a family history of diabetes), obesity and overweight were found in 21.3 and 26.6%, respectively, 45.6% had central adiposity, more than half were not practicing exercise daily, and 60.4% were not consuming fruits and vegetables daily. A significant percentage was found to have high blood sugar (9.5%) and high blood pressure (4.7%). The diabetes risk score was high or moderate in 16% of the students. Conclusion: Medical students in Tabuk City were at high risk for diabetes mellitus. Obesity, overweight, central adiposity, physical inactivity, and less consumption of fruits and vegetables substantially contributed to the risk. Measures to prevent obesity, improving fruit and vegetable consumption, and exercise are needed.

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          Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment—Lifestyle Over and Above Drugs in Diabetes (LOADD) study: randomised controlled trial

          Objective To determine the extent to which intensive dietary intervention can influence glycaemic control and risk factors for cardiovascular disease in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment. Design Randomised controlled trial. Setting Dunedin, New Zealand. Participants 93 participants aged less than 70 years with type 2 diabetes and a glycated haemoglobin (HbA1c) of more than 7% despite optimised drug treatments plus at least two of overweight or obesity, hypertension, and dyslipidaemia. Intervention Intensive individualised dietary advice (according to the nutritional recommendations of the European Association for the Study of Diabetes) for six months; both the intervention and control participants continued with their usual medical surveillance. Main outcome measures HbA1c was the primary outcome. Secondary outcomes included measures of adiposity, blood pressure, and lipid profile. Results After adjustment for age, sex, and baseline measurements, the difference in HbA1c between the intervention and control groups at six months (−0.4%, 95% confidence interval −0.7% to −0.1%) was highly statistically significant (P=0.007), as were the decreases in weight (−1.3 kg, −2.4 to −0.1 kg; P=0.032), body mass index (−0.5, −0.9 to −0.1; P=0.026), and waist circumference (−1.6 cm, −2.7 to −0.5 cm; P=0.005). A decrease in saturated fat (−1.9% total energy, −3.3% to −0.6%; P=0.006) and an increase in protein (1.6% total energy, 0.04% to 3.1%; P=0.045) in the intervention group were the most striking differences in nutritional intake between the two groups. Conclusions Intensive dietary advice has the potential to appreciably improve glycaemic control and anthropometric measures in patients with type 2 diabetes and unsatisfactory HbA1c despite optimised hypoglycaemic drug treatment. Trial registration Clinical trials NCT00124553.
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            The diabetes risk score: a practical tool to predict type 2 diabetes risk.

            Interventions to prevent type 2 diabetes should be directed toward individuals at increased risk for the disease. To identify such individuals without laboratory tests, we developed the Diabetes Risk Score. A random population sample of 35- to 64-year-old men and women with no antidiabetic drug treatment at baseline were followed for 10 years. New cases of drug-treated type 2 diabetes were ascertained from the National Drug Registry. Multivariate logistic regression model coefficients were used to assign each variable category a score. The Diabetes Risk Score was composed as the sum of these individual scores. The validity of the score was tested in an independent population survey performed in 1992 with prospective follow-up for 5 years. Age, BMI, waist circumference, history of antihypertensive drug treatment and high blood glucose, physical activity, and daily consumption of fruits, berries, or vegetables were selected as categorical variables. Complete baseline risk data were found in 4435 subjects with 182 incident cases of diabetes. The Diabetes Risk Score value varied from 0 to 20. To predict drug-treated diabetes, the score value >or=9 had sensitivity of 0.78 and 0.81, specificity of 0.77 and 0.76, and positive predictive value of 0.13 and 0.05 in the 1987 and 1992 cohorts, respectively. The Diabetes Risk Score is a simple, fast, inexpensive, noninvasive, and reliable tool to identify individuals at high risk for type 2 diabetes.
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              Type 2 Diabetes Mellitus in Saudi Arabia: Major Challenges and Possible Solutions.

              The World Health Organization has ranked Saudi Arabia as having the second highest rate of diabetes in the Middle East (7th highest in the world) with an estimated population of 7 million living with diabetes and more than 3 million with pre-diabetes. This presents a pressing public health problem. Several challenges in diabetes management need to be tackled in Saudi Arabia, including the growing prevalence (chiefly among children and young adults), micro-and macrovascular complications, lifestyle changes, late diagnosis, poor awareness and high treatment costs. Over the last two decades, the Saudi population saw an increase in the expenses in healthcare and treatment of diabetes by more than 500%. In 2014, the health care budget was 180 billion (Saudi Riyal) of which 17 billion was spent on all Saudis, with an approximate 25 billion on the entire Saudi diabetic population. This implies that the direct expense of diabetes is costing Saudi Arabia around 13.9% of the total health expenditure. Therefore, unless a comprehensive epidemic control program/ multidisciplinary approach is stringently enforced, the diabetes mellitus burden on Saudi Arabia will probably increase to very serious levels. It is crucial to implement improved health and health-related quality of life of to those with diabetes, thus minimizing the social and personal expenses for diabetes care in Saudi Arabia. In this study we discuss the significant and major threats posed by diabetes mellitus to the Saudi population and recommend essential possible solutions to delay/ prevent this formidable issue.

                Author and article information

                International Journal of Diabetes and Metabolism
                S. Karger AG
                December 2020
                27 May 2020
                : 26
                : 1
                : 27-30
                aDepartment of Internal Medicine, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
                bDepartment of Family and Community Medicine, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
                Author notes
                *Hyder Osman Mirghani, Department of Internal Medicine, Faculty of Medicine, University of Tabuk, PO Box 3378, Tabuk 51941 (Saudi Arabia), s.hyder632@hotmail.com
                507245 Dubai Diabetes Endocrinol J 2020;26:27–30
                © 2020 The Author(s) Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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                Tables: 3, Pages: 4
                Research Article


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