Moderating effect for illness uncertainty on the relationship of depressive and anxiety symptoms among patients with type 1 diabetes in Taif region, Saudi Arabia.

Background: Illness uncertainty was found to be associated with the development of depressive and anxiety symptoms among patients with type 1 diabetes and chronic illness in general. However, the moderating effect of illness uncertainty was not examined in sufficient depth. The current study evaluates how the path from diabetes distress to depression and anxiety is mediated by illness uncertainty, ambiguity, symptoms and course predictability, and illness complexity. Method: Descriptive cross-sectional survey of a large-scale sample of patients living with type one diabetes in Saudi Arabia. We utilized structural equation modelling mediation analysis to examine the effect of illness uncertainty and its subcategories (illness-related ambiguity, symptoms and course predictability, and illness complexity) on depressive and anxiety symptoms. Results: The current survey analyzed data pertaining to (n = 536) type one diabetes patients. Mean Mishel Uncertainty of Illness Scale score was 80.8 points (Cronbach's α = 0.91) signifying moderate uncertainty among our patients. Diabetes-related uncertainty was associated with marriage (t = 3.337, P = 0.0009937), diabetes complications (t = 5.257, P < 0.00001), pain (r = 0.2247, P < 0.00001), and children count (correlation coefficient r = 0.195, P < 0.00001). The prevalence of depression was (n = 367, 68.5%) and for anxiety was (n = 173, 30.3%). Illness uncertainty correlated with depressive (r = 0.2484, P < 0.00001) and anxiety (r = 0.2548, P < 0.00001) symptoms' scores. Illness uncertainty exerted a partial moderating effect on both anxiety (ß = 0.060, P < 0.001) and depressive symptoms (ß =0.056, P < 0.001). We observed a partial moderating effect for diabetes-related ambiguity and diabetes-related symptom unpredictability in terms of depressive and anxiety symptoms. However, for diabetes-related course unpredictability, the moderating effect was significant only for anxiety. Diabetes-related complexity did not exert a significant moderating effect on either depressive or anxiety symptoms. Discussion: We confirmed high levels of depression and anxiety among patients with type one diabetes in Saudi Arabia. Our findings suggest that illness uncertainty affects both diabetes-related distress and depression constructs and is likely to be affected by them.

Fasting Ramadan in patients with T1DM - Saudi Arabia versus other countries during the COVID-19 pandemic.

BACKGROUND AND AIMS: To compare Saudi Arabia with other countries regarding patient attitudes towards fasting Ramadan and complications related to fasting during the COVID-19 pandemic. METHODS: Data collected from Saudi Arabia and 12 other mostly Muslim majority countries, via physician administered questionnaire within post Ramadan 2020. RESULTS: 1485 Type1 diabetes (T1DM) patients analyzed; 705 (47.5%) from Saudi Arabia vs. 780 (52.5%) from other countries. 1056 (71.1%) fasted Ramadan; 636 (90.2%) of Saudi patients vs. 420 (53.8%) of other countries. Experiencing Ramadan during the COVID-19 pandemic did not affect the Saudi T1DM patients' decision to fast while it significantly influenced their decision in other countries (1.4 vs 9.9%, P < 0.001). More Saudi patients needed to break the fast due to a diabetes related complication compared to other countries (67.4% vs. 46.8%, p=<0.001). The mean number of days fasted in Saudi and other countries was 24 ± 7 and 23 ± 8 days respectively. Hypoglycemic events were more common among Saudi patients during Ramadan compared to other countries 72% and 43.6% (p < 0.001) respectively. There was a significant difference in timing; the largest peak for Saudi Arabia patients was after dawn (35% vs 7%, p < 0.001), while it was pre-sunset for the other countries (23 vs 54%, p = 0.595). Day time-hyperglycemia was also more common among Saudi patients (48.6% vs. 39%, p < 0.001), however it was a less likely cause to break the fast (25.6% vs 38.3%, p < 0.001). CONCLUSION: Observing the fast of Ramadan is extremely common among Saudi T1DM patients compared to other Muslim countries and was not affected by the COVID-19 pandemic. However, it was associated with higher frequency of hypoglycemic and hyperglycemic episodes.

Evaluation of glycemic control among Type 2 diabetic patients in the first visit after COVID-19 lockdown, Prince Mansour Military Hospital, Taif, Saudi Arabia.

Background: The coronavirus disease (COVID-19) pandemic causes significant morbidities and mortalities. Lockdown is applied worldwide to counteract the spread of the disease. These circumstances limit diabetic patients from hospital visits and follow-ups. Objectives: To evaluate glycemic control for type 2 diabetic patients in the first visit after COVID-19 lockdown and to study the effect of COVID-19 lockdown on glycemic control. Methods: A cross-sectional study was conducted at Prince Mansour Military Hospital, Taif city, Western Saudi Arabia. It included type 2 diabetic patients of both genders aged over 20 years that were assigned to follow-up in the diabetic center. Data were collected from patients' medical records using a simple random technique. It included patients` gender, age group, body mass index, and three glycosylated hemoglobin (HbA1c) readings for each year (2018-2019) and one HbA1C reading upon the first visit after COVID-19 lockdown. HbA1c level was treated as a continuous variable. Results: The study included 420 diabetic patients. Females represented 51% of them, and more than a third (39.8%) were aged 60 years and over. The majority of them were either overweight (29.3%) or obese (61.2%). There was an increase in the overall level of HbA1c after curfew (8.72 ± 1.73) than before it (8.58 ± 1.72). However, the difference did not reach a statistically significant level, P = 0.056. Among females, the level of hemoglobin A1c (HbA1c) was statistically and significantly higher after curfew than before it (8.71 ± 1.82 vs. 8.43 ± 1.71), P = 0.005. Also, among obese subjects, the level of hemoglobin A1c was statistically and significantly higher after curfew than before it (8.55 ± 1.74 vs. 8.34 ± 1.63), P = 0.034. Conclusion: There was a relative increase in the level of HbA1c after the lockdown during COVID-19, indicating poorer glycemic control; this impact was more obvious among female and obese type 2 diabetic patients.

Hyperglycaemic and hypoglycaemic emergencies among patients with diabetes mellitus who participated in pilgrims of the 2019/1440H Hajj season.

Background: Diabetic emergencies are serious acute life-threatening complications of diabetes mellitus (DM). The Hajj season requires the health system in Saudi Arabia to prepare efficiently for the healthcare of millions of pilgrims, particularly for diabetic emergencies. Thus, diabetic emergencies need rapid recognition, diagnosis and treatment. This study aimed to explore the frequency and associated factors of diabetic emergencies among the pilgrim's patients with DM during Hajj, Mecca 2019. Methods: This is a prospective study which was conducted on 153 patients with DM. They were selected from three major healthcare-providing facilities during Hajj, which are Arafat, Muzdelefah and Muna healthcare centres. The study was conducted from Aug 5 to 12, 2019. All the patients who presented with any of the hypoglycaemic or hyperglycaemic emergencies had their demographic and clinical characteristics recorded to estimate the prevalence of each emergency and identify its significant associated factors. Result: More than 90% of the study participants were patients with type 2 diabetes mellitus (T2DM), while around 7% had type 1 diabetes mellitus (T1DM). Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) and hypoglycaemia were presented in (n = 11, 7.2%), (n = 19, 12.4%) and (n = 28, 18%), respectively, of the participants. Moreover, the study found that "younger age" (odds = 30.4, P = 0.0115) and "type of medication" are significantly associated with DKA. Furthermore, "older age", "type of medication", "having Cardiovascular Disease (CVD)" and "diabetes duration" were found to have a significant association with HHS. Moreover, hypoglycaemia was associated with neuropathy complication (odds = 3.54948, P = 0.0187). Conclusions: Among the pilgrims with diabetes participating in Hajj, a considerable proportion with a range of diabetic emergencies present to the onsite medical facilities. Preparation is required in terms of logistics and health education about diabetic emergencies to meet the needs of pilgrims with DM, especially those who use insulin and have longstanding diabetes. Further research on DM and the creation of guidelines for health providers and patients with DM during Hajj are important focuses for the future.

Ramadan fasting in people with type 1 diabetes during COVID-19 pandemic: The DaR Global survey.

OBJECTIVES: The DaR Global survey was conducted to determine the impact of the COVID-19 pandemic on the intentions to fast and the outcomes of fasting in <18 years versus ≥18 years age groups with type 1 diabetes mellitus (T1DM). METHODS: Muslim people with T1DM were surveyed in 13 countries between June and August 2020, shortly after the end of Ramadan (23rd April-23rd May 2020) using a simple questionnaire. RESULTS: 71.1% of muslims with T1DM fasted during Ramadan. Concerns about COVID-19 were higher in individuals ≥18 years (p = 0.002). The number of participants who decided not to fast plus those who received Ramadan-focused education were significantly higher in the ≥18-year group (p < 0.05). Hypoglycemia (60.7%) as well as hyperglycemia (44.8%) was major complications of fasting during Ramadan in both groups irrespective of age. CONCLUSION: COVID-19 pandemic had minor impact on the decision to fast Ramadan in T1DM cohort. This was higher in the age group of ≥18 years compared to those <18 years group. Only regional differences were noted for fasting attitude and behavior among T1DM groups. This survey highlights the need for Ramadan focused diabetes education to improve glucose control and prevent complications during fasting.

Vitamin D deficiency and glycemic control among patients with type 2 diabetes mellitus in Jazan City, Saudi Arabia.

Background: The prevalence of vitamin D deficiency (VDD) is predicted to be high in patients with type 2 diabetes mellitus (T2DM), but the exact figure is not known in Jazan, Saudi Arabia. Emerging data suggests that VDD plays a role in glycemic control. The aim of this study was to measure the prevalence of VDD among T2DM patients and to investigate its association with patients' characteristics and glycemic control in Jazan. Methods: This is an analytical cross-sectional study which recruited 309 patients with T2DM randomly from primary health care centers in Jazan. Logistic regression analysis was conducted to determine the VDD predictors and to examine the association of VDD and glycemic control. Results: The VDD prevalence was found to be 60.8% in patients with T2DM. Age, gender, diabetic retinopathy (DR), dyslipidemia, glycemic control, and obesity were significantly associated with VDD, and all except obesity were independent predictors of VDD. There was a significant negative correlation between 25-hydroxyvitamin D and HbA1c. VDD was a significant independent predictor of poor glycemic control after adjustment for hypertension, DR, diabetic neuropathy, type of diabetes medication, diabetes duration, and education level. Conclusion: In this Saudi Arabian population, VDD is highly prevalent in people with T2DM and is associated with poor glycemic control. Health education targeting patients with T2DM and national strategies regarding vitamin D fortification are needed to prevent VDD in Saudi Arabia. Earlier VDD diagnosis by health care providers may help to improve the outcome for patients with T2DM. Establishing the causal association between VDD and glycemic control and clarifying the biological role of vitamin D in T2DM are important aims for future studies.