Recommendations for management of diabetes and its complications during Hajj (Muslim Pilgrimage) - 2024 update.

Hajj is an obligatory duty for all healthy adult Muslims once in the lifetime subjected to the ability. Considering the 10.5 % global prevalence of diabetes coupled with the numbers of Muslims performing the Hajj, ∼ 1.8 million in 2023, it is estimated that Muslims with diabetes performing Hajj may exceed 340,000 this year. During Hajj the pattern and amount of their meal, fluid intake and physical activity are markedly altered. Many people with diabetes insist on doing the Hajj duty, thereby creating a medical challenge for themselves and their health care providers. It is therefore important that medical professionals be aware of the potential risks that may be associated with Hajj. People with diabetes may face many health hazards during Hajj including but not limited to the killer triad which might occur during Hajj: Hypoglycemia, Foot injury and Infections. Many precautions should be taken to prevent and treat these potentially serious complications. Risk stratification, medication adjustments, proper clinical assessment, and education before doing Hajj are crucial.

Cardio-renal-metabolic disease in primary care setting.

In the primary care setting providers have more tools available than ever before to impact positively obesity, diabetes, and their complications, such as renal and cardiac diseases. It is important to recognise what is available for treatment taking into account diabetes heterogeneity. For those who develop type 2 diabetes (T2DM), effective treatments are available that for the first time have shown a benefit in reducing mortality and macrovascular complications, in addition to the well-established benefits of glucose control in reducing microvascular complications. Some of the newer medications for treating hyperglycaemia have also a positive impact in reducing heart failure (HF). Technological advances have also contributed to improving the quality of care in patients with diabetes. The use of technology, such as continuous glucose monitoring systems (CGM), has improved significantly glucose and glycated haemoglobin A1c (HbA1c) values, while limiting the frequency of hypoglycaemia. Other technological support derives from the use of predictive algorithms that need to be refined to help predict those subjects who are at great risk of developing the disease and/or its complications, or who may require care by other specialists. In this review we also provide recommendations for the optimal use of the new medications; sodium-glucose co-transporter-2 inhibitors (SGLT2i) and Glucagon-like peptide-receptor agonists 1 (GLP1RA) in the primary care setting considering the relevance of these drugs for the management of T2DM also in its early stage.

Optimizing Ramadan fasting: A randomised controlled trial for people with type 2 diabetes during Ramadan applying the principles of the ADA/EASD consensus.

BACKGROUND: Fasting during the holy month of Ramadan is one of the five pillars of Islam. Fasting is not meant to create excessive hardship on the Muslim individual according to religious tenets. It is important that health professionals are aware of potential risks associated with fasting during the month of Ramadan (mainly hypoglycemia and hyperglycemia). AIMS: To explore the impact of applying the principles of our 2020 recommendations for the management of type 2 diabetes (T2D) during the month of Ramadan. METHODS: A multinational randomized controlled trial (RCT) was conducted in five Muslim majority countries. Six hundred and sixty participants were deemed eligible for the study; however, 23% declined to participate later for various reasons. In total, 506 participants were enroled and were equally randomized to the intervention or the control group. At the end of the study, data from 231 participants in the intervention group and 221 participants from the control group were collected after 12.6% and 8.7% were, respectively, lost to follow-up. Participants were randomized to receive a Ramadan-focussed education with treatment for diabetes adjusted as per our 2020 recommendation update compared with the local usual care (control group). Results are presented using mean, standard deviation, odds ratio (OR), and percentages. RESULTS: At the end of the study, the number of hypoglycemic episodes in the intervention group was less than in participants who received usual care. The intervention group had significantly lower severe hypoglycemia compared to the control group with an OR of 0.2 [0.1-0.8]. Compared to baseline, both groups had a significant reduction in glycated haemoglobin (HbA1c), but the improvements were significantly greater in the intervention group. Whilst body weight reduced and high-density lipoprotein cholesterol increased with the intervention, these changes were not significantly different from usual care. CONCLUSIONS: A pre-Ramadan assessment of people with T2D coupled with pre-Ramadan education and an adjustment of glucose-lowering treatment as per our updated 2020 recommendations can prevent acute complications and allow a safer fast for people with T2D. We have shown that such an approach reduces the risk of developing severe hypoglycemia and improves the metabolic outcomes in people with T2D.

Sulfonylureas in the Current Practice of Type 2 Diabetes Management: Are They All the Same? Consensus from the Gulf Cooperation Council (GCC) Countries Advisory Board on Sulfonylureas.

Since their inception in the commercial market in the mid-twentieth century, sulfonylureas (SUs) have remained a therapeutic option in the management of type 2 diabetes (T2D). Despite their established glucose-lowering effects, there is no consensus among global experts and modern guidelines regarding the priority of SUs in relation to other therapeutic options, given the lack of evidence that SUs are associated with a low risk of macrovascular events and excess mortality. However, findings from recent trials and real-time observations have resolved this contentious issue somewhat, albeit to varying degrees. The present consensus discusses the role of SUs in contemporary diabetes management in the Gulf Cooperation Council (GCC) countries. Regional experts from these countries gathered virtually to formulate a consensus following presentations of topics relevant to SU therapy with an emphasis on gliclazide, including long-term efficacy, cost, end-organ benefits, and side effects, based on up-to-date evidence. The present narrative review reflects the conclusions of this assembly and provides a platform upon which future guidelines for the use of SUs in the GCC can be tailored.

Recommendations for management of diabetes during Ramadan: update 2020, applying the principles of the ADA/EASD consensus.

Fasting the Holy month of Ramadan constitutes one of the five pillars of the Muslim faith. Although there is some evidence that intermittent fasting during Ramadan may be of benefit in losing weight and cardiometabolic risk factors, there is no strong evidence these benefits apply to people with diabetes. The American Diabetes Association/European Association for the Study of Diabetes consensus recommendations emphasize the importance of patient factors and comorbidities when choosing diabetes medications including the presence of comorbidities, atherosclerotic cardiovascular disease, heart failure, chronic kidney disease, hypoglycemia risk, weight issues and costs. Structured education and pre-Ramadan counseing are key components to successful management of patients with diabetes. These should cover important aspects like glycemic targets, self-monitoring of blood glucose, diet, physical activity including Taraweeh prayers, medication and dose adjustment, side effects and when to break the fast. The decision cycle adapted for the specific situation of Ramadan provides an aid for such an assessment. Children with type 1 diabetes should strongly be advised not to fast due to the high risk of acute complications such as hypoglycemia and probably diabetic ketoacidosis (DKA), although there is very little evidence that DKA is increased in Ramadan. Pregnant women with diabetes or gestational diabetes should be advised to avoid fasting because of possible negative maternal and fetal outcomes. Hypoglycemia is a common concern during Ramadan fasting. To prevent hypoglycemic and hyperglycemic events, we recommend the adoption of diabetes self-management education and support principles. The use of the emerging technology and continuous glucose monitoring during Ramadan could help to recognize hypoglycemic and hyperglycemic complications related to omission and/or medication adjustment during fasting; however, the cost represents a significant barrier.

Diagnosis and management of vitamin D deficiency in the Gulf Cooperative Council (GCC) countries: an expert consensus summary statement from the GCC vitamin D advisory board.

OBJECTIVE: A summary of recommendations is given within the Gulf Cooperation Council (GCC) setting on the assessment and management of vitamin D deficiency in the region. METHODS: An assembly of 11 regional experts gathered to formulate an all-inclusive approach to vitamin D deficiency within GCC. RESULTS AND CONCLUSION: Several gaps were identified before regional guidelines could be developed. These include adequacy and standardization of vitamin D testing, frequency of repeated testing and reference ranges, distinguishing prevention from the treatment of vitamin D deficiency, quality assurance of vitamin D products sold within GCC including contents and origins of products, and cut-points for vitamin D levels in local populations. A platform is created that can be further developed for overall regional implementation.

Trajectory Analysis of Glycemic Control in Adolescents with Type 1 Diabetes Mellitus at Dammam Medical Complex, Saudi Arabia.

BACKGROUND: Saudi Arabia is reported to have the highest number of children and adolescents with T1DM. However, data concerning glycemic control during adolescence are lacking. OBJECTIVES: To determine glycemic control at transition stage from pediatric to adult clinics, determine HBA1c patterns during follow-up, and identify any clinical or demographic variables that may predict a distinctive glycemic pattern. DESIGN: Observational retrospective study. Setting. Dammam Medical Complex, secondary care hospital. Patients and Method. Adolescents aged ≥12 years, with HbA1c recorded at least once a year over 4 years of follow-up, were eligible for inclusion. A trajectory analysis from 2008 to 2019 was conducted, using latent class growth modelling (LCGM), and two-sample t-tests and Fisher's exact tests were conducted to determine whether there was a statistically significant difference in demographic and clinical variables. Sample Size. 44 patients. RESULTS: 61.36% were referred from pediatric clinics, and 84% were on multiple insulin daily injections. For the trajectory prediction, two groups were identified. Group 1 comprised 71.7%, had high HbA1c values at age 13 (HbA1c, 11.28%), and had a significant and stable decrease in HbA1c values with age (-0.32, p < 0.00). Group 2 comprised 28.2%, showed poor HbA1c values at age 13 (HbA1c, 13.28%), and showed increase in HbA1c values slightly by age 15, which then steadily decreased with age (-0.27). Results indicated that the initial HBA1c value was a significant predictor for group trajectory (p=0.01), while the remaining variables did not have any significance. CONCLUSION: Our study identified two groups with poorly controlled diabetes; however, the first group performed relatively better than the second group. Both groups almost doubled their targets, with a trend towards HbA1c reduction by the age of 19 in both groups. Limitations. Retrospective study with convenient, small sample size.

Attitude and safety of patients with diabetes observing the Ramadan fast.

AIMS: To describe the attitude of type 2 diabetes patients toward Ramadan fasting. A Secondary purpose was to describe rates of hypoglycemia during Ramadan according to type of treatment. METHODS: A prospective, non-randomized study for 2 years. Participants with type 2 diabetes attending Dammam Diabetes Center, Saudi Arabia were stratified for fasting according to ADA recommendations. Results are presented using mean, standard deviation and percentages. RESULTS: Total of 360 participants with type 2 diabetes. Mean ±â€¯SD glycosylated hemoglobin was 8.9 ±â€¯2.1. More than 80% of individuals were in the ADA higher risk group however, they all fasted Ramadan. The mean non-fasting days was 2.6 days and overall rate of hypoglycaemia was 24.7%. Both parameters were directly proportionate to the risk stratification level (P-value <0.05). Despite hypoglycaemia, 29.3% continued fasting. Hypoglycemia was highest in patients treated with insulin (P-value <0.05) followed by those treated with oral agents including sulphonylurea as compared to oral agents excluding sulfonylurea (P-value = 0.002). Those who experienced hypoglycemia prior to Ramadan had the highest rate of hypoglycemia during Ramadan (53.3%) (P-value = 0.0065). CONCLUSIONS: Despite medical advice, the vast majority of type 2 diabetes participants categorized as high risk, fasted Ramadan. Approximately one quarter of people with type 2 diabetes in our cohort experience hypoglycaemia and this was directly related to their fasting risk level. A sizeable proportion continued the fast despite hypoglycemic. Insulin therapy with or without oral agents and previous episodes of hypoglycemia before Ramadan predicted hypoglycemia risk during Ramadan. HbA1c and weight showed some clinical improvements post Ramadan fasting. This is a single center study of mostly high risk fasting patients and hence, these results should not be generalized.

Diabetic hypoglycaemia during Ramadan fasting: A trans-national observational real-world study.

OBJECTIVES: To describe the risk of hypoglycaemia during Ramadan and determine its risk factors, and the impact of hypoglycaemia on patients' behaviour. METHODS: A cross-sectional multi-country observational study, with data captured within 6 weeks after Ramadan 2015. Patients' and disease characteristics and its management, the risk of hypoglycaemia and patients' response to hypoglycaemia were recorded. RESULTS: A cohort of 1759 patients; majority with type 2 diabetes mellitus from North Africa, Arabian Gulf, Saudi Arabia, and the Indian subcontinent. Hypoglycaemia was reported by 290 patients (16.8%); particularly affecting type 1 diabetes patients and in insulin-treated patients in general. Age was significantly younger in the hypoglycaemia group (P < 0.001). The commonest responses were reducing the dose or frequency of medications (42%), attending primary care providers (24.5%) or increasing monitoring (20.7%). Fasting was interrupted by 67% only of those who experienced hypoglycaemia and recourse to emergency services was pursued by less than a quarter of patients with hypoglycaemia. The country-wise analysis of the rates of hypoglycaemia was greatest in Egypt (51.3%) and lowest in Pakistan (3.5%). CONCLUSIONS: Hypoglycaemia is a significant complication of fasting during Ramadan. It may be predicted by type of diabetes, and use of insulin. Patients' responses are varied and call for more formal pre-Ramadan education.

Recommendations for management of diabetes and its complications during Hajj (Muslim pilgrimage).

Hajj is one of the five pillars of Islam and is a must-do for all adult Muslims once in their life provided they are able to do it. Considering the 8.8% global prevalence of diabetes, coupled with the number of Muslims performing Hajj (~2.5 million adult Muslims), it could be estimated that Muslims with diabetes performing Hajj may exceed 220 000 per year. According to Islamic rules, Hajj should not cause severe difficulties for Muslims. The Holy Qur'an specifically exempts from this duty Muslims who are unable physically or financially if it might lead to harmful consequences for the individual. This should be applicable to subjects with diabetes considering its severe and chronic complications. During the Hajj, diet, amount of fluid intake and physical activity may be altered significantly. This exemption from the duty is usually not considered a simple permission; Muhammad the Prophet of Islam mentioned, 'God likes his permission to be fulfilled, as he likes his will to be executed'. However, most Muslims with diabetes prefer to do the Hajj duty, and this may cause major medical challenges for Muslims with diabetes and their healthcare providers. So it is very important that healthcare providers are aware of the possible risks that could happen during the Hajj. People with diabetes may face many health hazards during the Hajj, including but not limited to the 'killer triad': hypoglycemia, foot injury and infections. Many precautions are necessary in the prevention and treatment of possible serious complications. Risk stratification, medication adjustments, proper clinical assessment, and education before doing the Hajj are crucial.

Closing Gaps in Diabetes Care: From Evidence to Practice.

BACKGROUND: Tracking progress in diabetes care may help in evaluating the quality of efforts and identifying gaps in the care. OBJECTIVES: To demonstrate that tracking important clinical indicators of diabetes mellitus can result in improved care as well as help identify and close gaps between evidence and practice in diabetes care. SUBJECTS AND METHODS: The study is an observational, random audit of medical records of patients with diabetes who received care at the Diabetes Center, Dammam Medical Complex. Thirteen process and four outcome key performance indicators were studied using the quality improvement Plan-Do-Study-Act model, for the period between October 2012 and March 2016. Individual physician performance was also measured for the same duration. All data were benchmarked against peer organizations worldwide. RESULTS: Urine examination for proteinuria, foot examination, annual influenza vaccination, aspirin prescription, structured education, personalized nutritional advice and self-monitoring of blood glucose significantly improved between baseline and the final observation of the study (P < 0.001). The proportion of patients with hemoglobin A1c >9% decreased, and that of those who achieved the recommended levels of hemoglobin A1c (<7%), low-density lipoprotein cholesterol (<2.6 mmol/L) and blood pressure (<140/90 mmHg) significantly increased (P < 0.001). Benchmarking against peer organizations worldwide showed comparable results overall, and better results for certain indicators. CONCLUSION: Quality improvement strategies and key performance indicators can be utilized to improve the quality of diabetes care delivered, and thus reduce gaps and barriers that exist between recommended diabetes care and practice.

Hepatitis C virus infection among patients with diabetes mellitus in Dammam, Saudi Arabia.

BACKGROUND: Data regarding comorbidities of hepatitis C virus infection (HCV) in the kingdom of Saudi Arabia (KSA) are lacking. The present study aimed to determine the prevalence and risk factors of HCV among Saudi patients with diabetes mellitus (DM) in Dammam, KSA. METHODS: In this cross-sectional study done in 2011, a total of 1054 Saudi DM patients were randomly selected from the Diabetes Center in Dammam Medical Complex, KSA, for interview and HCV screening using the HCV Rapid Test. Positive cases were later confirmed via INNO-LIA HCV score line immune assay. RESULTS: Seropositivity of HCV was 1.9 %. DM duration of >5 years increased the probability of HCV risk to 3.7 fold while insulin users were 3.2 times more likely to have HCV infection. Increased hospital admission (3-4 times) also increased HCV risk by 11.5 times and 13.6 times among patients with ≥5 admissions. Similarly, having 3-4 surgical procedures increased HCV risk by 8.6 times and 39.3 times with ≥5 procedures. HCV transmission is 4 times more likely by blood transfusion. Those who shared personal items were 8.5 times more likely to have HCV. Tattooing increased HCV risk by 6.7 times. The likelihood of HCV infection was also higher among DM patients with liver diseases and elevated liver enzymes. CONCLUSION: The study confirmed a significant association between HCV risk and DM. Frequency of HCV among DM Saudis was 1.9 %. Predictors of HCV among DM patients were sharing personal items, occupational exposure to blood or its products, elevated transaminases, tattooing, disease duration > 5 years, increased hospital admission and blood transfusion.

Frequency and factors associated with hepatitis C virus infection among patients with diabetes, Dammam, KSA.

BACKGROUND: Hepatitis C virus (HCV) infection and diabetes mellitus (DM) are main causes of morbidity and mortality worldwide. There is an increasing evidence of association between HCV and type 2 DM. Comorbidity will cause devastating health and financial burdens. Early detection may help proper management and better prognosis. OBJECTIVE: The aim of this study was to examine the frequency and risk factors of HCV among Saudi patients with diabetes. PATIENTS AND METHODS: In this cross-sectional study, 1054 Saudi patients with diabetes type 1 and type 2 were randomly selected, interviewed, and tested for HCV in Dammam Medical Complex, KSA (2011), using the HCV Rapid Test. Positive cases were later confirmed using the INNO-LIA HCV score line immunoassay. RESULTS: Seropositivity of HCV was 1.9%. Regression analysis revealed the following independent predictors: sharing articles, elevated liver enzymes, exposure to blood or blood products in occupational setting, disease duration more than 5 years, tattooing, blood transfusion, and hospitalization more than two times. CONCLUSION AND RECOMMENDATIONS: The study confirmed a positive association between HCV and DM. The frequency of HCV among patients with diabetes was 1.9%. Predictors of HCV among DM patients were sharing articles, elevated transaminases, occupational exposure to blood or its products, disease duration more than 5 years, tattooing, blood transfusion, and hospitalization more than two times. We recommend screening for HCV among DM patients with elevated serum transaminases and those having the disease for more than 5 years and education of patients with diabetes as regards their high risk for HCV and how to avoid infection.

Antithyroid drug induced a granulocytosis: what still we need to learn?

Antithyroid drugs (ATDs) induced agranulocytosis is a rare but life threatening condition. We report a 29 years Filipino female diagnosed as having hyperthyroidism with normal base line blood counts, liver and renal profile. She was started on maximum 60 mg (20mg TID) oral dose of carbimazole since one month by her treating physician. Exactly after one month of treatment she presented to emergency room (ER) with fever, sore throat and generalized weakness for several days.

Low rate of non-compliance to antituberculous therapy under the banner of directly observed treatment short course (DOTS) strategy and well organized retrieval system: a call for implementation of this strategy at all DOTS centers in Saudi Arabia.

INTRODUCTION: The objective of this study was to show the effectiveness of revised retrieval system on non-compliance. METHODS: We retrospectively evaluated the effectiveness of a revised retrieval system on non-compliance during continuous phase of antituberculous treatment (Jan-2005 to Dec-2010) compared to baseline non-compliance (Jan-2002 to Dec-2004). RESULTS: In the baseline period, 141 of 501 (28%) patients did not attend their first appointment. Of these 141 patients, 63 (45%) patients could be brought back to treatment while 78 patients (16%) dropped out and could not be retrieved. During the 2nd phase after launching a revised retrieval system, 98 of 835 (13%) patients did not attend their first appointment. Using the retrieval system, 79 (81%) patients were brought back for regular follow up, and 19 patients could not be retrieved, a dropout rate of 2.27%. By virtue of revised retrieval system, there was a significant drop in non-compliance by 15% and a decline in net dropout rate by 14%. The number of those brought back to treatment by revised retrieval system almost doubled (81%) compared to 44% retrieval in initial period. CONCLUSION: The revised retrieval system had a significant impact on the reduction of dropout rate and significant improvement in the retrieval of those patients.

Recommendations for management of diabetes during Ramadan: update 2015.

Since the first ADA working group report on the recommendations for management of diabetes during Ramadan in 2005 and our update in 2010, we received many inquiries asking for regular updates on information regarding education, nutritional habits and new oral and injectable agents that may be useful for the management of patients with diabetes during Ramadan. Patients can be stratified into their risk of hypoglycemia and/or complications prior to the start of the fasting period of Ramadan. Those at high risk of hypoglycemia and with multiple diabetic complications should be advised against prolonged fasting. Even in the lower hypoglycemia risk group, adverse effects may still occur. In order to minimize adverse side effects during fasting in patients with diabetes and improve or maintain glucose control, education and discussion of glucose monitoring and treatment regimens should occur several weeks prior to Ramadan. Agents such as metformin, thiazolidinediones and dipeptidyl peptidase-4 inhibitors appear to be safe and do not need dose adjustment. Most sulfonylureas may not be used safely during Ramadan except with extreme caution; besides, older agents, such as chlorpropamide or glyburide, should not be used. Reduction of the dosage of sulfonylurea is needed depending on the degree of control prior to fasting. Misconceptions and local habits should be addressed and dealt with in any educational intervention and therapeutic planning with patients with diabetes. In this regard, efforts are still needed for controlled prospective studies in the field of efficacy and safety of the different interventions during the Ramadan Fast.

Impact of an individualized type 2 diabetes education program on clinical outcomes during Ramadan.

OBJECTIVE: To determine if individualized education before Ramadan results in a safer fast for people with type 2 diabetes. METHODS: Patients with type 2 diabetes who received care from participating clinics in Egypt, Iran, Jordan and Saudi Arabia and intended to fast during Ramadan 2014 were prospectively studied. Twelve clinics participated. Individualized education addressed meal planning, physical activity, blood glucose monitoring and acute metabolic complications and when deemed necessary, provided an individualized diabetes treatment plan. RESULTS: 774 people met study criteria, 515 received individualized education and 259 received usual care. Those who received individualized education were more likely to modify their diabetes treatment plan during Ramadan (97% vs 88%, p<0.0001), to perform self-monitoring of blood glucose at least twice daily during Ramadan (70% vs 51%, p<0.0001), and to have improved knowledge about hypoglycemic signs and symptoms (p=0.0007). Those who received individualized education also reduced their body mass index (-1.1±2.4 kg/m(2) vs -0.2±1.7 kg/m(2), p<0.0001) and glycated haemoglobin (-0.7±1.1% vs -0.1±1.3%, p<0.0001) during Ramadan compared those who received usual care. There were more mild (77% vs 67%, p=0.0031) and moderate (38% vs 19%, p<0.0001) hypoglycemic events reported by participants who received individualized education than those who received usual care, but fewer reported severe hypoglycemic events during Ramadan (23% vs 34%, p=0.0017). CONCLUSIONS: This individualized education and diabetes treatment program helped patients with type 2 diabetes lose weight, improve glycemic control and achieve a safer fast during Ramadan.

Intensified glucose self-monitoring with education in Saudi DM patients.

The purpose of this study is to assess the impact of intensified SMBG with patient education on DM patients at the Eastern province of Saudi Arabia. 60 poorly controlled adult type 1 and 2 DM patients (30 intervention; 30 control) were included in this 4-month case-control study. All patients were subjected to the same educational program at baseline. Controls were followed up after 3 months. The intervention group was followed monthly. Fasting blood glucose, HbA1c and lipid profile levels were the main outcome measures. The intervention arm showed significant reduction in the post-fasting glucose (P<0.001) and HbA1c (P<0.001) levels as well as a significant increase in glucose testing (P<0.001) than pre-levels. Both post-fasting glucose and HbA1c levels were significantly lower in the intervention arm than the control arm (P<0.001 and P=0.001, respectively). The intervention group also showed higher improvement in knowledge, attitude and behavior than the controls (P<0.001). Short duration of structured periodic SMBG with patient education significantly improved glycemic control in all DM patients, regardless of the type or mode of treatment. It facilitated timely and aggressive treatment modification and encouraged patient self-care behavior.

The rates of sputum conversion among new smear positive open pulmonary tuberculosis patients treated under directly observed treatment, short course strategy.

OBJECTIVE: To evaluate effectiveness of directly observed treatment short course (DOTS) by monthly sputum conversion rates at first, second, and third month in newly diagnosed patients of pulmonary tuberculosis (TB) (category-1), and to study patterns of lesions on chest radiographs and their correlation to smear sputum positivity, also to record reaction to Mantoux tuberculin skin test (TST) in active TB patients. METHODS: This prospective cohort study was conducted among 100 newly diagnosed patients of open pulmonary tuberculosis CAT-1, admitted and treated under DOTS, at the Tuberculosis Center, Dammam Medical Complex, Dammam, Kingdom of Saudi Arabia between July to December 2010. Chest radiographs were studied for the patterns of lesions and their correlation to the grades of sputum positivity. Three fasting state sputum specimens were tested on 3 consecutive days by direct smear microscopy at first, second, and third month. As per DOTS, intensive phase treatment was extended for another 4 weeks in those still positive at the end of 2 months. Mantoux TST was performed on all patients with tuberculin purified protein derivative-RT-23 2TU. RESULTS: The overall sputum conversion rate observed at the first month was 56%, 76% on the second month, and 94% on the third month. Reaction to TST of more than 10 mm was recorded in most of the studied patients (97%). CONCLUSION: The DOTS is an appropriate strategy for early and progressive conversion of smear positive patients to break the chain of infection, which is epidemiologically important for the control, elimination, and eradication of TB.