Prevalence and Factors Associated With Poor Sleep Quality Among Visitors of Primary Healthcare Centers in Al-Ahsa, Kingdom of Saudi Arabia: An Analytical Cross-Sectional Study.

Introduction Poor sleep quality can predict poor health and is associated with mortality risk. Many factors are associated with sleep quality such as gender, health, education, socioeconomic status, and stress. The objective of this study was to estimate the magnitude of poor sleep quality among visitors of Primary Healthcare Centers (PHCCs) in Al-Ahsa and to identify factors associated with poor sleep quality. Methods This is an analytical cross-sectional study. A multistage cluster sampling technique was used to recruit 461 visitors to PHCCs in Al-Ahsa Governorate in the Eastern Province of Saudi Arabia. A structured questionnaire was administered through face-to-face interviews. The questionnaire includes demographics, a validated Arabic version of the Pittsburgh Sleep Quality Index (PSQI), the Arabic version of the International Physical Activity Questionnaire (IPAQ), the Arabic version of the Patient Health Questionnaire-2 (PHQ-2), the Arabic version of the Generalized Anxiety Disorder-2 (GAD-2), the Arabic version of Perceived Stress Scale-10 (PSS-10), and a translated Mobile Related Sleep Risk Factors (MRSRF). Univariate analysis was performed using the Mann-Whitney U test for continuous data, the chi-square test (χ²) or Fishers's exact test (as appropriate) for categorical data, and logistic regression for multivariable analysis. A P-value of less than or equal to 0.05 was considered significant. Results The study included 433 participants, with 72.5% of them being poor sleepers (PSQI global score of over 5). The highest percentage of poor sleepers was found among those aged 18 - 28 years (81.7%), with no significant difference between genders (p = 0.676). The study's multivariable logistic regression analysis revealed that poor sleep is associated with smoking four hours before bedtime (OR = 2.9, CI = 1.2 - 6.7), consuming caffeine (drinks or pills) three hours before sleep (OR = 2.3, CI = 1.23 - 4.12) or immediately before bedtime (OR = 3.2, CI = 1.02 - 9.9), using mobile phones right before bedtime (OR = 2.6, CI = 1.5 - 4.5), having anxiety (OR = 5.8, CI = 1.3 - 26.2), and depression symptoms (OR = 6.5, CI = 2.9 - 14.5), among other risk factors. Conclusion The prevalence of poor sleep quality in our sample was notably high at 72.5%. Many factors are strongly associated with poor sleep quality including experiencing symptoms of anxiety and depression. Longitudinal studies are needed to explore this crucial health issue further. Healthcare providers in Al-Ahsa should pay particular attention while assessing patients who suffer from sleep disturbance by screening them for depression and anxiety and raising public awareness of the importance of good quality sleep and the factors that affect it.

Hypertension and its related factors among patients with type 2 diabetes mellitus - a multi-hospital study in Bangladesh.

BACKGROUND: Hypertension and type 2 diabetes are associated with each other, and their coexistence is linked to diabetes-related complications such as stroke, coronary artery disease, kidney disease, retinopathy and diabetic foot. This study aimed to determine the prevalence, awareness and control of hypertension and factors associated with hypertension among people with type 2 diabetes mellitus (T2DM) in Bangladesh. METHODS: A cross-sectional and retrospective study was conducted in 2017, and data from 1252 adults with T2DM were collected from six hospitals that specialise in diabetes care. These hospitals provide primary, secondary and tertiary healthcare and cover the rural and urban populations of Bangladesh. Cross-sectional data were collected from patients via face-to-face interviews, and retrospective data were collected from patients' past medical records (medical passport), locally known as the patients' guidebook or record book. The associations between hypertension and its related factors were examined using the bootstrapping method with multiple logistic regression to adjust for potential confounders. RESULTS: The mean age of participants was 55.14 (± 12.51) years. Hypertension was found to be present among 67.2% of participants, and 95.8% were aware that they had it. Of these, 79.5% attained the blood pressure control. The mean duration of diabetes was 10.86 (± 7.73) years. The variables that were found to be related to hypertension include an age of above 60 years, physical inactivity, being overweight or obese, a longer duration of diabetes and chronic kidney disease. CONCLUSION: The prevalence of hypertension as well as its awareness and control were very high among people with known type 2 diabetes. As there is a strong relationship between hypertension and diabetes, patients with diabetes should have their blood pressure regularly monitored to prevent major diabetes-related complications.

Adherence to the recommended physical activity duration among Saudis with type 2 diabetes mellitus.

BACKGROUND: Physical activity is important in managing type 2 diabetes, since it leads to better glycemic control, decreases macrovascular complications, and controls diabetes-related comorbidities. OBJECTIVE: This study aimed to assess the levels of adherence to physical activity in Saudi adults with type 2 diabetes. METHOD: Participants with type 2 diabetes mellitus who visited diabetes centers in Riyadh, Jeddah, and Hofuf and completed interviewer-administered electronic questionnaires between May 15 and November 31 in 2017 were included in this study. Data related to sociodemographic information, medical history, level of physical activity, and depression and anxiety were collected. In addition, blood pressure, anthropometric measurements, and the most recent HbA1c, and fasting lipid profiles were obtained. RESULTS: In total, 1,111 participants (65.2% women, mean age of 57.5 ± 11 years) were included in the analysis; 62.1% were obese (Body Mass Index [BMI] >30 kg/m2). Mean duration of DM was 13.8 ± 8.3 years. Approximately 75% of participants had uncontrolled diabetes (i.e. HbA1c ≥7%). Furthermore, only 30% adhered to the recommended physical activity duration of 150 min/week. Non-adherence to physical activity was associated with female sex, older age, low education, low economic status, longer disease duration, absence of family support, poor education from the physician or DM educator, and follow-up in health institutions other than the diabetes center. CONCLUSIONS: The majority of patients with T2DM in Saudi do not adhere to the recommended duration of physical activity. Sex, age, level of education, monthly income, disease duration, follow-up institution, among others, influenced adherence to physical activity.

Renal Disease Is Associated With Poor Outcomes Following Isolated Coronary Artery Bypass Grafting.

BACKGROUND: People with renal disease have a markedly higher risk of cardiovascular disease as well as morbidity and mortality after cardiac surgery. Little is known regarding the post-operative adverse outcomes following isolated coronary artery bypass graft (CABG) in the Australian population with renal disease. OBJECTIVES: The aim of this study was to examine the effect of different stages of renal disease on patients' risk of post-operative mortality and complications following isolated CABG in an Australian cohort. METHODS: Using the ANZSCTS (Australian and New Zealand Society of Cardiac and Thoracic Surgeons) registry, data from 44,968 patients who underwent isolated CABG between 2001 and 2014 were used. The effect of renal disease stages on short- and long-term outcomes were examined using multivariable logistic and Cox's regression methods respectively. RESULTS: Three of 4 Australian patients (74.6%) who underwent isolated CABG had some degree of renal disease: 50.2% mild; 20.9% moderate; 2.1% severe; and 1.6% dialysis-dependent. Adjusted risk of 30-day mortality increased with deteriorating renal disease from mild (1.6-fold) to dialysis-dependent (4.6-fold). Worsening renal disease was also associated with higher risk of post-operative complications. Hazard ratio for long-term survival shows steady increase of mortality risk with worsening renal disease categories from 1.1-fold for mild to 3.9-fold for patients on dialysis. CONCLUSIONS: Pre-existing renal disease is significantly associated with 30-day and long-term mortality, length of intensive care unit and hospital stay as well as several other post-operative complications.

Type 2 diabetes mellitus in Bangladesh: a prevalence based cost-of-illness study.

BACKGROUND: The economic burden of type 2 diabetes has not been adequately investigated in many low- and lower middle-income countries, including Bangladesh. The aim of this study was to estimate the cost-of-illness of type 2 diabetes and to find its determinants in Bangladesh. METHODS: A cross-sectional study was conducted in 2017 to recruit 1253 participants with type 2 diabetes from six diabetes hospitals, providing primary to tertiary health care services, located in the northern and central regions of Bangladesh. A structured questionnaire was used for face-to-face interviewing to collect non-clinical data. Patients' medical records were reviewed for clinical data and hospital records were reviewed for hospitalisation data. Cost was calculated from the patient's perspective using a bottom-up methodology. The direct costs for each patient and indirect costs for each patient and their attendants were calculated. The micro-costing approach was used to calculate direct cost and the human capital approach was used to calculate indirect cost. Median regression analysis was performed to identify the determinants of average annual cost. RESULTS: Among the participants, 54% were male. The mean (±SD) age was 55.1 ± 12.5 years and duration of diabetes was 10.7 ± 7.7 years. The average annual cost was US$864.7 per patient. Medicine cost accounted for 60.7% of the direct cost followed by a hospitalisation cost of 27.7%. The average annual cost for patients with hospitalisation was 4.2 times higher compared to those without hospitalisation. Being females, use of insulin, longer duration of diabetes, and presence of diabetes complications were significantly related to the average annual cost per patient. CONCLUSIONS: The cost of diabetes care is considerably high in Bangladesh, and it is primarily driven by the medicine and hospitalisation costs. Optimisation of diabetes management by positive lifestyle changes is urgently required for prevention of comorbidities and complications, which in turn will reduce the cost.

Glycaemic Control for People with Type 2 Diabetes Mellitus in Bangladesh - An urgent need for optimization of management plan.

AIMS: The objective of this study was to identify the determinants of glycaemic control among people with type 2 diabetes mellitus in Bangladesh. A cross-sectional study was carried out during March to September 2017, and 1253 adult patients with type 2 diabetes mellitus were recruited from six hospitals. Data were collected from patients via face-to-face interview, and their medical records were reviewed. Multiple logistic regression analysis was performed. Among the participants, 53.2% were male. Mean (±SD) age was 54.1 (±12.1) years and mean (±SD) duration of diabetes was 9.9 (±7.2) years. About 82% participants had inadequate glycaemic control (HbA1c ≥ 7%) and 54.7% had very poor control (HbA1c ≥ 9%). Low education level, rural residence, unhealthy eating habits, insulin use, infrequent follow up check-ups and history of coronary artery diseases found associated with inadequate and very poor controls. Being female and smokeless tobacco consumer appeared to be associated with inadequate control however cognitive impairment was associated with very poor control only. Prevalence of inadequate glycaemic level was very high in Bangladesh. Having understood relatable lifestyle modification factors, demographics and co-morbidities among people with type 2 diabetes, health care providers in conjunction with patients should work together to address the glycaemic control.

Lifestyle factors and macro- and micro-vascular complications among people with type 2 diabetes in Saudi Arabia.

AIMS: The aim of this study is to identify lifestyle factors that place people with type 2 diabetes in Saudi Arabia at a greater risk of macro- and microvascular complications. METHODS: A survey was conducted among adults with type 2 diabetes who attended diabetes centres in three major cities in Saudi Arabia. Participants were interviewed and their medical files were reviewed for lab test results and documented comorbidities. Associations between complication and lifestyle factors were assessed using multiple logistic regression analysis. RESULTS: A total of 1121 participants were recruited. Mean age was 57.6 (±11.1) years. The prevalence of coronary artery disease, diabetic foot, and stroke was 17.0%, 13.1% and 3.7%, and that of neuropathy, renal impairment, and retinopathy was 20.3%, 14.5%, and 42.8% respectively. Lifestyle factors associated with one or more of the complications were inadequate physical activity, longer sitting time, obesity, current or past smoking, passive smoking, hypertension, poor glycaemic control, low HDL and high triglycerides. CONCLUSIONS: Diabetes complications are common among people with type 2 diabetes in Saudi Arabia. Life style factors such as inadequate physical activity, longer sitting time, obesity, smoking, hypertension, and poor control of blood glucose and lipids should be assimilated into complications prevention program.

Cost-of-illness of type 2 diabetes mellitus in low and lower-middle income countries: a systematic review.

BACKGROUND: Diabetes is one of the world's most prevalent and serious non-communicable diseases (NCDs). It is a leading cause of death, disability and financial loss; moreover, it is identified as a major threat to global development. The chronic nature of diabetes and its related complications make it a costly disease. Estimating the total cost of an illness is a useful aid to national and international health policy decision making. The aim of this systematic review is to summarise the impact of the cost-of-illness of type 2 diabetes mellitus in low and lower-middle income countries, and to identify methodological gaps in measuring the cost-of-illness of type 2 diabetes mellitus. METHODS: This systematic review considers studies that reported the cost-of-illness of type 2 diabetes in subjects aged 18 years and above in low and lower-middle income countries. The search engines MEDLINE, EMBASE, CINAHL, PSYCINFO and COCHRANE were used form date of their inception to September 2018. Two authors independently identified the eligible studies. Costs reported in the included studies were converted to US dollars in relation to the dates mentioned in the studies. RESULTS: The systematic search identified eight eligible studies conducted in low and lower-middle income countries. There was a considerable variation in the costs and method used in these studies. The annual average cost (both direct and indirect) per person for treating type 2 diabetes mellitus ranged from USD29.91 to USD237.38, direct costs ranged from USD106.53 to USD293.79, and indirect costs ranged from USD1.92 to USD73.4 per person per year. Hospitalization cost was the major contributor of direct costs followed by drug costs. CONCLUSION: Type 2 diabetes mellitus imposes a considerable economic burden which most directly affects the patients in low and lower-middle income countries. There is enormous scope for adding research-based evidence that is methodologically sound to gain a more accurate estimation of cost and to facilitate comparison between studies.

Glycaemic control for people with type 2 diabetes in Saudi Arabia - an urgent need for a review of management plan.

BACKGROUND: The aim of this study was to assess inadequate glycaemic control and its associated factors among people with type 2 diabetes in Saudi Arabia. METHODS: A cross-sectional study design was used. Adults with type 2 diabetes attending diabetes centres in Riyadh, Hofuf and Jeddah cities were interviewed and their anthropometrics were measured. Their medical records were also reviewed to collect information related to recent lab tests, medications, and documented comorbidities. Multivariable logistic regression were used for data analysis. RESULTS: A total of 1111 participants were recruited in the study. Mean age was 57.6 (±11.1) years, 65.2% of the participants were females, and mean HbA1c was 8.5 ± 1.9%. About three-fourths of participants had inadequate glycaemic control (≥ 7%). Multivariable analysis showed that age ≤ 60 years, longer duration of diabetes, living in a remote location, low household income, low intake of fruits and vegetable, low level of physical activity, lack of knowledge about haemoglobin A1c, high waist-hip ratio, low adherence to medication, and using injectable medications were independent risk factors for inadequate glycaemic control. CONCLUSIONS: Inadequate glycaemic control is prevalent among people with type 2 diabetes in Saudi Arabia. In order to improve glycaemic control diabetes management plan should aim at controlling the modifiable risk factors which include low intake of fruits and vegetable, low level of physical activity, lack of knowledge about haemoglobin A1c, high waist-hip ratio, and low adherence to medications.

Safe driving practices and factors associated with motor-vehicle collisions among people with insulin-treated diabetes mellitus: Results from the Diabetes and Driving (DAD) study.

INTRODUCTION: The aim of this study was to assess the prevalence of people with insulin-treated diabetes mellitus (ITDM) who have discussed issues related to diabetes and driving with their health care providers (HCPs). We also sought to determine the safe driving practices that are currently employed by this group. Finally, we investigated the factors that might increase the risk of motor-vehicle collisions (MVCs) among this group in Saudi Arabia. METHOD: This cross-sectional study surveyed a representative sample of 429 current male drivers with ITDM using a structured questionnaire in Saudi Arabia. RESULTS: Most of the participants (76.5%) never discussed topics regarding diabetes and driving with their HCPs. The majority of the participants (61.8%) reported at least never doing one of the following: (a) carrying a blood glucose testing kit while driving, (b) testing their blood glucose level before driving or during a journey, or (c) having thought of a specific threshold of blood glucose level that would preclude driving. Three factors were associated with a higher risk of MVCs among participants with ITDM: (a) being on a basal/boluses regimen, (b) never having a discussion regarding diabetes and driving with their HCPs, and (c) having experienced hypoglycemia during driving. CONCLUSIONS: The majority of people with ITDM had not had a discussion regarding diabetes and driving with their HCPs, which was reflected by a lack of safe driving practices. People with ITDM should be encouraged to take precautions while driving in order to prevent future MVCs. PRACTICAL APPLICATIONS: This research highlights the importance of investing more effort in educating drivers who have diabetes about safe driving practices by their health care providers. Also, it will attracts the attention of policymakers for an urgent need to establish clear policies and procedures for dealing with drivers who have diabetes.

Patient-Related Determinants of Glycaemic Control in People with Type 2 Diabetes in the Gulf Cooperation Council Countries: A Systematic Review.

The aim of this systematic review is to assess patient-related factors affecting glycaemic control among people with type 2 diabetes in the Arabian Gulf Council countries. MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane CENTRAL databases were searched from their date of inception to May 2016. Two researchers independently identified eligible studies and assessed the risk of bias. A total of 13 studies met the inclusion criteria. One study was population based, six recruited participants from multiple centres, and the remaining were single centred. The majority of the studies were of low to moderate quality. Factors associated with poor glycaemic control include longer duration of diabetes, low level of education, poor compliance to diet and medication, poor attitude towards the disease, poor self-management behaviour, anxiety, depression, renal impairment, hypertension, and dyslipidaemia. Healthcare providers should be aware of these factors and provide appropriate education and care especially for those who have poor glycaemic control. Innovative educational programs should be implemented in the healthcare systems to improve patient compliance and practices. A variation in the results of the included studies was observed, and some potentially important risk factors such as dietary habits, physical activity, family support, and cognitive function were not adequately addressed. Further research is needed in this area.