External validation of a cardiovascular risk model for Omani patients with type 2 diabetes mellitus: a retrospective cohort study.

OBJECTIVES: To externally validate a recently developed cardiovascular disease (CVD) risk model for Omanis with type 2 diabetes mellitus (T2DM). DESIGN: Retrospective cohort study. SETTING: Nine primary care centres in Muscat Governorate, Oman. PARTICIPANTS: A total of 809 male and female adult Omani patients with T2DM free of CVD at baseline were selected using a systematic random sampling strategy. OUTCOME MEASURES: Data regarding CVD risk factors and outcomes were collected from the patients' electronic medical records between 29 August 2020 and 2 May 2021. The ability of the model to discriminate CVD risk was assessed by calculating the area under the curve (AUC) of the receiver-operating characteristic curve. Calibration of the model was evaluated using a Hosmer-Lemeshow χ2 test and the Brier score. RESULTS: The incidence of CVD events over the 5-year follow-up period was 4.6%, with myocardial infarction being most frequent (48.6%), followed by peripheral arterial disease (27%) and non-fatal stroke (21.6%). A cut-off risk value of 11.8% demonstrated good sensitivity (67.6%) and specificity (66.5%). The area under the curve (AUC) was 0.7 (95% CI 0.60 to 0.78) and the Brier score was 0.01. However, the overall mean predicted risk was greater than the overall observed risk (11.8% vs 4.6%) and the calibration graph showed a relatively significant difference between predicted and observed risk levels in different subgroups. CONCLUSIONS: Although the model slightly overestimated the CVD risk, it demonstrated good discrimination. Recalibration of the model is required, after which it has the potential to be applied to patients presenting to diabetic care centres elsewhere in Oman.

Knowledge, attitudes, and practices toward research among Oman medical specialty board residents.

OBJECTIVES: The Accreditation Council for Graduate Medical Education has mandated residency programs to teach the basic principles of research in residency programs. This study aimed to assess the research knowledge, attitude, and practice among the Oman Medical Specialty Board (OMSB) residents. Secondarily, it aimed to asses associations between different factors and research-related knowledge, attitude, and practice. MATERIALS AND METHODS: This cross-sectional study was conducted among all residents who were involved in OMSB various training programs in the academic year 2018/2019. A validated self-administered questionnaire was used. Hard copies of the questionnaire were delivered to residents in addition to the online forms. Data were entered using EpiData entry software and analyzed using SPSS version 24. RESULTS: A total of 256 residents participated in the study with a response rate of 46.5%. Around 55% of included residents have poor knowledge level, and 44% have moderate knowledge level. The study showed that the majority (93%) of the residents have positive research attitude. However, the practice domain showed that only 27.8% of residents have published articles as first or coauthor. Lack of time was reported as a major hindrance in nearly two-thirds of the residents. Lack of training (56%), lack of research-focused curriculum (47%), and lack of effective supervision (46%) were among major reported obstacles beside others. CONCLUSIONS: This study showed that OMSB residents have inadequate knowledge and lagging research practices, but a positive attitude toward research. This emphasizes the need for research-focused curricula and further training. In addition, applying new regulations, including mandatory manuscript submission, may improve the practice status.

The effect of low-carbohydrate ketogenic diet in the management of obesity compared with low caloric, low-fat diet.

BACKGROUND & AIMS: Previous studies comparing low-carbohydrate ketogenic diet (LCKD) and low caloric fat low diets (LCLF) in obesity management are still controversial. This study evaluated the effect of LCKD in weight reduction compared to the LCLF diet among Omani obese adults. METHODS: This prospective cohort study was conducted at the National Diabetes and Endocrine Centre (NDEC), Royal Hospital, Muscat, Oman, between 2015 and 2017. We included 200 (100 in each group) obese patient with Body Mass Index (BMI) more than 30kg/m2, who attended the outpatient department and met the inclusion criteria were enrolled in the study for six months follow-up. Anthropometric, biochemical and clinical data was gathered before starting the diet. Follow-up outcomes included reduction in weight, fat mass and visceral fat, lipid profile and HbA1c. Data were analysed using SPSS-24. RESULTS: The LCKD group showed a significant reduction of 13.0 kg (95% CI: 11.0-15.1) in body weight compared to 4.7 kg (95% CI: 3.4-5.9) in the LCLF group with p-value<0.001. LCKD group showed a significant reduction of 4.0% (95% CI: 3.3-4.7) in fat mass, compared to 1.4% (95% CI: 0.83-1.9) in the LCLF group with p-value<0.001. In addition, LCKD group showed a significant reduction of 2.5L (95% CI: 2.0-2.9, P < 0.001) in visceral fat compared to 1.2L (95% CI: 0.86-1.56) P < 0.001) in the LCLF group with p-value<0.001. Combined with significant reduction in HbA1c with 0.69% (95% CI: 0.5-0.89, P < 0.001) in LCKD and a reduction of 0.74% (95% CI: 0.47-1.2, P < 0.001) in LCLF. Furthermore, this diet has not increased lipid profile with a mean reduction of 0.19 mmol/L (95% CI: 0.003-0.37, P < 0.001) in total cholesterol and mean change of 0.04 mmol/L (95% CI: 0.12-0.21) in LDL level. In addition, it has not increased uric acid with a mean reduction of 20.8 umol/L (95% CI: 4.8-36.7), (P = 0.01). CONCLUSION: LCKD seems superior to LCLF in weight, fat mass and visceral fat reduction. In addition, this diet does not increase serum cholesterol and uric acid, which encourage the use of this diet in obesity management.

New approaches to disease causation research based on the sufficient-component cause model.

Up to date, the sufficient-component cause model seems to be a theoretical framework for disease causation in epidemiology, and its implications in epidemiological research methods is currently still limited. Recently, pitfalls in current epidemiological research methods were addressed based on the sufficient-component cause model; hence, new research approaches are needed as alternatives. Therefore, this paper aims to review and suggest new epidemiological methods used to assess disease causation. A new approach was discussed to identify potential mechanisms of disease occurrence which may be useful for risk prediction and disease prevention. In addition, a novel "exposed case-control" design was introduced to identify potential component causes. Furthermore, this paper suggested a new approach of conducting a systematic review/meta-analysis related to causation studies.

Diabetic retinopathy among Omanis: Prevalence and clinical profile.

PURPOSE: The aim of this study is to describe the prevalence, severity and clinical profile of diabetic retinopathy (DR) among Omani diabetic patients attending a tertiary care hospital. MATERIALS AND METHODS: This is a retrospective study involving the record review of diabetic patients attending the diabetes retina clinic of the National Diabetes and Endocrine Centre in the period between June 2015 and May 2016. Retinal evaluation of 442 native patients was conducted using direct ophthalmological examination and digital photography. DR was graded using the Early Treatment DR Study criteria. The statistical analysis was conducted using SPSS, version 20. RESULTS: The estimated total prevalence of DR was 31% (95% confidence interval: 26.6-35.3). Mild nonproliferative diabetic retinopathy (NPDR) constitutes 21.3%, while moderate-to-severe NPDR and proliferative diabetic retinopathy constitute 4.5% and 5.2%, respectively. The prevalence of vision-threatening diabetic retinopathy (VTDR) and diabetic maculopathy was 15.4% and 13.3%, respectively. Retinopathy was significantly associated with age, diabetes duration, Type 2 diabetes mellitus, coexisting comorbidities or complications, systolic blood pressure, glycated hemoglobin (HbA1c), fasting blood sugar, triglycerides, and albumin/creatinine ratio. In the regression analysis, age (P = 0.02), duration (P < 0.001), and HbA1c (P < 0.001) were independently associated with DR. CONCLUSIONS: The prevalence of DR and VTDR among Omani diabetics is high. Age, duration of diabetes, and HbA1c are the risk factors for the development of DR among Omanis. This emphasizes the importance of planning resources for different modalities of treatment of DR to face the future challenge.

Cancer Risk Factors Among Omanis: A Review.

BACKGROUND: Studying risk factors for cancer is the way for prevention and control. This study aims to review analytic studies reporting the identified risk factors of cancer in Oman. METHODS: A comprehensive literature search was conducted on "PubMed database, Scopus database, and Google Scholar", using appropriate key terms/words. No date limits were defined until March 2019. Both; keyword and MeSH term strategies were used to retrieve studies. RESULTS: This review yielded 10 analytic studies related to cancer risk factors in Oman, all of which utilized the case control design. Seven studies were related to various genetic factors, two were related to dietary factors and obesity, and one was related to diabetes as a risk factor. There was insufficient evidence available on essential modifiable risk factors such as smoking, use of alcohol, environmental factors and infectious agents. CONCLUSION: The scanty local literature is focused on genetic, non-modifiable factors, and very little is related to modifiable factors which should be given more attention to allow prevention and control. Locally, this is challenged by training needs for health professionals, and availability of financial resources, emphasizing the need for multisectorial work.

Pediatric Diabetic Retinopathy: Experience of a Tertiary Hospital in Oman.

PURPOSE: The aim of this study is to describe the prevalence and clinical profile of pediatric diabetic retinopathy (DR) among Omani diabetic children and adolescents attending a tertiary care hospital. METHODS: This retrospective cross-sectional study involved the record review of 216 diabetic children attending the diabetes retina clinic of the National Diabetes and Endocrine Centre in the period between June 2015 and November 2018. The retinal evaluation was conducted using direct ophthalmological examination and fundus photography. DR was graded using the Early Treatment DR Study criteria. The statistical analysis was performed using SPSS, version 20. RESULTS: The prevalence of DR among the study sample was 3.7% (95% confidence interval: 1.2-6.2). Mild and moderate nonproliferative diabetic retinopathy was seen in 2.8% (6) and 0.9% (2) of patients, respectively. Diabetic maculopathy was observed in 2 (0.9%) cases. Diabetic ketoacidosis was seen in 33.8% of children at presentation. DR was significantly associated with age (P = 0.01), duration (P < 0.001), Type 1 diabetes mellitus (P = 0.01), dyslipidemia (P = 0.005), microalbuminuria (P = 0.001), glycated hemoglobin (P = 0.003), total cholesterol (P = 0.001), high-density lipoproteins (P = 0.001), low-density lipoproteins (P < 0.001), and albumin/creatinine ratio (P < 0.001). CONCLUSIONS: This is the first study describing DR among the pediatric age group in Oman. This study reveals a relatively low prevalence of DR and maculopathy among the pediatric diabetic population. However, novel strategies are to be adopted at primary levels to achieve timely screening of diabetic children to enhance the early detection of DR.

'MOVEdiabetes': a cluster randomized controlled trial to increase physical activity in adults with type 2 diabetes in primary health in Oman.

OBJECTIVE: This study examined the impact of a multicomponent intervention to increase physical activity (PA) in adults with type 2 diabetes (T2D) in Oman. RESEARCH DESIGN AND METHODS: This is a cluster randomized controlled trial in eight primary health centers. Participants were physically inactive, aged ≥18 years, and with no contraindication to PA. Patients attending intervention health centers (n=4) received the 'MOVEdiabetes' intervention, which consisted of personalized, individual face-to-face consultations by dietitians. Pedometers and monthly telephone WhatsApp messages were also used. Patients attending comparison health centers received usual care. The primary outcome was change in PA [Metabolic Equivalent(MET).min/week] after 12 months assessed by the Global Physical Activity Questionnaire. The secondary outcomes were changes in daily step counts, sitting time, weight, body mass index, glycated hemoglobin, blood pressure and lipids. RESULTS: Of the 232 participants (59.1% female, mean (SD) age 44.2 (8.1) years), 75% completed the study. At 12 months, the mean change in MET.min/week was +631.3 (95% CI 369.4 to 893.2) in the intervention group (IG) vs +183.2 (95% CI 83.3 to 283.0) in the comparison group, with a significant between-group difference of +447.4 (95% CI 150.7 to 744.1). The odds of meeting PA recommendations were 1.9 times higher in the IG (95% CI 1.2 to 3.3). Significant between-group differences in favor of IG were detected for mean steps/day (+757, 95% CI 18 to 1531) and sitting time hours/ per day (-1.5, 95% CI -2.4 to -0.7). Clinical measures of systolic and diastolic blood pressure and triglycerides also showed significant intervention effects. CONCLUSIONS: 'MOVEdiabetes' was effective in increasing PA, the likelihood of meeting PA recommendations, and providing cardioprotective benefits in adults with T2D attending primary care.

Validation of the cardiovascular risk model developed for Omanis with type 2 diabetes.

AIM: The first cardiovascular risk prediction model in the Arab world was recently developed for Omanis with type 2 diabetes mellitus. This study aims to validate the newly developed model. MATERIALS AND METHODS: A retrospective cohort study design was applied in this study. The model was validated in two samples; the model derivation sample and a separate validation sample, consisting of 1314 and 405 diabetics respectively. All patients were free of cardiovascular disease at the baseline (2009-2010) and were followed up until: the first cardiovascular event occurred; the patient died; or up to December 2015. All data were retrieved from the patients' medical records in a primary care setting. RESULTS: In both the derivation and validation samples, the model showed good discrimination, with an area under the receiver operating curve of 0.73 (95% CI; 0.69-0.77) and 0.70 (95% CI: 0.59-0.75) respectively. Calibration of the model was satisfactory and the actual difference between the mean predicted and observed risk in different risk groups ranged from 0.7%-3.1% and 0.1%-4.2% in the derivation and validation samples respectively. CONCLUSION: The recently developed cardiovascular disease risk assessment model for Omanis with type 2 diabetes achieved adequate overall validity. The model showed good discrimination and acceptable calibration; it therefore has the potential to be used in local clinical settings. However, further validation and comparison studies are needed to judge the generalizability and superiority of the model over other tools currently used in Oman.

Cardiovascular risk prediction model for Omanis with type 2 diabetes.

AIM: To date, no cardiovascular risk assessment tool has been developed specifically for any Arabian population including Omanis. This study aims to develop a suitable cardiovascular risk prediction model in the form of a statistical equation, for Omanis with type 2 diabetes. MATERIALS AND METHODS: A sample of 2039 patients with type 2 diabetes selected from primary care settings in the Aldakhiliyah Province of Oman were involved in a retrospective cohort study. All patients were free of cardiovascular disease at baseline (in 2009-2010) and were followed up until: 1) their first cardiovascular event occurred; 2) the patient died, or 3) the end of the data collection in December 2015. RESULTS: Among the total sample, 192 cardiovascular disease events were recorded within a mean follow-up period of 5.3-year. The 5-year probability of a cardiovascular event was given as 1-0.9991Exp∑XiBi, where Exp ∑XiBi (hazard ratio)=Exp (0.038 age+0.052 DM duration+0.102 HbA1c+0.201 total cholesterol+0.912 albuminuria [1 if present]+0.166 hypertension [1 if present]+0.005 BMI). CONCLUSION: The first cardiovascular risk prediction tool in the Arab world was developed in this study. It may be used to estimate the 5-year cardiovascular risk among Omanis with type 2 diabetes in order to plan patient management and preventive measures. However, further validation studies are required to determine the accuracy of the model.